Summary
- A recent change in how the NHS manages patients’ registration with their GP has seen a rapid increase in patient removal/ de-registration, with over a hundred thousand patients removed from London GP surgery’s list in the past 12 months.
- Across London 134,489 patients have been de-registered between June 2025 and June 2026 – 44.6% of the total of 301,815 patients de-registered nationally in the same period.
- Practices report a sharp rise in patient deductions by PCSE (Capita, under contract to NHSE) and high numbers of FP69 flags being applied to patient records indicating further anticipated removals. In some cases, practices are seeing bulk deductions of hundreds of patients at a time, representing between 1% and 10% of their patient list and resulting in excessive practice workload.
- Vulnerable patients (elderly, non-English speakers, those in unstable or temporary housing) can be at risk removal without knowing it, either because they mistake PCSE letters for scams or simply don’t engage with them.
- The policy has been to identify patients including those who have not been in recent contact with their GP practice for some time, students who are still registered beyond the likely end of their course, people living at addresses with multiple occupancy, those who have migrated to England a year ago, and the very elderly.
- The removal of large numbers of patients at the same time defunds and destabilises GP practices, with practices losing income for each patient de-registered. The cumulative financial loss to London general practice core funding (of these 134,489 patients being removed) is around £17.5m, with additional capitated finances based on patient numbers, and the lack of predictability makes it difficult for practices to manage financial and business planning.
The London picture
| Area | Patients Jun 2025 | Patients Jun 2026 | Change | % change | Est. annual GS loss | Est. monthly loss |
| North Central London | 1,836,133 | 1,802,029 | -34,104 | -1.86% | −£4.44M | −£370K |
| North East London | 2,479,33 | 2,454,659 | -24,678 | -1.00% | −£3.21M | −£267K |
| North West London | 2,916,512 | 2,893,100 | -23,412 | -0.80% | −£3.05M | −£254K |
| South East London | 2,123,136 | 2,094,802 | -28,334 | -1.33% | −£3.69M | −£307K |
| South West London | 1,775,612 | 1,751,651 | -23,961 | -1.35% | −£3.12M | −£260K |
| London total | 11,130,730 | 10,996,241 | −134,489 | −1.21% | −£17,492,984 | −£1,457,749 |
(June 2025-June 2026, Londonwide LMCs’ analysis of NHS Digital figures on global sum income)
How you can help
Please consider cascading this information to patients and community groups through your networks and communication channels to ensure patients understand that if they receive a letter/ contact, they must reply to remain registered?
We have produced a poster (PDF or Jpeg), a video clip and text to paste into WhatsApp to share with patients. Due to the nature of FP69 flags, for patient communications to be effective we need to encourage people who do not currently engage with general practice to respond, and we need to cascade the information through friends, family, housemates, other groups and spaces to reach those who are registered but not engaging with the practice.
