Patients Registered at a GP Practice, April 2022

The trend in the number of patients registered at a GP practice in England remained in excess of the population estimates produced by ONS in each mid-year estimate from 2013 (the first year that Patients registered at a GP was published) until 2020. This excess has increased in number each year from just under 2.2 million in 2013 to almost 3.9 million in 2020.

The discrepancy between the estimated size of the England population and the number of people registered at GP practices is known as list inflation, over-coverage or ghost patients.

List inflation occurs when the National Patient Register continues to record individuals that should have been de-registered. This can happen for a variety of reasons, including - but not limited to:

• Patients move away and do not de-register when they leave
• Young, healthy people have moved to a new address but did not prioritise de-registering with their former GP practice
• Patients have left the country but did not de-register
• Shared custody of children with split residence is not flagged in the medical record resulting in double-counting
• Duplicate records, for example due to use of different names, particularly surnames
  • For example, children are recorded against their mother’s and their father’s surname, resulting in double-counting
• Patients in nursing or residential care are registered for that address as well as their original place of residence
• Death

In addition to list inflation, which incorrectly increases the count of patients, there are also issues associated with under-coverage. For example:

• Individuals move to a new area, de-register from their former GP and do not register with a new practice in a timely fashion, if at all
• Members of the armed forces and their families are included in population estimates but are not covered in the National Patient Register. However, from a statistical perspective, adjustments are made to mitigate the effect of this
• Babies may not be included in the National Patient Register until formally registered
• New (or returning) migrants may delay registration with a practice
• Individuals may be inappropriately removed from a GP list under the “no-contact” criteria and may need to be restored

For more information on mid-year population estimates, please see the Population estimates for the UK, England and Wales, Scotland and Northern Ireland: mid-2020 page on the ONS website.