Patients Registered at a GP Practice, August 2022

This spotlight report compares census data from 21st March 2021 with list size data from 1st April 2021. In previous spotlight reports, the number of patients registered at GP Practices in England (informally known as "List Size") have been compared with the ONS mid-year population estimates. This is the first census that has been carried out and published since NHS Digital has been receiving practice list size data.

In April 2021 there were 60.7 million patients registered with a General Practice in England; 14,000 of those patients were living in Wales.  In comparison, 56.5 million people were recorded as residing in England by the ONS census. This means there were an extra 4.2 million people registered at GP practices in England (and living in England) compared to the recorded population. There are several factors that will both inflate and deflate the list size, which are outlined below, along with some geographical observations.

List Size Inflation, over-coverage or "ghost patients" are terms used to describe the situation where the National Patient Register is greater than the estimated population. Since the first List Size publication in 2013 there have always been more patients registered at GP practices than are estimated to exist. This can happen due to a variety of reasons, including the following:

• Patients move away and don't de-register with their old GP
• Patients have left the country but did not de-register
• Children that are under shared custody with split residence are not flagged in the medical record and therefore double-counted
• Duplicate records due to use of different names
• Patients in nursing or residential care are registered for that address as well as their original place of residence
• Patients have died but their patient record has not yet been updated to reflect this

Although the list size is inflated, this does not necessarily mean that every person in England is registered with a GP practice. Patients may not be registered with a GP practice, but the number of records associated with list size inflation compensate for their absence. There are a number of reasons why a person may not be registered, including the following:

• Patients move to a new area, de-register from their former GP and either delay or fail to register with a new practice
• Babies are included in the census but may not be registered with a GP yet
• New or returning migrants may delay registration with a practice
• Individuals may be inappropriately removed from their GP under the "no-contact" criteria

Metropolitan areas such as London, Birmingham and Manchester see the highest number of "ghost patients" in the country.

In contrast, rural areas tend to be closer to the census population records, or even observe list size deflation where the population estimate is higher than the number of patients registered to a GP practice.

When isolating outlier areas, it is notable that most areas with a high proportion of ghost patients are in the London area.

Of the 36 total outliers, there are only 3 are areas where the recorded population is higher than the number of registered patients.

The interactive dashboard below allows you to view this analysis in further detail, from national down to local authority district level. We would suggest viewing the interactive dashboard in full screen mode, or via this link.