Keeping GP patient registration lists up to date

NHS England has a legal duty to keep and maintain a list of all patients registered with GP practices in England. 

It is therefore important for GP practices to keep their patient lists up to date and accurate. This is sometimes called 'list maintenance' and is in line with the requirements of the GP Contract and NHS England's Primary medical services policy and guidance manual (PGM).

List maintenance is an ongoing national-level activity to make sure GP practice patient lists accurately show the patients the practice is responsible for. Inaccuracies in patient lists are mainly a result of patients moving without informing their practice so they can be transferred or deregistered. 

List maintenance helps NHS England: 

• plan for services using reliable population data 
• ensure that patients are registered with the right practice 
• maintain correct patient contact details to prevent returned mail and ensure important health information reaches the patient 
• allocate the use of NHS resources fairly 
• maintain reliable screening and vaccination monitoring and reporting 

NHS England contacts patients digitally first, using the NHS App, email or text message where contact details are available. If a patient does not respond, NHS England sends a letter. Patients can respond using digital and non-digital routes.

Patients can respond via the NHS App, the 'Confirm your home address' service or by text message. 

They can also call the customer contact centre on 0300 311 22 33 or email them at [email protected].

If patients are unable to use any of these methods, they may contact their GP for help. 

GP practices may receive notifications through existing systems when address verification processes result in an FP69 flag being applied. Practices will continue to manage registrations and patient records through their normal workflows.

Some patients may contact their GP to check the message they have received from NHS England is valid. They may also need help confirming their address. 

On behalf of NHS England, PCSE also sends letters to patients to check that a patient’s home address is correct.

It will say ‘Primary Care Support England’ (PCSE) on the letterhead. If a patient is contacted by PCSE, they will need to follow the steps in that letter to respond. 

If needed, PCSE will then contact the GP practice to update the patient information. 

NHS England uses several tools to help support practices in managing patient lists. This helps reduce admin burden and save practice time. 

NHS England does not use artificial intelligence in this process. 

The entire process, from identifying a patient who may no longer live in England to removing them from a practice list, takes over 5 months.

NHS England uses statistical modelling and demographic and administrative data to identify patient records that are more likely to be out of date.

Checks are applied for: 

• registration status 
• recent clinical activity (in the past 18 months, using the datasets that are available to NHS England) 
• existing list maintenance activities 
• transient checks (patients arrived from abroad) 
• size of gap between Office for National Statistics (ONS) and Primary Care Registration Management (PCRM) figures in local area
• historic deduction rates per practice 

NHS England also checks for any reasons that the patient should not be contacted.

For example: 

• patients with recent clinical activity (in the past 18 months, using the datasets that are available to NHS England) 
• patients who have a sensitive marker on their Personal Demographics Service (PDS) record 
• deceased patients 
• patients registered at specialist GP practices (for example, prison GPs or young offender institutes) 
• patients under 18 years old 

During a 2-month period NHS England will attempt to contact the patient. Patients have 30 days to respond to the message that is sent. 

NHS England takes a digital first approach. If the patient has digital contact details on the Personal Demographic Service (PDS), NHS England prioritises contact via NHS App, email, and text messages.

If there’s no response, attempts will be made to contact the patient via letter.

The patient is asked to confirm one of the following: 

• their home address is still accurate 
• they have moved house within the UK 
• they have left the UK 

Patients can respond: 

• online via NHS App, email or text message if they have a fully verified NHS account 
• by calling or emailing the NHS England customer contact centre 

If the patient updates their address at their GP or another NHS provider connected to the Personal Demographics Service (PDS) this will stop the process. 

If a patient uses the online service to tell NHS England they have left the UK, their GP practice will receive an embarkation notice for that patient. 

If a patient reports that they have moved outside the practice catchment area, NHS England records the change on the PDS. The practice sees this information when it next accesses the patient’s record and can decide whether to keep the patient registered or request an out-of-area removal. 

All patients sent for practice review will have been sent a letter.

An FP69 review notification is raised with the practice if a patient does not respond to messages from NHS England. This notification will come via GP Links. An FP69 is a flag set on a patient’s registration record when it is believed they may no longer live at the registered address. 

Practices will need to use local information to confirm they should remain responsible for providing services to the patient. They may contact the patient using the details they have on their local record. 

If NHS England does not receive a response from the practice within 3 months, the patient will be removed from their registration list. 

NHS England monitors patient and practice response rates, the number and outcomes of practice reviews, and re-registration rates. This information provides assurance and helps NHS England refine the model used to identify patient records that may be out of date.

Safeguarding 

Patients are not removed from a GP practice list straight away. The list maintenance process has several steps to ensure that patients are only removed if: 

• the patient and practice have not responded to messages from NHS England during the 5-month review process 
• the patient or the practice has confirmed they should no longer be registered 

Patients with evidence of recent and available NHS activity, for example, screening appointments, vaccinations or GP visits, will not be contacted to be removed from lists. 

Patients who have been mistakenly removed from a GP list or have returned to England can quickly re-register using the Register with a GP service. 

Datasets used to identify patients who are not to be contacted 

• Personal Demographics Service (PDS)

• Hospital Episode Statistics (HES)

• Emergency Care Data Set (ECDS) - NHS England Digital 

• English prescribing data (EPD) | NHSBSA 

Selection criteria include: 

• no changes to their PDS record in the past 18 months 
• has a university email address 
• patient's age at time of NHS number allocation 
• if the patient has a visitor or migrant registration 
• if their practice has higher numbers of historic removals for patients leaving the UK 
• the size of the gap between the Office for National Statistics (ONS) and PDS numbers in that area 

Patients are not selected based on ethnicity, nationality, names, or protected characteristic. 

Some patients are filtered out from the assessment results. They will not be contacted and asked to confirm their address. 

This includes: 

• patients with recent clinical activity (in the past 18 months, using the datasets that are available to NHS England) 
• patients who have a sensitive marker on their PDS record 
• deceased patients 
• patients registered at specialist GP practices (for example, prison GPs or young offender institutes) 
• patients under 18 years old 

Your practice may receive an FP69 notification through GP Links if a patient does not respond to NHS England. 

An FP69 is a flag on the patient’s registration record. It means there is information suggesting that the patient may no longer live at their recorded address. 

When you receive an FP69 notification, review the information available to your practice.

You should then: 

• update the patient’s address if it is incorrect 
• confirm that the patient should remain registered if you have verified their circumstances 
• confirm that you cannot contact the patient or do not know where they live 
• confirm that the patient has no fixed address or cannot reliably receive post but should remain registered

PCSE guidance gives more information and scenarios on how to respond to FP69 Flags. 

Patients may contact you after receiving a request from NHS England, or PCSE on behalf of NHS England, to confirm their address. This could happen before the FP69 notification has been sent to your practice. 

You should reassure patients that these communications are genuine and sent by NHS England or PCSE on behalf of NHS England. This is to help keep NHS records accurate and up to date and to ensure patients do not miss out on important letters and communications about their medical care. 

Ask the patient to follow the instructions in the message or letter. Depending on how they were contacted, they may be able to respond using: 

• the NHS App 
• the online address confirmation service 
• text message 
• the NHS England customer contact centre 

If your practice has received an FP69 notification, check the patient’s details and respond to the notification. 

ICBs receive monthly reporting from NHS England regions to understand the impact of patient list maintenance. 

This can help them identify and support practices in their area who are handling patient list maintenance requests.

NHS Notify is used for sending patient communications. 

On behalf of NHS England, Primary Care Support England (PCSE) processes new registrations and removals from GP practice lists. It also carries out list reconciliations (meaning, the list of patients of the GP practiceclinical systems is the same as the list of patients held by NHS England) to make sure that GP practice lists are up to date. 

The Personal Demographics Service (PDS) holds demographic information for NHS patients, including names, addresses and contact details. It is updated when a patient changes their details through an NHS service or tells their GP practice that they have moved. 

The National Back Office (NBO) manages NHS Numbers and PDS records. They also investigate and resolve data quality incidents on (PDS) records.

Primary Care Registration Management manages patient address updates and sends information to PDS. 

Register with a GP surgery allows patients to find and register with a local GP surgery. 

Find your NHS number helps patients who have lost or do not know their NHS number. 

Deductions and practice list reconciliation 

FP69 Flags | PCSE (link opens in a new tab) 

GP Practice List Reconciliation | PCSE (Link opens in a new tab) 

GP policies and contracts 

NHS England » GP Contract (link opens in a new tab) 

NHS England » Primary medical services policy and guidance manual (PGM) (link opens in a new tab) 

Live service incident: [email protected]

General enquiries about the service: [email protected]