GPs push back on list cleaning, QOF obesity flaws, ARRS underspend
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Hello and welcome to Talking General Practice, the podcast from GP Online. I'm Emma Bauer, the editor of GP Online. On the podcast today, I'm joined by our Deputy Editor Nick Bostock to talk about some of the key news stories affecting general practice. Coming up, we're discussing the impact the current list cleaning drive has had on GP practices and explaining why GP leaders have called for a pause in the process amid fears of inappropriate removals and a huge loss of funding for the profession. We're talking about prescribing for obesity after the BMA warned that the funding practices we'll receive for new COAF targets on this is unlikely to cover the cost of the work involved. And the union warned that some ICBs are cutting back on locally commissioned services related to prescribing Lounge RO since it's been added to the COAF.
And we'll be looking at the additional Rolls Reimbursement Scheme after we found that millions of pounds earmarks for the scheme went unspent in 2025-26. Our good news story this week is about those GPs who received awards in the King's Birthday Honours list. So Nick, first up, let's talk about list cleaning. I mean, we talked about this last time on the podcast, but this story has moved on quite a lot over the past couple of weeks. So firstly, remind us what list cleaning is and very briefly why this has become such a big story for general practice.
We reported at the start of June that um hundreds of thousands of patients had been removed from GP practice lists as part of what NHS England said was a drive to address patient list inflation. So what is list inflation? The BMA says the population registered with GP practices is generally a bit higher than the official population recorded by the Office for National Statistics because of people move, there are delays in updating patient details when their circumstances change. Temporary residents or overseas visitors can add to list fluctuation and it just takes time to to process changes. List cleaning then is an administrative process to try to reduce the gap between the actual population and the registered population by identifying people who shouldn't still be on practice lists.
So this is something that happens all the time. But the reason this is a huge issue right now is that the scale and pace of removals we've seen since the end of last year is unprecedented. I've looked at the The NHS data on this and what that shows is that total registered patients dropped by more than 458,000 across England between the start of November 2025 and the start of June this year. Practices have seen hundreds of patients flagged for removal at a time. Some have seen 10% or more of their entire practice list removed. And the data show list cleaning is actually accelerating. Well, over a hundred thousand patients came off practice lists in the month to the first of June alone. So nationally, this means the loss of around 60 million pounds from core funding for general practice.
10% of the entire contract uplift for 2026-27. And it'll translate into big losses from other income streams that are also calculated from registered patients, so PCN, COF, and other funding. So this is something with huge consequences for the viability of practices. And the BMA has now identified this issue as one of the most significant financial and operational challenges facing general practice this year.
One of the problems with this latest list cleaning drive is the time frames involved for practices to verify patients before their removal. And those have changed, haven't they? I think we mentioned this last time as well. But you've got some more information about why these time frames have changed, didn't you, in the last week or so?
Yeah, so th the timeframes have changed and that's a big factor driving up the rate of removals. Until October last year, NHS England would contact a patient to confirm their registration And if they didn't respond, something called an FP sixty-nine flag was attached to their patient record.
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