GPs are raking in more cash than ever from patients who do not exist, the Daily Mail can today reveal.
Despite ministers vowing to stamp out the scourge of 'ghost patients' a decade ago, an all-time high of 4.9 million are now registered in England.
It means the army of phantom patients – many of whom will have either died, moved abroad or are duplicates – has ballooned 95% in a decade and is now more than the combined populations of Kent, Essex and Hampshire.
In parts of England, analysis suggests up to 20 per cent of registered patients might not exist.
Senior politicians have urged the government to break of its 'glacial' pace of reforms and stop ghost patients 'haunting' a system that's 'not fit for purpose'.
Surgeries pocket £169.74 on average for each patient on their books – regardless of whether they see them. It means they could be getting the equivalent of £838million a year for patients who do not exist.
NHS Counter Fraud Authority chiefs began investigating whether GPs were cheating the system in 2019. Work was halted during Covid but insiders hinted the issue could be 'revisited' in the future.
There is no suggestion GPs, who earn £120,000 on average, are abusing the system for any personal financial gain.
Cash typically goes towards costs involved in running a GP practice such as heating, lighting, maintenance and staff salaries, according to The King's Fund.
After outgoings, leftover cash is shared between partners, minus their own expenses such as tax, pension and indemnity.
The majority of England's 6,800+ GP surgeries operate as private sector contractors to the NHS, rather than direct public sector entities.
The British Medical Association (BMA) has claimed efforts to purge lists would be 'a bureaucratic burden' on overstretched doctors.
And the Royal College of GPs (RCGP) denied practices were deliberately profiting by keeping non-existent patients on their lists.
NHS chiefs believe a small number of GPs deliberately keep names on their lists but that most are simply failing to prioritise the issue.
As well as for financial gain, critics fear that GPs may also be using inflated list sizes politically, with unions having promoted the rising patient-to-GP ratios as a means of demanding funding for more staff.
The BMA said the average GP today is responsible for 2,247 patients – 309 more than in 2015. Under widely accepted guidelines, the safe limit is 1,800.
In a fresh attempt to tackle the issue, new rules were adopted in September. Primary Care Support England, managed by outsourcing firm Capita, automatically flags any patients who may have moved home on GP systems.
Surgeries now get three months to confirm their patient either still lives there or has moved to a new address, down from six before.
The Daily Mail's analysis, based on NHS Digital statistics, was carried out before the rules were tightened.
As of September 1, there were 63.8m patients registered at GP practices.
However, the latest Office for National Statistics (ONS) projections show the nation's population at around 58.8m in 2025 – a discrepancy of 4.9m.
Of all of England's 106 integrated care boards (ICBs), only ten had smaller patient list sizes than their populations. Seven were in the north.
North West London sub-ICB W2U3Z, covering Chelsea and Kensington all the way up to Ruislip in Hillingdon, had the biggest disparity. It had 2.9m patients on its books, NHS statistics showed, 31.5 per cent more than its actual population of 2.2m.
The Humber and North Yorkshire 42D came in at 29.7 per cent but a spokesman said the population count is not up to date.
Similarly high discrepancies were seen in Lancashire and South Cumbria 00R (25.8 per cent) and Greater Manchester 14L (23.7 per cent).
The NHS only allows patients to be permanently registered with one GP at a time. All records are transferred upon moving.
Shimeon Lee, of the TaxPayers' Alliance, said: 'The continuing presence of ghost patients is a damning indictment of the failure of the NHS bureaucracy.
'This is one of the best funded healthcare systems in the world, yet it cannot even work out who is on its records.
'Ministers need to drastically reform the healthcare system so that it delivers for patients and taxpayers.'
Taxpayers don't pay extra to cover ghost patients.
Funds are instead allocated from within a ring-fenced 'global sum payments' budget operated by NHS England which this year topped £4.6bn.
The £838m allocated for ghost patients could, in theory, fully fund the training for an additional 22,000 nurses, according to the Royal College of Nursing which estimates one nurse's training at £37,000.
Capita was initially brought in to sort the ghost patient problem in 2015. At the time, NHS figures suggested the tally stood below 2m.
The firm was asked to vet GP lists and remove patients who could no longer attend the practice. But its work was put on hold until 2018 because of budget cuts.
It said at the time it would also go through patients aged 16 recorded as living alone, those living in demolished properties and those living in student accommodation for more than four years to see if they should still be on lists.
On the back of the 2018 pause, its work shifted to cleansing the record system once every three years, checking the details of all patients registered as being over 100 to check if they are still alive.
A Capita spokesperson said: 'List inflation is the term used when individuals remain on a general practice's patient list, despite no longer being eligible.
'Primary Care Support England will continue to support the NHS England list maintenance programme, which helps practices to maintain and reconcile their patient lists through regular checks and data reviews.'
Still the problem grew, sparking an investigation by the NHS Counter Fraud Authority in 2019.
Investigators claimed they had noticed suspicious anomalies when they opened the formal probe. The audit was paused due to a lack of funding.
An NHS Counter Fraud Authority spokesperson said: 'This work was halted by difficulties in obtaining core data and our priorities shifting from this position with the NHS response to Covid.
'We have not yet revisited the issue as we direct our resources to where the intelligence indicates the most appropriate priorities in relation to the NHS budget sit.'
A 2019 University of Manchester study denied GP fraud was potentially behind the issue.
Dr Patrick Burch, a practicing GP, instead blamed the 'high mobility' of patients.
Writing in his paper in the Journal of Epidemiology and Community Health, he said: 'When a person has left the UK, the practice has no way of knowing this has occurred so the patient will remain registered.
'Under-funded and overworked GPs are in no position to regularly check the status of each of their registered patients.'
Dr Burch added 'it would be very dangerous to reduce practice funding' if patient list sizes were incorrect.
It comes after family doctors hinted they could strike over changes to make it easier for patients to book appointments.
GP surgeries in England are now required to keep online forms open for the duration of their working hours for non-urgent appointment requests, medication queries and admin requests.
Officials said the move, introduced nationwide on October 1, would be 'subject to necessary safeguards in place to avoid urgent clinical requests being erroneously submitted online'.
But the BMA, which warns doctors that carrying out more than 25 appointments a day is dangerous, has dangled the threat of a formal dispute. Union chiefs said safeguards were never put in place and no additional staff were brought in to manage what it predicts to be a 'barrage of online requests'.
Health Secretary Wes Streeting has vowed to not back down over the changes, in a row that raises the prospect of GPs capping daily consultations to the BMA safe limit – described as 'arbitrary' by NHS bosses.
Sir Geoffrey Clifton-Brown MP, chair of the public accounts committee, told the Daily Mail: 'Successive inquiries by our Committee have highlighted the misdirection and waste that can occur in the allocation of public funds, when policymakers lack the right data to guide their decisions.
'Ghost patients are yet another example of a failure of recordkeeping to match the reality on the ground.
'We know from our scrutiny of the NHS’ wider financial sustainability that our country’s healthcare system lacks a consistent data infrastructure, and that NHS providers vary in terms of their levels of technological maturity.
'The government plans major health reforms, which this Committee will continue to scrutinise.
'But if the pace of digital transformation in the NHS remains glacial, and the culture of complacency demonstrated by both the DHSC and NHS England persists, ghost patients will continue to haunt the system.'
Dr Luisa Pettigrew, senior policy fellow at the Health Foundation, told the Daily Mail: ‘While not a new phenomenon, the mismatch between the number of patients registered with an NHS GP and the ONS population estimates appears to have increased in recent years.
'This is due to several reasons, including delays in removing people from GP’s lists and duplicate patient records.
‘The discrepancies are larger in some areas, for example, where there is greater population mobility.
'However, conversely, "under coverage" also exists where people either aren’t registered or may have been inappropriately removed from a GP list after a period of no contact.'
Helen Morgan, Lib Dem health spokesperson, told the Daily Mail: 'It’s clear our GP services have been stretched to breaking point, with too few doctors, crumbling surgeries and systems that are simply not fit for purpose.'
British Medical Association GP committee chair Dr Katie Bramall said: 'From students moving, to patients passing away or even moving country, the term "ghost patients" doesn't accurately illustrate the many reasons why the number of patients registered with a GP may not reflect official local population data.
'Despite practices best efforts it's impossible for each and every practice to hold accurate information 100 per cent of the time.
'They rely on a constant stream of accurate information being received and shared between practices and commissioners, and the support of Primary Care Support England to ensure ongoing list validation.'
Dr Bramall added: 'The Government doesn't give enough even now to fund practices to meet the demand across the population so even with "ghost patients", practices aren't turning a profit but barely staying afloat.'
Professor Kamila Hawthorne, chair of the Royal College of GPs, said: 'People's circumstances, and therefore our records, change all the time. So-called "ghost patients" are the result of a records management issue, not a case of surgeries deliberately profiting by keeping patients on their lists when they shouldn't be there.
'Indeed, having "ghost patients" can seriously reduce a practice’s ability to achieve its clinical targets, for which the practice receives payment and therefore it is in a practice’s interests to ensure they have an accurate patient register.
'Our administrative staff already spend a lot of time trying to keep patient lists as accurate as possible and processing patients' notes when we are informed that they have died, left the surgery or moved elsewhere.
'We should be supporting GPs by addressing the intense workload and workforce pressures in general practice and investing in adequate IT and booking systems – not wrongfully suggesting they are defrauding the health service.'
A spokesman for the North West London sub-ICB said: 'We recognise that the number of people registered with our GPs is higher than the resident population. London is a highly mobile city, and registration patterns can reflect that movement. Our practices regularly carry out list cleaning exercises to keep records up to date. We also know that a large number of patients from outside north west London are registered with "GP at Hand" - a digital-first practice based in Hammersmith that is open to anyone living or working within 40 minutes of one of its clinics across London. This service therefore skews the data, contributing to the difference between registered and resident populations.'
