FP69 has become a major concern for GP practices. Many are already seeing patients removed from their lists, with more activity expected over the coming months.
The immediate concern is income. Registered list size remains a major part of how practices are funded, so deductions have a direct financial impact. For practices already working under significant pressure, losing patients and income at the same time is understandably worrying.
But FP69 also raises a wider question: how closely do practices understand the patients leaving their list, and how much of that loss could potentially be prevented?
Why is FP69 activity increasing?
NHS England is trying to address the gap between the number of people registered with GP practices and the number believed to be living in England.
Its July 2026 update reported that GP lists contained 63.8 million patients in May 2025, compared with an Office for National Statistics population estimate of 58.2 million. After allowing for people who live in England but are not registered with a GP, NHS England estimates that lists are inflated by around 6.4 million patients.
One of the main reasons is that people who emigrate or die abroad are not always removed from GP lists.
NHS England is now using a combination of demographic information, statistical modelling and recent healthcare activity to identify people who may no longer be living in England. Patients are contacted through channels including the NHS App, email, SMS and letter and asked to confirm that they are still resident.
If they do not respond, their practice is asked to review the case before a deduction is made. Practices have three months to complete that review.
The volume is increasing, with practices expected to receive an average of around 14 cases a week and a maximum of 50. NHS England expects around 80% of the patients selected to be deducted.
The early evidence suggests that most of those deductions are legitimate. During the 2025/26 pilot, 95% of patients sent for practice review were removed and only 0.27% re-registered with the same practice within three months.
Practices therefore need a clear process for handling FP69 reviews and helping eligible patients keep their details up to date. This is not about trying to keep people registered when they have moved away or are no longer eligible. But FP69 should prompt practices to look more closely at all patient deductions, not just those generated through list cleansing.
Growing the list and protecting the gains
Through our Patient List Growth Support Service, we have seen how much difference a focused approach to new registrations can make. Practices are increasing their visibility, making it easier for local people to register and seeing strong growth in monthly registration numbers.
For practices with capacity, attracting new patients is one of the clearest ways to increase list size, strengthen income and recover patients lost through FP69 and other deductions.
But the number of new registrations is not the same as net list growth.
Put simply, if a practice registers 100 new patients but loses 80, its list has grown by 20. If it registers the same 100 patients but loses 40, it has grown by 60.
That does not make list growth any less important. It shows why retention matters alongside it. One brings more patients into the practice. The other helps the practice keep more of the patients it already has.
Together, they give a much clearer route to sustainable list growth.
Why are patients leaving?
Some deductions are unavoidable. Patients move home, leave the country, die or become ineligible to remain registered. Practices cannot and should not try to prevent those deductions.
But patients also leave because they have struggled to access care, found practice processes difficult to understand, received poor communication or had a negative experience that was never properly resolved.
These losses are harder to spot because practices do not always know why a patient has moved elsewhere. A deduction can appear as another administrative transaction, even when it reflects a problem experienced by other patients too.
This is where a retention strategy starts to add value.
Practices need to look at registrations, deductions and net list movement together, then separate the losses they cannot influence from those they might be able to reduce. It is also worth tracking whether new patients are still registered after three, six and twelve months. If large numbers leave soon after joining, that could point to a problem with onboarding, access or expectations.
The reasons may already be visible elsewhere. Complaints, GP Patient Survey results, Friends and Family Test feedback, Google reviews and conversations with reception staff can all reveal recurring frustrations.
The aim is to bring that evidence together and look for patterns. Are patients struggling to get through on the telephone? Do they understand how to use online access routes? Are appointment messages clear? Do new patients know how the practice works? When something goes wrong, does the practice have a good way of rebuilding trust?
Once those patterns are understood, practices can focus on the changes most likely to make a difference. That might mean improving new-patient communications, simplifying access routes, reviewing reception processes, strengthening complaints handling or showing patients how their feedback has led to change.
It is not about launching a patient loyalty campaign or making it harder for people to leave. It is about fixing avoidable frustrations and giving patients fewer reasons to want to.
Join our patient retention webinar
We will be exploring this in more detail during our webinar, Patient List Retention: Responding to FP69 and Protecting Practice Income, on 13 October 2026.
We will explain what practices need to know about FP69, how to get a clearer picture of patient loss and what practical steps can help retain more existing and newly registered patients.
Source: NHS England, Patient List Inflation: Patient List Management update and plan for FY26/27, July 2026.
