Following my recent blog on where practice income comes from, I’m turning the focus to something that underpins nearly all aspects of general practice funding—but is often misunderstood: your patient list size. More specifically, the difference between your raw list, weighted list, and PCN adjusted list—and why they all matter.
If you're aiming to optimise income streams, target workforce appropriately, or understand where your resources are being stretched, this is essential reading.
1. The Raw List: Your Actual Patient Count
Your raw list is the total number of patients registered at your practice. It’s the starting point for many calculations and monitoring purposes.
Funding directly based on raw list size includes:
CPI adjustment in QOF (each QOF point’s value is adjusted by your raw list size)
Dispensing fees and rurality adjustments (where applicable)
Global Sum reconciliation (although Global Sum is paid per weighted patient, your raw list is used for monthly reconciliation and list movement tracking)
Action point: Ensure your registration workflow is robust:
Regularly review incomplete or pending registrations (e.g. temporary registrations converted to permanent but not finalised)
Check for duplicate or ghost patients (patients who have moved or died but not de-registered)
Use your system’s data quality reports and deduplication tools to maintain accuracy
Ensure NHS numbers are correctly validated—mismatches can prevent patients from appearing in population searches
2. The Weighted List: Adjusting for Complexity and Need
Your weighted list size (also called the Carr-Hill weighted list) adjusts your raw patient numbers to reflect expected workload and resource need. It underpins how Global Sum is distributed across practices to account for differing patient demographics.
Key factors in the Carr-Hill formula:
Age and gender
List turnover
Rurality
Market Forces Factor (to reflect local staffing costs)
Some adjustment for morbidity via age proxies
Funding based on weighted list:
Global Sum (main core contract funding)
ARRS funding at PCN level (calculated per 1,000 weighted patients)
Why your weighted list might not reflect your actual workload:
The Carr-Hill formula underweights deprivation and multimorbidity
It hasn't been updated to reflect the realities of modern care delivery
Care home patients may not affect weighting unless the Residential Institute section has been completed correctly
Action points:
Check care home coding: The Residential Institute flag (used for Carr-Hill) is separate from SNOMED coding used for PCN DES claims.
Ensure registration details are complete and accurate—incorrect age, gender, or postcode fields can distort weighting.
Long-term conditions: While these don’t directly affect weighting, correct coding supports QOF prevalence and disease register accuracy.
3. PCN Adjusted List: Tailoring Funding at Network Level
The PCN adjusted list draws on each practice’s weighted population to form the basis of funding across the network. However, not all PCN funding is based purely on list size—some elements use bed numbers or disease registers instead.
Funding streams based on PCN adjusted list:
Enhanced Access
Capacity and Access Fund
Leadership and support payments
Funding not based on list size:
Care home premium / EHCH payments – based on the number of care home beds the PCN supports
IIF (2025/26) – currently includes only:
LD health checks – based on your LD register
FIT testing for cancer – based on activity, not list size
Key risks to be aware of:
Care home coding must reflect the actual number of beds covered—not just patient addresses. Work with local care homes and cross-check CHC lists.
LD register accuracy is crucial—make sure coding is consistent and searches are picking up eligible patients.
PCN boundary changes (e.g. practices joining or leaving) can affect list size–linked funding streams. Regularly verify population figures with your ICB or Federation.
📢 Top tip: Work with your PCN manager or data lead to cross-check PCN-adjusted population reports. Look out for anomalies that could affect funding or workforce planning.
Why This Matters More Than Ever
Accurate list data underpins every major income stream, from Global Sum to PCN payments. But it’s also about safety and access—poor registration workflows and inaccurate coding can skew your clinical data, distort your disease registers, and reduce the visibility of patient need.
This is especially important as funding becomes more population-based and condition-targeted.
If your deprivation burden isn’t visible in your weighted list, you won’t receive the adjustment your practice needs to meet that workload.