From f45cc8c765d5193bad540009d6a493f703c797aa Mon Sep 17 00:00:00 2001
From: Thomas Leese <thomas@leese.io>
Date: Mon, 8 Sep 2025 10:16:40 +0100
Subject: [PATCH 1/3] Rename `PatientSession`

This renames the `PatientSession` model to `PatientLocation` in
preparation for the next commit which will restructure the model to
remove the association to the session and instead link to a location and
an academic year.

Jira-Issue: MAV-1822
---
 app/components/app_activity_log_component.rb  | 14 +++---
 .../app_patient_programmes_table_component.rb |  3 +-
 .../app_programme_session_table_component.rb  | 14 +++---
 .../app_session_actions_component.rb          | 20 ++++----
 .../app_session_details_summary_component.rb  |  8 ++--
 ..._session_needs_review_warning_component.rb |  6 +--
 .../api/testing/teams_controller.rb           |  4 +-
 .../patient_sessions/base_controller.rb       |  8 ++--
 app/controllers/patients_controller.rb        |  2 +-
 app/controllers/programmes/base_controller.rb |  2 +-
 .../sessions/consent_controller.rb            |  6 +--
 .../sessions/invite_to_clinic_controller.rb   |  6 +--
 .../patient_specific_directions_controller.rb | 20 ++++----
 .../sessions/patients_controller.rb           |  6 +--
 app/controllers/sessions/record_controller.rb |  6 +--
 .../sessions/register_controller.rb           |  6 +--
 app/controllers/sessions/triage_controller.rb |  6 +--
 app/controllers/sessions_controller.rb        |  2 +-
 .../concerns/patient_merge_form_concern.rb    |  2 +-
 ...end_school_consent_notification_concern.rb |  6 +--
 .../enqueue_vaccinations_search_in_nhs_job.rb |  6 +--
 app/jobs/send_school_session_reminders_job.rb |  2 +-
 ...rb => clinic_patient_locations_factory.rb} | 12 ++---
 app/lib/generate/vaccination_records.rb       | 24 +++++-----
 app/lib/location_sessions_factory.rb          |  2 +-
 app/lib/mavis_cli/schools/move_patients.rb    |  2 +-
 app/lib/patient_merger.rb                     | 10 ++--
 app/lib/stats/consents_by_school.rb           |  6 +--
 app/lib/status_updater.rb                     | 24 +++++-----
 app/lib/team_sessions_factory.rb              |  2 +-
 app/models/class_import.rb                    |  2 +-
 app/models/immunisation_import.rb             | 14 +++---
 app/models/immunisation_import_row.rb         |  4 +-
 app/models/patient.rb                         | 16 +++----
 app/models/patient/vaccination_status.rb      |  2 +-
 app/models/patient_changeset.rb               |  4 +-
 app/models/patient_import_row.rb              |  4 +-
 ...patient_session.rb => patient_location.rb} | 34 +++++++-------
 app/models/school_move.rb                     |  4 +-
 app/models/session.rb                         |  6 +--
 app/models/team.rb                            |  4 +-
 app/policies/patient_policy.rb                |  4 +-
 app/policies/school_move_policy.rb            |  2 +-
 app/policies/vaccination_record_policy.rb     |  3 +-
 app/views/sessions/consent/show.html.erb      |  6 +--
 .../patient_specific_directions/show.html.erb |  6 +--
 app/views/sessions/patients/show.html.erb     |  6 +--
 app/views/sessions/record/show.html.erb       |  6 +--
 app/views/sessions/register/show.html.erb     |  6 +--
 app/views/sessions/triage/show.html.erb       |  6 +--
 .../20250909080957_rename_patient_session.rb  | 13 ++++++
 db/schema.rb                                  | 32 ++++++-------
 db/seeds.rb                                   |  4 +-
 docs/ops-tasks.md                             |  8 ++--
 script/generate_model_office_data.rb          |  2 +-
 .../app_activity_log_component_spec.rb        |  2 +-
 ...pp_patient_session_table_component_spec.rb |  2 +-
 .../app_patient_table_component_spec.rb       |  2 +-
 ...ion_needs_review_warning_component_spec.rb |  2 +-
 ...vaccination_record_table_component_spec.rb |  2 +-
 .../api/testing/teams_controller_spec.rb      |  4 +-
 ...tient_sessions.rb => patient_locations.rb} |  8 ++--
 spec/factories/patients.rb                    |  2 +-
 .../archive_vaccination_record_spec.rb        |  4 +-
 spec/features/cli_generate_consents_spec.rb   |  2 +-
 .../cli_schools_move_patients_spec.rb         |  4 +-
 .../cli_stats_consents_by_school_spec.rb      |  6 +--
 spec/features/cli_stats_organisations_spec.rb |  4 +-
 .../download_vaccination_reports_spec.rb      |  8 ++--
 ...accination_records_with_duplicates_spec.rb |  8 ++--
 spec/features/programme_cohorts_spec.rb       |  2 +-
 spec/forms/patient_search_form_spec.rb        | 46 ++++++++++---------
 ...eue_clinic_session_invitations_job_spec.rb |  2 +-
 .../patient_nhs_number_lookup_job_spec.rb     | 10 ++--
 ...matic_school_consent_reminders_job_spec.rb |  2 +-
 ...anual_school_consent_reminders_job_spec.rb |  2 +-
 .../send_school_consent_requests_job_spec.rb  |  2 +-
 .../send_school_session_reminders_job_spec.rb |  2 +-
 spec/lib/patient_archiver_spec.rb             |  2 +-
 spec/lib/patient_merger_spec.rb               |  6 +--
 .../reports/offline_session_exporter_spec.rb  | 16 +++----
 .../programme_vaccinations_exporter_spec.rb   |  6 +--
 spec/lib/stats/consents_by_school_spec.rb     | 10 ++--
 .../lib/status_generator/registration_spec.rb |  2 +-
 spec/lib/status_generator/session_spec.rb     | 14 +++---
 spec/lib/status_updater_spec.rb               |  2 +-
 spec/lib/tasks/status_update_spec.rb          |  6 +--
 spec/models/cohort_import_spec.rb             |  2 +-
 spec/models/immunisation_import_spec.rb       | 12 ++---
 .../models/patient/vaccination_status_spec.rb |  2 +-
 ...ssion_spec.rb => patient_location_spec.rb} | 32 ++++++-------
 spec/models/patient_spec.rb                   | 24 +++++-----
 spec/policies/patient_policy_spec.rb          |  4 +-
 93 files changed, 359 insertions(+), 344 deletions(-)
 rename app/lib/{clinic_patient_sessions_factory.rb => clinic_patient_locations_factory.rb} (79%)
 rename app/models/{patient_session.rb => patient_location.rb} (88%)
 create mode 100644 db/migrate/20250909080957_rename_patient_session.rb
 rename spec/factories/{patient_sessions.rb => patient_locations.rb} (71%)
 rename spec/models/{patient_session_spec.rb => patient_location_spec.rb} (82%)

diff --git a/app/components/app_activity_log_component.rb b/app/components/app_activity_log_component.rb
index 247e6cf816..72b7b751b0 100644
--- a/app/components/app_activity_log_component.rb
+++ b/app/components/app_activity_log_component.rb
@@ -63,9 +63,9 @@ def initialize(team:, patient:, session: nil)
           session ? scope.where(programme_ids: session.programmes.ids) : scope
         end
 
-    @patient_sessions =
+    @patient_locations =
       @patient
-        .patient_sessions
+        .patient_locations
         .includes_programmes
         .includes(session: :location)
         .then { |scope| session ? scope.where(session:) : scope }
@@ -105,7 +105,7 @@ def initialize(team:, patient:, session: nil)
               :notes,
               :notify_log_entries,
               :patient,
-              :patient_sessions,
+              :patient_locations,
               :patient_specific_directions,
               :pre_screenings,
               :attendance_records,
@@ -346,14 +346,14 @@ def pre_screening_events
   end
 
   def session_events
-    patient_sessions.map do |patient_session|
-      patient = patient_session.patient
-      session = patient_session.session
+    patient_locations.map do |patient_location|
+      patient = patient_location.patient
+      session = patient_location.session
 
       [
         {
           title: "Added to the session at #{session.location.name}",
-          at: patient_session.created_at,
+          at: patient_location.created_at,
           programmes: session.programmes_for(patient:)
         }
       ]
diff --git a/app/components/app_patient_programmes_table_component.rb b/app/components/app_patient_programmes_table_component.rb
index 7464847b37..6c011b5b98 100644
--- a/app/components/app_patient_programmes_table_component.rb
+++ b/app/components/app_patient_programmes_table_component.rb
@@ -258,7 +258,8 @@ def vaccination_records_for(programme:, academic_year: nil)
   end
 
   def eligible_year_groups_for(programme:)
-    location_ids = patient.patient_sessions.joins(:session).select(:location_id)
+    location_ids =
+      patient.patient_locations.joins(:session).select(:location_id)
 
     LocationProgrammeYearGroup
       .where(location_id: location_ids)
diff --git a/app/components/app_programme_session_table_component.rb b/app/components/app_programme_session_table_component.rb
index dd6c343b6d..ec0b252b23 100644
--- a/app/components/app_programme_session_table_component.rb
+++ b/app/components/app_programme_session_table_component.rb
@@ -13,11 +13,11 @@ def initialize(sessions, programme:)
   delegate :govuk_table, to: :helpers
 
   def cohort_count(session:)
-    format_number(patient_sessions(session:).count)
+    format_number(patient_locations(session:).count)
   end
 
   def no_response_scope(session:)
-    patient_sessions(session:).has_consent_status(:no_response, programme:)
+    patient_locations(session:).has_consent_status(:no_response, programme:)
   end
 
   def no_response_count(session:)
@@ -27,13 +27,13 @@ def no_response_count(session:)
   def no_response_percentage(session:)
     format_percentage(
       no_response_scope(session:).count,
-      patient_sessions(session:).count
+      patient_locations(session:).count
     )
   end
 
   def triage_needed_count(session:)
     format_number(
-      patient_sessions(session:).has_triage_status(:required, programme:).count
+      patient_locations(session:).has_triage_status(:required, programme:).count
     )
   end
 
@@ -48,13 +48,13 @@ def vaccinated_count(session:)
   def vaccinated_percentage(session:)
     format_percentage(
       vaccinated_scope(session:).count,
-      patient_sessions(session:).count
+      patient_locations(session:).count
     )
   end
 
-  def patient_sessions(session:)
+  def patient_locations(session:)
     session
-      .patient_sessions
+      .patient_locations
       .joins(:patient, :session)
       .appear_in_programmes([programme])
   end
diff --git a/app/components/app_session_actions_component.rb b/app/components/app_session_actions_component.rb
index 98f1d10fc7..3af1f7eec2 100644
--- a/app/components/app_session_actions_component.rb
+++ b/app/components/app_session_actions_component.rb
@@ -19,9 +19,9 @@ def render? = rows.any?
   delegate :govuk_summary_list, to: :helpers
   delegate :academic_year, :programmes, to: :session
 
-  def patient_sessions
+  def patient_locations
     session
-      .patient_sessions
+      .patient_locations
       .joins(:patient, :session)
       .appear_in_programmes(programmes)
   end
@@ -38,7 +38,7 @@ def rows
   end
 
   def no_nhs_number_row
-    count = patient_sessions.merge(Patient.without_nhs_number).count
+    count = patient_locations.merge(Patient.without_nhs_number).count
     href = session_patients_path(session, missing_nhs_number: true)
 
     generate_row(:children_without_nhs_number, count:, href:)
@@ -47,7 +47,7 @@ def no_nhs_number_row
   def no_consent_response_row
     status = "no_response"
     count =
-      patient_sessions.has_consent_status(status, programme: programmes).count
+      patient_locations.has_consent_status(status, programme: programmes).count
     href = session_consent_path(session, consent_statuses: [status])
     actions = [
       {
@@ -61,7 +61,7 @@ def no_consent_response_row
   def conflicting_consent_row
     status = "conflicts"
     count =
-      patient_sessions.has_consent_status(status, programme: programmes).count
+      patient_locations.has_consent_status(status, programme: programmes).count
     href = session_consent_path(session, consent_statuses: [status])
 
     generate_row(:children_with_conflicting_consent_response, count:, href:)
@@ -70,7 +70,7 @@ def conflicting_consent_row
   def triage_required_row
     status = "required"
     count =
-      patient_sessions.has_triage_status(status, programme: programmes).count
+      patient_locations.has_triage_status(status, programme: programmes).count
     href = session_triage_path(session, triage_status: status)
 
     generate_row(:children_requiring_triage, count:, href:)
@@ -80,7 +80,7 @@ def register_attendance_row
     return nil unless session.requires_registration? && session.today?
 
     status = "unknown"
-    count = patient_sessions.has_registration_status(status).count
+    count = patient_locations.has_registration_status(status).count
     href = session_register_path(session, register_status: status)
 
     generate_row(:children_to_register, count:, href:)
@@ -91,13 +91,13 @@ def ready_for_vaccinator_row
 
     counts_by_programme =
       session.programmes.index_with do |programme|
-        patient_sessions
+        patient_locations
           .has_registration_status(%w[attending completed])
           .includes(
             patient: %i[consent_statuses triage_statuses vaccination_statuses]
           )
-          .count do |patient_session|
-            patient_session.patient.consent_given_and_safe_to_vaccinate?(
+          .count do |patient_location|
+            patient_location.patient.consent_given_and_safe_to_vaccinate?(
               programme:,
               academic_year:
             )
diff --git a/app/components/app_session_details_summary_component.rb b/app/components/app_session_details_summary_component.rb
index 5abb39c2ad..e776f9dbf4 100644
--- a/app/components/app_session_details_summary_component.rb
+++ b/app/components/app_session_details_summary_component.rb
@@ -16,15 +16,15 @@ def call
   delegate :govuk_summary_list, to: :helpers
   delegate :programmes, to: :session
 
-  def patient_sessions
+  def patient_locations
     session
-      .patient_sessions
+      .patient_locations
       .joins(:patient, :session)
       .appear_in_programmes(programmes)
   end
 
   def cohort_row
-    count = patient_sessions.count
+    count = patient_locations.count
 
     { key: { text: "Cohort" }, value: { text: I18n.t("children", count:) } }
   end
@@ -33,7 +33,7 @@ def consent_refused_row
     status = "refused"
 
     count =
-      patient_sessions.has_consent_status(status, programme: programmes).count
+      patient_locations.has_consent_status(status, programme: programmes).count
 
     href = session_consent_path(session, consent_statuses: [status])
 
diff --git a/app/components/app_session_needs_review_warning_component.rb b/app/components/app_session_needs_review_warning_component.rb
index 14c4ee1ac1..2b5066db8b 100644
--- a/app/components/app_session_needs_review_warning_component.rb
+++ b/app/components/app_session_needs_review_warning_component.rb
@@ -33,7 +33,7 @@ def warning_href
   def warning_counts
     @warning_counts ||= {
       children_without_nhs_number:
-        patient_sessions.merge(Patient.without_nhs_number).count
+        patient_locations.merge(Patient.without_nhs_number).count
     }
   end
 
@@ -42,9 +42,9 @@ def make_row_from_warning(warning)
     link_to(t(warning, count: warning_counts[warning]), warning_href[warning])
   end
 
-  def patient_sessions
+  def patient_locations
     @session
-      .patient_sessions
+      .patient_locations
       .joins(:patient, :session)
       .appear_in_programmes(@session.programmes)
   end
diff --git a/app/controllers/api/testing/teams_controller.rb b/app/controllers/api/testing/teams_controller.rb
index 98ab0b3eab..9e91ecc6c4 100644
--- a/app/controllers/api/testing/teams_controller.rb
+++ b/app/controllers/api/testing/teams_controller.rb
@@ -28,7 +28,7 @@ def destroy
         patient_ids = team.patients.pluck(:id)
         consent_form_ids = team.consent_forms.pluck(:id)
 
-        log_destroy(PatientSession.where(session: sessions))
+        log_destroy(PatientLocation.where(session: sessions))
 
         log_destroy(AccessLogEntry.where(patient_id: patient_ids))
         log_destroy(ArchiveReason.where(patient_id: patient_ids))
@@ -41,7 +41,7 @@ def destroy
         log_destroy(NotifyLogEntry.where(patient_id: patient_ids))
         log_destroy(NotifyLogEntry.where(consent_form_id: consent_form_ids))
         log_destroy(PatientChangeset.where(patient_id: patient_ids))
-        log_destroy(PatientSession.where(patient_id: patient_ids))
+        log_destroy(PatientLocation.where(patient_id: patient_ids))
         log_destroy(PatientSpecificDirection.where(patient_id: patient_ids))
         log_destroy(PDSSearchResult.where(patient_id: patient_ids))
         log_destroy(PreScreening.where(patient_id: patient_ids))
diff --git a/app/controllers/patient_sessions/base_controller.rb b/app/controllers/patient_sessions/base_controller.rb
index dde01ee584..e247c8b6fd 100644
--- a/app/controllers/patient_sessions/base_controller.rb
+++ b/app/controllers/patient_sessions/base_controller.rb
@@ -4,7 +4,7 @@ class PatientSessions::BaseController < ApplicationController
   before_action :set_session
   before_action :set_academic_year
   before_action :set_patient
-  before_action :set_patient_session
+  before_action :set_patient_location
   before_action :set_programme
   before_action :set_breadcrumb_item
 
@@ -34,9 +34,9 @@ def set_patient
       )
   end
 
-  def set_patient_session
-    @patient_session =
-      PatientSession.find_by!(patient: @patient, session: @session)
+  def set_patient_location
+    @patient_location =
+      PatientLocation.find_by!(patient: @patient, session: @session)
   end
 
   def set_programme
diff --git a/app/controllers/patients_controller.rb b/app/controllers/patients_controller.rb
index b30d4465e0..850efd6827 100644
--- a/app/controllers/patients_controller.rb
+++ b/app/controllers/patients_controller.rb
@@ -29,7 +29,7 @@ def invite_to_clinic
     session =
       current_team.generic_clinic_session(academic_year: AcademicYear.pending)
 
-    PatientSession.find_or_create_by!(patient: @patient, session:)
+    PatientLocation.find_or_create_by!(patient: @patient, session:)
 
     redirect_to patient_path(@patient),
                 flash: {
diff --git a/app/controllers/programmes/base_controller.rb b/app/controllers/programmes/base_controller.rb
index 2b88881161..0aacc493c4 100644
--- a/app/controllers/programmes/base_controller.rb
+++ b/app/controllers/programmes/base_controller.rb
@@ -22,7 +22,7 @@ def set_academic_year
 
   def patient_ids
     @patient_ids ||=
-      PatientSession
+      PatientLocation
         .distinct
         .joins(:patient, :session)
         .where(session_id: session_ids)
diff --git a/app/controllers/sessions/consent_controller.rb b/app/controllers/sessions/consent_controller.rb
index 10bf452bb1..4dbf089c96 100644
--- a/app/controllers/sessions/consent_controller.rb
+++ b/app/controllers/sessions/consent_controller.rb
@@ -27,7 +27,7 @@ def show
 
     scope =
       @session
-        .patient_sessions
+        .patient_locations
         .includes_programmes
         .includes(patient: [:consent_statuses, { notes: :created_by }])
         .has_consent_status(
@@ -35,8 +35,8 @@ def show
           programme: @form.programmes
         )
 
-    patient_sessions = @form.apply(scope)
-    @pagy, @patient_sessions = pagy(patient_sessions)
+    patient_locations = @form.apply(scope)
+    @pagy, @patient_locations = pagy(patient_locations)
   end
 
   private
diff --git a/app/controllers/sessions/invite_to_clinic_controller.rb b/app/controllers/sessions/invite_to_clinic_controller.rb
index 55f00e84ec..1d920580b3 100644
--- a/app/controllers/sessions/invite_to_clinic_controller.rb
+++ b/app/controllers/sessions/invite_to_clinic_controller.rb
@@ -14,7 +14,7 @@ def edit
 
   def update
     if @session.school?
-      factory.create_patient_sessions!
+      factory.create_patient_locations!
 
       flash[
         :success
@@ -54,7 +54,7 @@ def set_generic_clinic_session
   def set_patients_to_invite
     @patients_to_invite =
       if @session.school?
-        factory.patient_sessions_to_create.map(&:patient)
+        factory.patient_locations_to_create.map(&:patient)
       else
         session_date = @generic_clinic_session.next_date(include_today: true)
         SendClinicSubsequentInvitationsJob.new.patients(@session, session_date:)
@@ -68,7 +68,7 @@ def set_invitations_to_send
   def factory
     @factory ||=
       if @session.school?
-        ClinicPatientSessionsFactory.new(
+        ClinicPatientLocationsFactory.new(
           school_session: @session,
           generic_clinic_session: @generic_clinic_session
         )
diff --git a/app/controllers/sessions/patient_specific_directions_controller.rb b/app/controllers/sessions/patient_specific_directions_controller.rb
index 90507b7886..b6da1d0471 100644
--- a/app/controllers/sessions/patient_specific_directions_controller.rb
+++ b/app/controllers/sessions/patient_specific_directions_controller.rb
@@ -10,20 +10,20 @@ class Sessions::PatientSpecificDirectionsController < ApplicationController
 
   def show
     scope =
-      @session.patient_sessions.includes_programmes.includes(
+      @session.patient_locations.includes_programmes.includes(
         patient: {
           patient_specific_directions: :programme
         }
       )
-    @eligible_for_bulk_psd_count = patient_sessions_allowed_psd.count
-    patient_sessions = @form.apply(scope)
-    @pagy, @patient_sessions = pagy(patient_sessions)
+    @eligible_for_bulk_psd_count = patient_locations_allowed_psd.count
+    patient_locations = @form.apply(scope)
+    @pagy, @patient_locations = pagy(patient_locations)
 
     render layout: "full"
   end
 
   def new
-    @eligible_for_bulk_psd_count = patient_sessions_allowed_psd.count
+    @eligible_for_bulk_psd_count = patient_locations_allowed_psd.count
   end
 
   def create
@@ -56,12 +56,12 @@ def set_vaccine
   end
 
   def psds_to_create
-    patient_sessions_allowed_psd.map do |patient_session|
+    patient_locations_allowed_psd.map do |patient_location|
       PatientSpecificDirection.new(
         academic_year: @session.academic_year,
         created_by: current_user,
         delivery_site: "nose",
-        patient_id: patient_session.patient_id,
+        patient_id: patient_location.patient_id,
         programme: @programme,
         team: current_team,
         vaccine: @vaccine,
@@ -70,10 +70,10 @@ def psds_to_create
     end
   end
 
-  def patient_sessions_allowed_psd
-    @patient_sessions_allowed_psd ||=
+  def patient_locations_allowed_psd
+    @patient_locations_allowed_psd ||=
       @session
-        .patient_sessions
+        .patient_locations
         .has_consent_status(
           "given",
           programme: @programme,
diff --git a/app/controllers/sessions/patients_controller.rb b/app/controllers/sessions/patients_controller.rb
index 87f0390318..538063ac00 100644
--- a/app/controllers/sessions/patients_controller.rb
+++ b/app/controllers/sessions/patients_controller.rb
@@ -12,12 +12,12 @@ def show
     @statuses = Patient::VaccinationStatus.statuses.keys
 
     scope =
-      @session.patient_sessions.includes_programmes.includes(
+      @session.patient_locations.includes_programmes.includes(
         patient: [:vaccination_statuses, { notes: :created_by }]
       )
 
-    patient_sessions = @form.apply(scope)
-    @pagy, @patient_sessions = pagy(patient_sessions)
+    patient_locations = @form.apply(scope)
+    @pagy, @patient_locations = pagy(patient_locations)
   end
 
   private
diff --git a/app/controllers/sessions/record_controller.rb b/app/controllers/sessions/record_controller.rb
index 0655f461d4..3f99f7c5fd 100644
--- a/app/controllers/sessions/record_controller.rb
+++ b/app/controllers/sessions/record_controller.rb
@@ -15,7 +15,7 @@ class Sessions::RecordController < ApplicationController
 
   def show
     scope =
-      @session.patient_sessions.includes(
+      @session.patient_locations.includes(
         patient: [
           :consent_statuses,
           :triage_statuses,
@@ -28,7 +28,7 @@ def show
       scope = scope.has_registration_status(%w[attending completed])
     end
 
-    patient_sessions =
+    patient_locations =
       filter_on_vaccine_method_or_patient_specific_direction(
         @form.apply(scope)
       ).consent_given_and_ready_to_vaccinate(
@@ -36,7 +36,7 @@ def show
         vaccine_method: @form.vaccine_method.presence
       )
 
-    @pagy, @patient_sessions = pagy_array(patient_sessions)
+    @pagy, @patient_locations = pagy_array(patient_locations)
 
     render layout: "full"
   end
diff --git a/app/controllers/sessions/register_controller.rb b/app/controllers/sessions/register_controller.rb
index dc5d30c1c0..1e473d006f 100644
--- a/app/controllers/sessions/register_controller.rb
+++ b/app/controllers/sessions/register_controller.rb
@@ -14,7 +14,7 @@ def show
     @statuses = Patient::RegistrationStatus.statuses.keys
 
     scope =
-      @session.patient_sessions.includes_programmes.includes(
+      @session.patient_locations.includes_programmes.includes(
         patient: [
           :consent_statuses,
           :registration_statuses,
@@ -24,8 +24,8 @@ def show
         ]
       )
 
-    patient_sessions = @form.apply(scope)
-    @pagy, @patient_sessions = pagy(patient_sessions)
+    patient_locations = @form.apply(scope)
+    @pagy, @patient_locations = pagy(patient_locations)
   end
 
   def create
diff --git a/app/controllers/sessions/triage_controller.rb b/app/controllers/sessions/triage_controller.rb
index 206e8528c0..c37eb46705 100644
--- a/app/controllers/sessions/triage_controller.rb
+++ b/app/controllers/sessions/triage_controller.rb
@@ -13,13 +13,13 @@ def show
 
     scope =
       @session
-        .patient_sessions
+        .patient_locations
         .includes_programmes
         .includes(patient: [:triage_statuses, { notes: :created_by }])
         .has_triage_status(@statuses, programme: @form.programmes)
 
-    patient_sessions = @form.apply(scope)
-    @pagy, @patient_sessions = pagy(patient_sessions)
+    patient_locations = @form.apply(scope)
+    @pagy, @patient_locations = pagy(patient_locations)
   end
 
   private
diff --git a/app/controllers/sessions_controller.rb b/app/controllers/sessions_controller.rb
index 0c2c07519e..92960ffbdb 100644
--- a/app/controllers/sessions_controller.rb
+++ b/app/controllers/sessions_controller.rb
@@ -17,7 +17,7 @@ def index
     sessions = @form.apply(scope)
 
     @patient_count_by_session_id =
-      PatientSession
+      PatientLocation
         .where(session_id: sessions.map(&:id))
         .joins(:patient, :session)
         .appear_in_programmes(@programmes)
diff --git a/app/forms/concerns/patient_merge_form_concern.rb b/app/forms/concerns/patient_merge_form_concern.rb
index 9f25e6f0fd..29ba0245df 100644
--- a/app/forms/concerns/patient_merge_form_concern.rb
+++ b/app/forms/concerns/patient_merge_form_concern.rb
@@ -20,7 +20,7 @@ def existing_patient
         ) ||
           Patient
             .where
-            .missing(:patient_sessions)
+            .missing(:patient_locations)
             .includes(vaccination_records: :programme)
             .find_by(nhs_number:)
       end
diff --git a/app/jobs/concerns/send_school_consent_notification_concern.rb b/app/jobs/concerns/send_school_consent_notification_concern.rb
index c183e1d240..caaecf6584 100644
--- a/app/jobs/concerns/send_school_consent_notification_concern.rb
+++ b/app/jobs/concerns/send_school_consent_notification_concern.rb
@@ -9,11 +9,11 @@ def patient_programmes_eligible_for_notification(session:)
     return unless session.school? && session.open_for_consent?
 
     session
-      .patient_sessions
+      .patient_locations
       .includes_programmes
       .includes(patient: %i[consent_notifications consents vaccination_records])
-      .find_each do |patient_session|
-        patient = patient_session.patient
+      .find_each do |patient_location|
+        patient = patient_location.patient
         next unless patient.send_notifications?
 
         ProgrammeGrouper
diff --git a/app/jobs/enqueue_vaccinations_search_in_nhs_job.rb b/app/jobs/enqueue_vaccinations_search_in_nhs_job.rb
index d1ff147b06..5fbba861fa 100644
--- a/app/jobs/enqueue_vaccinations_search_in_nhs_job.rb
+++ b/app/jobs/enqueue_vaccinations_search_in_nhs_job.rb
@@ -15,11 +15,7 @@ def perform(sessions = nil)
           .references(:session_dates)
       end
 
-    patient_ids =
-      Patient
-        .includes(:sessions)
-        .where(patient_sessions: { session: sessions.pluck(:id) })
-        .ids
+    patient_ids = PatientLocation.where(session: sessions).pluck(:patient_id)
 
     return if patient_ids.empty?
 
diff --git a/app/jobs/send_school_session_reminders_job.rb b/app/jobs/send_school_session_reminders_job.rb
index 3a1c248382..0de6aa9071 100644
--- a/app/jobs/send_school_session_reminders_job.rb
+++ b/app/jobs/send_school_session_reminders_job.rb
@@ -22,7 +22,7 @@ def perform
             SessionNotification
               .where(session:)
               .where(
-                "session_notifications.patient_id = patient_sessions.patient_id"
+                "session_notifications.patient_id = patient_locations.patient_id"
               )
               .where(session_date: date)
               .arel
diff --git a/app/lib/clinic_patient_sessions_factory.rb b/app/lib/clinic_patient_locations_factory.rb
similarity index 79%
rename from app/lib/clinic_patient_sessions_factory.rb
rename to app/lib/clinic_patient_locations_factory.rb
index e3f38fd91e..e32f1ea434 100644
--- a/app/lib/clinic_patient_sessions_factory.rb
+++ b/app/lib/clinic_patient_locations_factory.rb
@@ -1,19 +1,19 @@
 # frozen_string_literal: true
 
-class ClinicPatientSessionsFactory
+class ClinicPatientLocationsFactory
   def initialize(school_session:, generic_clinic_session:)
     @school_session = school_session
     @generic_clinic_session = generic_clinic_session
   end
 
-  def create_patient_sessions!
-    PatientSession.import!(
-      patient_sessions_to_create,
+  def create_patient_locations!
+    PatientLocation.import!(
+      patient_locations_to_create,
       on_duplicate_key_ignore: true
     )
   end
 
-  def patient_sessions_to_create
+  def patient_locations_to_create
     patients_in_school.filter_map do |patient|
       if SendClinicInitialInvitationsJob.new.should_send_notification?(
            patient:,
@@ -21,7 +21,7 @@ def patient_sessions_to_create
            programmes:,
            session_date:
          )
-        PatientSession.includes(:session_notifications).find_or_initialize_by(
+        PatientLocation.includes(:session_notifications).find_or_initialize_by(
           patient:,
           session: generic_clinic_session
         )
diff --git a/app/lib/generate/vaccination_records.rb b/app/lib/generate/vaccination_records.rb
index 65f5f6550b..bac14d456a 100644
--- a/app/lib/generate/vaccination_records.rb
+++ b/app/lib/generate/vaccination_records.rb
@@ -22,9 +22,9 @@ def create_vaccinations
     attendance_records = []
     vaccination_records = []
 
-    random_patient_sessions.each do |patient_session|
-      patient = patient_session.patient
-      session = patient_session.session
+    random_patient_locations.each do |patient_location|
+      patient = patient_location.patient
+      session = patient_location.session
 
       unless AttendanceRecord.exists?(patient:, location: session.location)
         attendance_records << FactoryBot.build(
@@ -36,16 +36,16 @@ def create_vaccinations
       end
 
       location_name =
-        patient_session.location.name if patient_session.session.clinic?
+        patient_location.location.name if patient_location.session.clinic?
 
       vaccination_records << FactoryBot.build(
         :vaccination_record,
         :administered,
-        patient: patient_session.patient,
+        patient: patient_location.patient,
         programme:,
         team:,
         performed_by:,
-        session: patient_session.session,
+        session: patient_location.session,
         vaccine:,
         batch:,
         location_name:
@@ -58,25 +58,25 @@ def create_vaccinations
     StatusUpdater.call(patient: vaccination_records.map(&:patient))
   end
 
-  def random_patient_sessions
+  def random_patient_locations
     if administered&.positive?
-      patient_sessions
+      patient_locations
         .sample(administered)
         .tap do |selected|
           if selected.size < administered
             info =
-              "#{selected.size} (patient_sessions) < #{administered} (administered)"
+              "#{selected.size} (patient_locations) < #{administered} (administered)"
             raise "Not enough patients to generate vaccinations: #{info}"
           end
         end
     else
-      patient_sessions
+      patient_locations
     end
   end
 
-  def patient_sessions
+  def patient_locations
     (session.presence || team)
-      .patient_sessions
+      .patient_locations
       .joins(:patient)
       .includes(
         :session,
diff --git a/app/lib/location_sessions_factory.rb b/app/lib/location_sessions_factory.rb
index e8be90a105..97210c92c0 100644
--- a/app/lib/location_sessions_factory.rb
+++ b/app/lib/location_sessions_factory.rb
@@ -56,7 +56,7 @@ def find_or_create_session!(programmes:)
   end
 
   def add_patients!(session:)
-    PatientSession.import!(
+    PatientLocation.import!(
       %i[patient_id session_id],
       patient_ids.map { [it, session.id] },
       on_duplicate_key_ignore: true
diff --git a/app/lib/mavis_cli/schools/move_patients.rb b/app/lib/mavis_cli/schools/move_patients.rb
index 870c38d4b9..43312fdda4 100644
--- a/app/lib/mavis_cli/schools/move_patients.rb
+++ b/app/lib/mavis_cli/schools/move_patients.rb
@@ -19,7 +19,7 @@ def call(source_urn:, target_urn:)
           return
         end
 
-        unless PatientSession
+        unless PatientLocation
                  .joins(:patient, :session)
                  .where(
                    patient: {
diff --git a/app/lib/patient_merger.rb b/app/lib/patient_merger.rb
index 31e4fdc72c..ae96097a5a 100644
--- a/app/lib/patient_merger.rb
+++ b/app/lib/patient_merger.rb
@@ -100,16 +100,16 @@ def call
         end
       end
 
-      patient_to_destroy.patient_sessions.each do |patient_session|
-        if patient_to_keep.patient_sessions.exists?(
-             session_id: patient_session.session_id
+      patient_to_destroy.patient_locations.each do |patient_location|
+        if patient_to_keep.patient_locations.exists?(
+             session_id: patient_location.session_id
            )
           next
         end
-        patient_session.update_column(:patient_id, patient_to_keep.id)
+        patient_location.update_column(:patient_id, patient_to_keep.id)
       end
 
-      PatientSession.where(patient: patient_to_destroy).destroy_all
+      PatientLocation.where(patient: patient_to_destroy).destroy_all
 
       patient_to_destroy.changesets.update_all(patient_id: nil)
 
diff --git a/app/lib/stats/consents_by_school.rb b/app/lib/stats/consents_by_school.rb
index f037d2e8ab..a7ca0e9d47 100644
--- a/app/lib/stats/consents_by_school.rb
+++ b/app/lib/stats/consents_by_school.rb
@@ -47,13 +47,13 @@ def collect_data
 
       sessions.find_each do |session|
         session
-          .patient_sessions
+          .patient_locations
           .includes(patient: { consents: %i[consent_form parent] })
-          .find_each do |patient_session|
+          .find_each do |patient_location|
             grouped_consents =
               @programmes.map do |programme|
                 ConsentGrouper.call(
-                  patient_session.patient.consents,
+                  patient_location.patient.consents,
                   programme_id: programme.id,
                   academic_year: @academic_year
                 )&.min_by(&:created_at)
diff --git a/app/lib/status_updater.rb b/app/lib/status_updater.rb
index c1af25ff92..b85c0625dd 100644
--- a/app/lib/status_updater.rb
+++ b/app/lib/status_updater.rb
@@ -2,12 +2,12 @@
 
 class StatusUpdater
   def initialize(patient: nil, session: nil)
-    scope = PatientSession
+    scope = PatientLocation
 
     scope = scope.where(patient:) if patient
     scope = scope.where(session:) if session
 
-    @patient_sessions = scope
+    @patient_locations = scope
   end
 
   def call
@@ -23,7 +23,7 @@ def self.call(...) = new(...).call
 
   private
 
-  attr_reader :patient_sessions
+  attr_reader :patient_locations
 
   def update_consent_statuses!
     Patient::ConsentStatus.import!(
@@ -33,7 +33,7 @@ def update_consent_statuses!
     )
 
     Patient::ConsentStatus
-      .where(patient: patient_sessions.select(:patient_id))
+      .where(patient: patient_locations.select(:patient_id))
       .includes(:consents, :patient, :programme, :vaccination_records)
       .find_in_batches(batch_size: 10_000) do |batch|
         batch.each(&:assign_status)
@@ -51,14 +51,14 @@ def update_consent_statuses!
   def update_registration_statuses!
     Patient::RegistrationStatus.import!(
       %i[patient_id session_id],
-      patient_session_statuses_to_import,
+      patient_location_statuses_to_import,
       on_duplicate_key_ignore: true
     )
 
     Patient::RegistrationStatus
       .where(
-        patient: patient_sessions.select(:patient_id),
-        session: patient_sessions.select(:session_id)
+        patient: patient_locations.select(:patient_id),
+        session: patient_locations.select(:session_id)
       )
       .includes(
         :patient,
@@ -87,7 +87,7 @@ def update_triage_statuses!
     )
 
     Patient::TriageStatus
-      .where(patient: patient_sessions.select(:patient_id))
+      .where(patient: patient_locations.select(:patient_id))
       .includes(:patient, :programme, :consents, :triages, :vaccination_records)
       .find_in_batches(batch_size: 10_000) do |batch|
         batch.each(&:assign_status)
@@ -110,7 +110,7 @@ def update_vaccination_statuses!
     )
 
     Patient::VaccinationStatus
-      .where(patient: patient_sessions.select(:patient_id))
+      .where(patient: patient_locations.select(:patient_id))
       .includes(
         :patient,
         :programme,
@@ -138,7 +138,7 @@ def academic_years
 
   def patient_statuses_to_import
     @patient_statuses_to_import ||=
-      patient_sessions
+      patient_locations
         .joins(:patient)
         .pluck(:patient_id, :"patients.birth_academic_year")
         .uniq
@@ -164,8 +164,8 @@ def vaccination_statuses_to_import
     end
   end
 
-  def patient_session_statuses_to_import
-    patient_sessions
+  def patient_location_statuses_to_import
+    patient_locations
       .joins(:patient, :session)
       .pluck(
         :"patients.id",
diff --git a/app/lib/team_sessions_factory.rb b/app/lib/team_sessions_factory.rb
index 465a0ff198..9b5d0e33b6 100644
--- a/app/lib/team_sessions_factory.rb
+++ b/app/lib/team_sessions_factory.rb
@@ -37,7 +37,7 @@ def destroy_orphaned_sessions!
         .where(academic_year:)
         .where.not(location: team.locations)
         .where
-        .missing(:patient_sessions)
+        .missing(:patient_locations)
         .destroy_all
     end
   end
diff --git a/app/models/class_import.rb b/app/models/class_import.rb
index 9a2cadc313..834fb3adfb 100644
--- a/app/models/class_import.rb
+++ b/app/models/class_import.rb
@@ -56,7 +56,7 @@ def postprocess_rows!
 
     existing_patients =
       Patient.where(birth_academic_year: birth_academic_years).where(
-        PatientSession
+        PatientLocation
           .joins(session: :location)
           .where("patient_id = patients.id")
           .where(session: { academic_year:, location: })
diff --git a/app/models/immunisation_import.rb b/app/models/immunisation_import.rb
index 619562805d..192f7b26d8 100644
--- a/app/models/immunisation_import.rb
+++ b/app/models/immunisation_import.rb
@@ -34,7 +34,7 @@ class ImmunisationImport < ApplicationRecord
   include CSVImportable
 
   has_and_belongs_to_many :batches
-  has_and_belongs_to_many :patient_sessions
+  has_and_belongs_to_many :patient_locations
   has_and_belongs_to_many :sessions
   has_and_belongs_to_many :vaccination_records
 
@@ -57,7 +57,7 @@ def process_row(row)
     @vaccination_records_batch ||= Set.new
     @batches_batch ||= Set.new
     @patients_batch ||= Set.new
-    @patient_sessions_batch ||= Set.new
+    @patient_locations_batch ||= Set.new
 
     @vaccination_records_batch.add(vaccination_record)
     if (batch = vaccination_record.batch)
@@ -65,8 +65,8 @@ def process_row(row)
     end
     @patients_batch.add(vaccination_record.patient)
 
-    if (patient_session = row.to_patient_session)
-      @patient_sessions_batch.add(patient_session)
+    if (patient_location = row.to_patient_location)
+      @patient_locations_batch.add(patient_location)
     end
 
     count_column_to_increment
@@ -78,16 +78,16 @@ def bulk_import(rows: 100)
     # We need to convert the batch to an array as `import` modifies the
     # objects to add IDs to any new records.
     vaccination_records = @vaccination_records_batch.to_a
-    patient_sessions = @patient_sessions_batch.to_a
+    patient_locations = @patient_locations_batch.to_a
 
     VaccinationRecord.import(vaccination_records, on_duplicate_key_update: :all)
-    PatientSession.import(patient_sessions, on_duplicate_key_ignore: :all)
+    PatientLocation.import(patient_locations, on_duplicate_key_ignore: :all)
 
     [
       [:vaccination_records, vaccination_records],
       [:batches, @batches_batch],
       [:patients, @patients_batch],
-      [:patient_sessions, patient_sessions.select { it.id.present? }]
+      [:patient_locations, patient_locations.select { it.id.present? }]
     ].each do |association, collection|
       link_records_by_type(association, collection)
       collection.clear
diff --git a/app/models/immunisation_import_row.rb b/app/models/immunisation_import_row.rb
index c358410632..6a3e902cd7 100644
--- a/app/models/immunisation_import_row.rb
+++ b/app/models/immunisation_import_row.rb
@@ -156,8 +156,8 @@ def to_vaccination_record
     vaccination_record
   end
 
-  def to_patient_session
-    PatientSession.new(patient:, session:) if patient && session
+  def to_patient_location
+    PatientLocation.new(patient:, session:) if patient && session
   end
 
   def batch_expiry = @data[:batch_expiry_date]
diff --git a/app/models/patient.rb b/app/models/patient.rb
index 0e8389dbfd..35db2e22c4 100644
--- a/app/models/patient.rb
+++ b/app/models/patient.rb
@@ -71,7 +71,7 @@ class Patient < ApplicationRecord
   has_many :notes
   has_many :notify_log_entries
   has_many :parent_relationships, -> { order(:created_at) }
-  has_many :patient_sessions
+  has_many :patient_locations
   has_many :pds_search_results
   has_many :pre_screenings
   has_many :registration_statuses
@@ -86,12 +86,12 @@ class Patient < ApplicationRecord
 
   has_many :parents, through: :parent_relationships
   has_many :patient_specific_directions
-  has_many :sessions, through: :patient_sessions
+  has_many :sessions, through: :patient_locations
   has_many :teams, -> { distinct }, through: :sessions
 
   has_many :pending_sessions,
            -> { where(academic_year: AcademicYear.pending) },
-           through: :patient_sessions,
+           through: :patient_locations,
            source: :session
 
   has_and_belongs_to_many :class_imports
@@ -142,7 +142,7 @@ class Patient < ApplicationRecord
   scope :appear_in_programmes,
         ->(programmes, academic_year:) do
           where(
-            PatientSession
+            PatientLocation
               .joins(:session)
               .where(sessions: { academic_year: })
               .where("patient_id = patients.id")
@@ -155,7 +155,7 @@ class Patient < ApplicationRecord
   scope :not_appear_in_programmes,
         ->(programmes, academic_year:) do
           where.not(
-            PatientSession
+            PatientLocation
               .joins(:session)
               .where(sessions: { academic_year: })
               .where("patient_id = patients.id")
@@ -503,7 +503,7 @@ def invalidate!
   end
 
   def not_in_team?(team:, academic_year:)
-    patient_sessions
+    patient_locations
       .joins(:session)
       .where(session: { academic_year:, team: })
       .empty?
@@ -514,7 +514,7 @@ def dup_for_pending_changes
       new_patient.nhs_number = nil
 
       pending_sessions.each do |session|
-        new_patient.patient_sessions.build(session:)
+        new_patient.patient_locations.build(session:)
       end
 
       school_moves.each do |school_move|
@@ -534,7 +534,7 @@ def clear_pending_sessions!(team: nil)
 
     sessions = sessions.where(team_id: team.id) unless team.nil?
 
-    patient_sessions.where(session: sessions).destroy_all_if_safe
+    patient_locations.where(session: sessions).destroy_all_if_safe
   end
 
   def self.from_consent_form(consent_form)
diff --git a/app/models/patient/vaccination_status.rb b/app/models/patient/vaccination_status.rb
index 3454fc8cbe..b174b33657 100644
--- a/app/models/patient/vaccination_status.rb
+++ b/app/models/patient/vaccination_status.rb
@@ -38,7 +38,7 @@ class Patient::VaccinationStatus < ApplicationRecord
            -> { kept.order(performed_at: :desc) },
            through: :patient
 
-  has_one :patient_session
+  has_one :patient_location
 
   has_one :attendance_record,
           -> { today },
diff --git a/app/models/patient_changeset.rb b/app/models/patient_changeset.rb
index 577967cae3..5a230173a2 100644
--- a/app/models/patient_changeset.rb
+++ b/app/models/patient_changeset.rb
@@ -114,7 +114,7 @@ def patient
         Patient.new(
           child_attributes.merge(
             "home_educated" => false,
-            "patient_sessions" => []
+            "patient_locations" => []
           )
         )
       end
@@ -209,7 +209,7 @@ def existing_patients
     end
 
     matches =
-      Patient.includes(:patient_sessions).match_existing(
+      Patient.includes(:patient_locations).match_existing(
         nhs_number: child_attributes["nhs_number"],
         given_name: child_attributes["given_name"],
         family_name: child_attributes["family_name"],
diff --git a/app/models/patient_import_row.rb b/app/models/patient_import_row.rb
index cd0dd2ea99..e0a42dd291 100644
--- a/app/models/patient_import_row.rb
+++ b/app/models/patient_import_row.rb
@@ -51,7 +51,7 @@ def to_patient
       prepare_patient_changes(existing_patient, import_attributes)
     else
       Patient.new(
-        import_attributes.merge(home_educated: false, patient_sessions: [])
+        import_attributes.merge(home_educated: false, patient_locations: [])
       )
     end
   end
@@ -346,7 +346,7 @@ def existing_patients
       return
     end
 
-    Patient.includes(:patient_sessions).match_existing(
+    Patient.includes(:patient_locations).match_existing(
       nhs_number: nhs_number_value,
       given_name: first_name.to_s,
       family_name: last_name.to_s,
diff --git a/app/models/patient_session.rb b/app/models/patient_location.rb
similarity index 88%
rename from app/models/patient_session.rb
rename to app/models/patient_location.rb
index 89b1e8fe94..8480a142dc 100644
--- a/app/models/patient_session.rb
+++ b/app/models/patient_location.rb
@@ -2,7 +2,7 @@
 
 # == Schema Information
 #
-# Table name: patient_sessions
+# Table name: patient_locations
 #
 #  id         :bigint           not null, primary key
 #  created_at :datetime         not null
@@ -12,8 +12,8 @@
 #
 # Indexes
 #
-#  index_patient_sessions_on_patient_id_and_session_id  (patient_id,session_id) UNIQUE
-#  index_patient_sessions_on_session_id                 (session_id)
+#  index_patient_locations_on_patient_id_and_session_id  (patient_id,session_id) UNIQUE
+#  index_patient_locations_on_session_id                 (session_id)
 #
 # Foreign Keys
 #
@@ -37,7 +37,7 @@
 # that case, the list of programmes they appear in won't be the same as the
 # complete list of programmes administered in the session.
 
-class PatientSession < ApplicationRecord
+class PatientLocation < ApplicationRecord
   audited associated_with: :patient
   has_associated_audits
 
@@ -143,7 +143,7 @@ class PatientSession < ApplicationRecord
         ->(status, programme:, vaccine_method: nil) do
           consent_status_scope =
             Patient::ConsentStatus
-              .where("patient_id = patient_sessions.patient_id")
+              .where("patient_id = patient_locations.patient_id")
               .where("academic_year = sessions.academic_year")
               .where(status:, programme:)
 
@@ -159,8 +159,8 @@ class PatientSession < ApplicationRecord
         ->(status) do
           where(
             Patient::RegistrationStatus
-              .where("patient_id = patient_sessions.patient_id")
-              .where("session_id = patient_sessions.session_id")
+              .where("patient_id = patient_locations.patient_id")
+              .where("session_id = patient_locations.session_id")
               .where(status:)
               .arel
               .exists
@@ -171,7 +171,7 @@ class PatientSession < ApplicationRecord
         ->(status, programme:) do
           joins(:session).where(
             Patient::TriageStatus
-              .where("patient_id = patient_sessions.patient_id")
+              .where("patient_id = patient_locations.patient_id")
               .where("academic_year = sessions.academic_year")
               .where(status:, programme:)
               .arel
@@ -183,7 +183,7 @@ class PatientSession < ApplicationRecord
         ->(status, programme:) do
           joins(:session).where(
             Patient::VaccinationStatus
-              .where("patient_id = patient_sessions.patient_id")
+              .where("patient_id = patient_locations.patient_id")
               .where("academic_year = sessions.academic_year")
               .where(status:, programme:)
               .arel
@@ -195,7 +195,7 @@ class PatientSession < ApplicationRecord
         ->(vaccine_method, programme:) do
           joins(:session).where(
             Patient::TriageStatus
-              .where("patient_id = patient_sessions.patient_id")
+              .where("patient_id = patient_locations.patient_id")
               .where("academic_year = sessions.academic_year")
               .where(vaccine_method:, programme:)
               .arel
@@ -203,14 +203,14 @@ class PatientSession < ApplicationRecord
           ).or(
             joins(:session).where(
               Patient::TriageStatus
-                .where("patient_id = patient_sessions.patient_id")
+                .where("patient_id = patient_locations.patient_id")
                 .where("academic_year = sessions.academic_year")
                 .where(status: "not_required", programme:)
                 .arel
                 .exists
             ).where(
               Patient::ConsentStatus
-                .where("patient_id = patient_sessions.patient_id")
+                .where("patient_id = patient_locations.patient_id")
                 .where("academic_year = sessions.academic_year")
                 .where(programme:)
                 .has_vaccine_method(vaccine_method)
@@ -222,9 +222,9 @@ class PatientSession < ApplicationRecord
 
   scope :consent_given_and_ready_to_vaccinate,
         ->(programmes:, vaccine_method:) do
-          select do |patient_session|
-            patient = patient_session.patient
-            session = patient_session.session
+          select do |patient_location|
+            patient = patient_location.patient
+            session = patient_location.session
 
             programmes.any? do |programme|
               patient.consent_given_and_safe_to_vaccinate?(
@@ -240,7 +240,7 @@ class PatientSession < ApplicationRecord
         ->(programme:, team:) do
           joins(:session).where.not(
             PatientSpecificDirection
-              .where("patient_id = patient_sessions.patient_id")
+              .where("patient_id = patient_locations.patient_id")
               .where("academic_year = sessions.academic_year")
               .where(programme:, team:)
               .not_invalidated
@@ -253,7 +253,7 @@ class PatientSession < ApplicationRecord
         ->(programme:, team:) do
           joins(:session).where(
             PatientSpecificDirection
-              .where("patient_id = patient_sessions.patient_id")
+              .where("patient_id = patient_locations.patient_id")
               .where("academic_year = sessions.academic_year")
               .where(programme:, team:)
               .not_invalidated
diff --git a/app/models/school_move.rb b/app/models/school_move.rb
index e16187e993..179dfbee88 100644
--- a/app/models/school_move.rb
+++ b/app/models/school_move.rb
@@ -98,13 +98,13 @@ def update_archive_reasons!(user:)
 
   def update_sessions!
     patient
-      .patient_sessions
+      .patient_locations
       .joins(:session)
       .where("academic_year >= ?", academic_year)
       .destroy_all_if_safe
 
     sessions_to_add.find_each do |session|
-      PatientSession.find_or_create_by!(patient:, session:)
+      PatientLocation.find_or_create_by!(patient:, session:)
     end
 
     StatusUpdater.call(patient:)
diff --git a/app/models/session.rb b/app/models/session.rb
index b23129714a..a9a25c319b 100644
--- a/app/models/session.rb
+++ b/app/models/session.rb
@@ -39,7 +39,7 @@ class Session < ApplicationRecord
 
   has_many :consent_notifications
   has_many :notes
-  has_many :patient_sessions
+  has_many :patient_locations
   has_many :session_dates, -> { order(:value) }
   has_many :session_notifications
   has_many :session_programmes,
@@ -54,7 +54,7 @@ class Session < ApplicationRecord
   has_many :pre_screenings, through: :session_dates
   has_many :programmes, through: :session_programmes
   has_many :gillick_assessments, through: :session_dates
-  has_many :patients, through: :patient_sessions
+  has_many :patients, through: :patient_locations
   has_many :vaccines, through: :programmes
 
   has_many :location_programme_year_groups,
@@ -301,7 +301,7 @@ def open_for_consent?
   def next_reminder_date = next_reminder_dates.first
 
   def patients_with_no_consent_response_count
-    patient_sessions.has_consent_status(
+    patient_locations.has_consent_status(
       "no_response",
       programme: programmes
     ).count
diff --git a/app/models/team.rb b/app/models/team.rb
index 0c4e1614d9..c58316cf98 100644
--- a/app/models/team.rb
+++ b/app/models/team.rb
@@ -52,8 +52,8 @@ class Team < ApplicationRecord
 
   has_many :community_clinics, through: :subteams
   has_many :locations, through: :subteams
-  has_many :patient_sessions, through: :sessions
-  has_many :patients, -> { distinct }, through: :patient_sessions
+  has_many :patient_locations, through: :sessions
+  has_many :patients, -> { distinct }, through: :patient_locations
   has_many :programmes, through: :team_programmes
   has_many :schools, through: :subteams
   has_many :vaccination_records, through: :sessions
diff --git a/app/policies/patient_policy.rb b/app/policies/patient_policy.rb
index e7f2ca1d1d..0c84d437f9 100644
--- a/app/policies/patient_policy.rb
+++ b/app/policies/patient_policy.rb
@@ -9,10 +9,10 @@ def resolve
       return scope.none if team.nil?
 
       existence_criteria = [
-        PatientSession
+        PatientLocation
           .select("1")
           .joins(:session)
-          .where("patient_sessions.patient_id = patients.id")
+          .where("patient_locations.patient_id = patients.id")
           .where(sessions: { team_id: team.id })
           .arel,
         ArchiveReason
diff --git a/app/policies/school_move_policy.rb b/app/policies/school_move_policy.rb
index a1c15ef832..078f26f3c9 100644
--- a/app/policies/school_move_policy.rb
+++ b/app/policies/school_move_policy.rb
@@ -8,7 +8,7 @@ def resolve
 
       patient_subquery =
         Patient
-          .joins(patient_sessions: :session)
+          .joins(patient_locations: :session)
           .select(:id)
           .distinct
           .where(sessions: { team_id: team.id })
diff --git a/app/policies/vaccination_record_policy.rb b/app/policies/vaccination_record_policy.rb
index b6b8ed8a19..f8556cfe2f 100644
--- a/app/policies/vaccination_record_policy.rb
+++ b/app/policies/vaccination_record_policy.rb
@@ -70,10 +70,11 @@ def resolve
       relevant_patients =
         Patient
           .select("1")
-          .joins(patient_sessions: :session)
+          .joins(patient_locations: :session)
           .where("patients.id = vaccination_records.patient_id")
           .where(sessions: { team_id: team.id })
           .arel
+
       scope
         .kept
         .where(relevant_patients.exists)
diff --git a/app/views/sessions/consent/show.html.erb b/app/views/sessions/consent/show.html.erb
index 72cfa112ea..b3ca8aa8e1 100644
--- a/app/views/sessions/consent/show.html.erb
+++ b/app/views/sessions/consent/show.html.erb
@@ -22,10 +22,10 @@
   <div class="app-grid-column-results">
     <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
     <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-      <% @patient_sessions.each do |patient_session| %>
+      <% @patient_locations.each do |patient_location| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
-              patient: patient_session.patient,
-              session: patient_session.session,
+              patient: patient_location.patient,
+              session: patient_location.session,
               context: :consent,
               programmes: @form.programmes,
             ) %>
diff --git a/app/views/sessions/patient_specific_directions/show.html.erb b/app/views/sessions/patient_specific_directions/show.html.erb
index 1f88295d09..4aa9d0b076 100644
--- a/app/views/sessions/patient_specific_directions/show.html.erb
+++ b/app/views/sessions/patient_specific_directions/show.html.erb
@@ -38,10 +38,10 @@
 
     <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
     <%= render AppSearchResultsComponent.new(@pagy, label: "children", heading: "Review PSDs") do %>
-      <% @patient_sessions.each do |patient_session| %>
+      <% @patient_locations.each do |patient_location| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
-              patient: patient_session.patient,
-              session: patient_session.session,
+              patient: patient_location.patient,
+              session: patient_location.session,
               context: :patient_specific_direction,
             ) %>
       <% end %>
diff --git a/app/views/sessions/patients/show.html.erb b/app/views/sessions/patients/show.html.erb
index b4c570e1f2..d4ea5a8005 100644
--- a/app/views/sessions/patients/show.html.erb
+++ b/app/views/sessions/patients/show.html.erb
@@ -22,10 +22,10 @@
   <div class="app-grid-column-results">
     <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
     <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-      <% @patient_sessions.each do |patient_session| %>
+      <% @patient_locations.each do |patient_location| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
-              patient: patient_session.patient,
-              session: patient_session.session,
+              patient: patient_location.patient,
+              session: patient_location.session,
               context: :patients,
               programmes: @form.programmes,
             ) %>
diff --git a/app/views/sessions/record/show.html.erb b/app/views/sessions/record/show.html.erb
index a84035a2c0..ff95b77896 100644
--- a/app/views/sessions/record/show.html.erb
+++ b/app/views/sessions/record/show.html.erb
@@ -24,10 +24,10 @@
       <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
       <%= render AppVaccinationsSummaryTableComponent.new(current_user:, session: @session, request_session: session) %>
       <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-        <% @patient_sessions.each do |patient_session| %>
+        <% @patient_locations.each do |patient_location| %>
           <%= render AppPatientSessionSearchResultCardComponent.new(
-                patient: patient_session.patient,
-                session: patient_session.session,
+                patient: patient_location.patient,
+                session: patient_location.session,
                 context: :record,
                 programmes: @form.programmes,
               ) %>
diff --git a/app/views/sessions/register/show.html.erb b/app/views/sessions/register/show.html.erb
index 2e61205792..ad98be5335 100644
--- a/app/views/sessions/register/show.html.erb
+++ b/app/views/sessions/register/show.html.erb
@@ -24,10 +24,10 @@
     <div class="app-grid-column-results">
       <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
       <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-        <% @patient_sessions.each do |patient_session| %>
+        <% @patient_locations.each do |patient_location| %>
           <%= render AppPatientSessionSearchResultCardComponent.new(
-                patient: patient_session.patient,
-                session: patient_session.session,
+                patient: patient_location.patient,
+                session: patient_location.session,
                 context: :register,
                 programmes: @form.programmes,
               ) %>
diff --git a/app/views/sessions/triage/show.html.erb b/app/views/sessions/triage/show.html.erb
index 9676d9a85f..a88df021fa 100644
--- a/app/views/sessions/triage/show.html.erb
+++ b/app/views/sessions/triage/show.html.erb
@@ -22,10 +22,10 @@
   <div class="app-grid-column-results">
     <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
     <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-      <% @patient_sessions.each do |patient_session| %>
+      <% @patient_locations.each do |patient_location| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
-              patient: patient_session.patient,
-              session: patient_session.session,
+              patient: patient_location.patient,
+              session: patient_location.session,
               context: :triage,
               programmes: @form.programmes,
             ) %>
diff --git a/db/migrate/20250909080957_rename_patient_session.rb b/db/migrate/20250909080957_rename_patient_session.rb
new file mode 100644
index 0000000000..1d2cdf1be9
--- /dev/null
+++ b/db/migrate/20250909080957_rename_patient_session.rb
@@ -0,0 +1,13 @@
+# frozen_string_literal: true
+
+class RenamePatientSession < ActiveRecord::Migration[8.0]
+  def change
+    rename_table :patient_sessions, :patient_locations
+
+    rename_table :immunisation_imports_patient_sessions,
+                 :immunisation_imports_patient_locations
+    rename_column :immunisation_imports_patient_locations,
+                  :patient_session_id,
+                  :patient_location_id
+  end
+end
diff --git a/db/schema.rb b/db/schema.rb
index 5af036ab1e..9a601887d7 100644
--- a/db/schema.rb
+++ b/db/schema.rb
@@ -358,10 +358,10 @@
     t.index ["uploaded_by_user_id"], name: "index_immunisation_imports_on_uploaded_by_user_id"
   end
 
-  create_table "immunisation_imports_patient_sessions", id: false, force: :cascade do |t|
+  create_table "immunisation_imports_patient_locations", id: false, force: :cascade do |t|
     t.bigint "immunisation_import_id", null: false
-    t.bigint "patient_session_id", null: false
-    t.index ["immunisation_import_id", "patient_session_id"], name: "idx_on_immunisation_import_id_patient_session_id_b5003c646e", unique: true
+    t.bigint "patient_location_id", null: false
+    t.index ["immunisation_import_id", "patient_location_id"], name: "idx_on_immunisation_import_id_patient_location_id_97ddfb7192", unique: true
   end
 
   create_table "immunisation_imports_patients", id: false, force: :cascade do |t|
@@ -536,6 +536,15 @@
     t.index ["status"], name: "index_patient_consent_statuses_on_status"
   end
 
+  create_table "patient_locations", force: :cascade do |t|
+    t.bigint "session_id", null: false
+    t.bigint "patient_id", null: false
+    t.datetime "created_at", null: false
+    t.datetime "updated_at", null: false
+    t.index ["patient_id", "session_id"], name: "index_patient_locations_on_patient_id_and_session_id", unique: true
+    t.index ["session_id"], name: "index_patient_locations_on_session_id"
+  end
+
   create_table "patient_registration_statuses", force: :cascade do |t|
     t.integer "status", default: 0, null: false
     t.bigint "patient_id", null: false
@@ -546,15 +555,6 @@
     t.index ["status"], name: "index_patient_registration_statuses_on_status"
   end
 
-  create_table "patient_sessions", force: :cascade do |t|
-    t.bigint "session_id", null: false
-    t.bigint "patient_id", null: false
-    t.datetime "created_at", null: false
-    t.datetime "updated_at", null: false
-    t.index ["patient_id", "session_id"], name: "index_patient_sessions_on_patient_id_and_session_id", unique: true
-    t.index ["session_id"], name: "index_patient_sessions_on_session_id"
-  end
-
   create_table "patient_specific_directions", force: :cascade do |t|
     t.bigint "created_by_user_id", null: false
     t.bigint "patient_id", null: false
@@ -1013,8 +1013,8 @@
   add_foreign_key "identity_checks", "vaccination_records", on_delete: :cascade
   add_foreign_key "immunisation_imports", "teams"
   add_foreign_key "immunisation_imports", "users", column: "uploaded_by_user_id"
-  add_foreign_key "immunisation_imports_patient_sessions", "immunisation_imports"
-  add_foreign_key "immunisation_imports_patient_sessions", "patient_sessions"
+  add_foreign_key "immunisation_imports_patient_locations", "immunisation_imports"
+  add_foreign_key "immunisation_imports_patient_locations", "patient_locations"
   add_foreign_key "immunisation_imports_patients", "immunisation_imports"
   add_foreign_key "immunisation_imports_patients", "patients"
   add_foreign_key "immunisation_imports_sessions", "immunisation_imports"
@@ -1037,10 +1037,10 @@
   add_foreign_key "patient_changesets", "patients"
   add_foreign_key "patient_consent_statuses", "patients", on_delete: :cascade
   add_foreign_key "patient_consent_statuses", "programmes"
+  add_foreign_key "patient_locations", "patients"
+  add_foreign_key "patient_locations", "sessions"
   add_foreign_key "patient_registration_statuses", "patients", on_delete: :cascade
   add_foreign_key "patient_registration_statuses", "sessions", on_delete: :cascade
-  add_foreign_key "patient_sessions", "patients"
-  add_foreign_key "patient_sessions", "sessions"
   add_foreign_key "patient_specific_directions", "patients"
   add_foreign_key "patient_specific_directions", "programmes"
   add_foreign_key "patient_specific_directions", "teams"
diff --git a/db/seeds.rb b/db/seeds.rb
index 47da84f57f..d5c481705b 100644
--- a/db/seeds.rb
+++ b/db/seeds.rb
@@ -170,9 +170,9 @@ def setup_clinic(team)
   # All patients belong to the community clinic. This is normally
   # handled by school moves, but here we need to do it manually.
 
-  PatientSession.import(
+  PatientLocation.import(
     team.patients.map do
-      PatientSession.new(patient: it, session: clinic_session)
+      PatientLocation.new(patient: it, session: clinic_session)
     end,
     on_duplicate_key_ignore: :all
   )
diff --git a/docs/ops-tasks.md b/docs/ops-tasks.md
index 758f648557..9e420ad3ae 100644
--- a/docs/ops-tasks.md
+++ b/docs/ops-tasks.md
@@ -13,7 +13,7 @@ session = org.sessions.find_by(location:)
 session.patients.count # get the number of patients
 
 # check all the patients can be safely removed from the session
-session.patient_sessions.all?(&:safe_to_destroy?)
+session.patient_locations.all?(&:safe_to_destroy?)
 
 # update all the patients to unknown school
 session.patients.update_all(
@@ -23,7 +23,7 @@ session.patients.update_all(
 )
 
 # removes all patients from the session
-session.patient_sessions.destroy_all
+session.patient_locations.destroy_all
 ```
 
 ## Add a patient from community clinic to school session
@@ -143,9 +143,9 @@ This can be done manually, and doesn't need a `SchoolMove`:
 
 ```rb
 # Check if the patient session in question is safe to be destroyed.
-patient.patient_sessions.first.safe_to_destroy?
+patient.patient_locations.first.safe_to_destroy?
 
-patient.patient_sessions.first.destroy
+patient.patient_locations.first.destroy
 
 patient.sessions << clinic_session
 ```
diff --git a/script/generate_model_office_data.rb b/script/generate_model_office_data.rb
index 0f60428b85..9836532a37 100644
--- a/script/generate_model_office_data.rb
+++ b/script/generate_model_office_data.rb
@@ -262,7 +262,7 @@ def create_students_and_vaccinations_for(school:, team:, year_size_estimate:)
       session_participants = [dose_1_cohort, dose_2_cohort].flatten.compact
 
       session_participants.filter_map do |student|
-        patient_session = PatientSession.create!(patient: student, session:)
+        patient_session = PatientLocation.create!(patient: student, session:)
 
         next if rand < 0.1 # assume 90% uptake
 
diff --git a/spec/components/app_activity_log_component_spec.rb b/spec/components/app_activity_log_component_spec.rb
index c63ec1cf6d..8e2194d1d6 100644
--- a/spec/components/app_activity_log_component_spec.rb
+++ b/spec/components/app_activity_log_component_spec.rb
@@ -35,7 +35,7 @@
     create(:parent_relationship, :father, parent: dad, patient:)
 
     create(
-      :patient_session,
+      :patient_location,
       patient:,
       session:,
       created_at: Time.zone.parse("2025-05-29 12:00")
diff --git a/spec/components/app_patient_session_table_component_spec.rb b/spec/components/app_patient_session_table_component_spec.rb
index e8d8cab403..80ed27f4ab 100644
--- a/spec/components/app_patient_session_table_component_spec.rb
+++ b/spec/components/app_patient_session_table_component_spec.rb
@@ -31,7 +31,7 @@
     # relative to the current academic year.
     let(:patient) { create(:patient, date_of_birth: Date.new(2011, 9, 1)) }
 
-    before { create_list(:patient_session, 1, patient:, session:) }
+    before { create_list(:patient_location, 1, patient:, session:) }
 
     it { should have_content("Location") }
     it { should have_content("Session dates") }
diff --git a/spec/components/app_patient_table_component_spec.rb b/spec/components/app_patient_table_component_spec.rb
index 35dfc988dd..f62862b78c 100644
--- a/spec/components/app_patient_table_component_spec.rb
+++ b/spec/components/app_patient_table_component_spec.rb
@@ -77,7 +77,7 @@
     let(:team) { current_user.selected_team }
     let(:session) { create(:session, team:) }
 
-    before { create(:patient_session, patient: patients.first, session:) }
+    before { create(:patient_location, patient: patients.first, session:) }
 
     it "renders links" do
       expect(rendered).to have_link("SMITH, John")
diff --git a/spec/components/app_session_needs_review_warning_component_spec.rb b/spec/components/app_session_needs_review_warning_component_spec.rb
index 6cd7a64a6e..fc20e9ce5b 100644
--- a/spec/components/app_session_needs_review_warning_component_spec.rb
+++ b/spec/components/app_session_needs_review_warning_component_spec.rb
@@ -26,7 +26,7 @@
         create(
           :patient,
           nhs_number: nil,
-          patient_sessions: [build(:patient_session, session:)],
+          patient_locations: [build(:patient_location, session:)],
           year_group: session.programmes.sample.default_year_groups.sample
         )
       end
diff --git a/spec/components/app_vaccination_record_table_component_spec.rb b/spec/components/app_vaccination_record_table_component_spec.rb
index 0fed305ebf..c1f4e1fee7 100644
--- a/spec/components/app_vaccination_record_table_component_spec.rb
+++ b/spec/components/app_vaccination_record_table_component_spec.rb
@@ -66,7 +66,7 @@
 
   context "with a vaccination record not performed by the team" do
     before do
-      vaccination_records.first.patient.patient_sessions.destroy_all
+      vaccination_records.first.patient.patient_locations.destroy_all
       vaccination_records.first.update!(
         session: nil,
         source: "historical_upload",
diff --git a/spec/controllers/api/testing/teams_controller_spec.rb b/spec/controllers/api/testing/teams_controller_spec.rb
index b7eb5b878a..e071ccc802 100644
--- a/spec/controllers/api/testing/teams_controller_spec.rb
+++ b/spec/controllers/api/testing/teams_controller_spec.rb
@@ -85,7 +85,7 @@
           .and(change(NotifyLogEntry, :count).by(-3))
           .and(change(Parent, :count).by(-4))
           .and(change(Patient, :count).by(-3))
-          .and(change(PatientSession, :count).by(-3))
+          .and(change(PatientLocation, :count).by(-3))
           .and(change(VaccinationRecord, :count).by(-9))
           .and(change(SessionDate, :count).by(-1))
       )
@@ -106,7 +106,7 @@
             .and(change(NotifyLogEntry, :count).by(-3))
             .and(change(Parent, :count).by(-4))
             .and(change(Patient, :count).by(-3))
-            .and(change(PatientSession, :count).by(-3))
+            .and(change(PatientLocation, :count).by(-3))
             .and(change(VaccinationRecord, :count).by(-9))
             .and(change(SessionDate, :count).by(-1))
         )
diff --git a/spec/factories/patient_sessions.rb b/spec/factories/patient_locations.rb
similarity index 71%
rename from spec/factories/patient_sessions.rb
rename to spec/factories/patient_locations.rb
index 7f791bc095..b93048c674 100644
--- a/spec/factories/patient_sessions.rb
+++ b/spec/factories/patient_locations.rb
@@ -2,7 +2,7 @@
 
 # == Schema Information
 #
-# Table name: patient_sessions
+# Table name: patient_locations
 #
 #  id         :bigint           not null, primary key
 #  created_at :datetime         not null
@@ -12,8 +12,8 @@
 #
 # Indexes
 #
-#  index_patient_sessions_on_patient_id_and_session_id  (patient_id,session_id) UNIQUE
-#  index_patient_sessions_on_session_id                 (session_id)
+#  index_patient_locations_on_patient_id_and_session_id  (patient_id,session_id) UNIQUE
+#  index_patient_locations_on_session_id                 (session_id)
 #
 # Foreign Keys
 #
@@ -21,7 +21,7 @@
 #  fk_rails_...  (session_id => sessions.id)
 #
 FactoryBot.define do
-  factory :patient_session do
+  factory :patient_location do
     transient { programmes { [association(:programme)] } }
 
     patient
diff --git a/spec/factories/patients.rb b/spec/factories/patients.rb
index f38f95fbba..97c75f6844 100644
--- a/spec/factories/patients.rb
+++ b/spec/factories/patients.rb
@@ -125,7 +125,7 @@
 
     after(:create) do |patient, evaluator|
       if evaluator.session
-        PatientSession.find_or_create_by!(patient:, session: evaluator.session)
+        PatientLocation.find_or_create_by!(patient:, session: evaluator.session)
       end
     end
 
diff --git a/spec/features/archive_vaccination_record_spec.rb b/spec/features/archive_vaccination_record_spec.rb
index f9eb2d0c2d..208702684a 100644
--- a/spec/features/archive_vaccination_record_spec.rb
+++ b/spec/features/archive_vaccination_record_spec.rb
@@ -136,8 +136,8 @@ def given_an_hpv_programme_is_underway
         team: @team
       )
 
-    @patient_session =
-      create(:patient_session, patient: @patient, session: @session)
+    @patient_location =
+      create(:patient_location, patient: @patient, session: @session)
   end
 
   def and_an_administered_vaccination_record_exists
diff --git a/spec/features/cli_generate_consents_spec.rb b/spec/features/cli_generate_consents_spec.rb
index f25e0ceb9c..42f330495c 100644
--- a/spec/features/cli_generate_consents_spec.rb
+++ b/spec/features/cli_generate_consents_spec.rb
@@ -56,7 +56,7 @@ def then_consents_are_created_with_the_given_statuses
 
     expect(
       @team
-        .patient_sessions
+        .patient_locations
         .has_consent_status(:given, programme: @programme)
         .has_triage_status(:not_required, programme: @programme)
         .count
diff --git a/spec/features/cli_schools_move_patients_spec.rb b/spec/features/cli_schools_move_patients_spec.rb
index 1d965f62a9..8ddb017163 100644
--- a/spec/features/cli_schools_move_patients_spec.rb
+++ b/spec/features/cli_schools_move_patients_spec.rb
@@ -52,11 +52,11 @@
   end
 
   context "when some patient sessions are not safe to destroy" do
-    let!(:patient_session) { create(:patient_session, patient:, session:) } # rubocop:disable RSpec/LetSetup
+    let!(:patient_location) { create(:patient_location, patient:, session:) } # rubocop:disable RSpec/LetSetup
 
     before do
       # rubocop:disable RSpec/AnyInstance
-      allow_any_instance_of(PatientSession).to receive(
+      allow_any_instance_of(PatientLocation).to receive(
         :safe_to_destroy?
       ).and_return(false)
       # rubocop:enable RSpec/AnyInstance
diff --git a/spec/features/cli_stats_consents_by_school_spec.rb b/spec/features/cli_stats_consents_by_school_spec.rb
index c0e0cfe06f..2b7f0b5a79 100644
--- a/spec/features/cli_stats_consents_by_school_spec.rb
+++ b/spec/features/cli_stats_consents_by_school_spec.rb
@@ -111,9 +111,9 @@ def given_organisation_has_consent_data
         session: session_prev_year
       )
 
-    create(:patient_session, session: session1, patient: patient1)
-    create(:patient_session, session: session2, patient: patient2)
-    create(:patient_session, session: session3, patient: patient3)
+    create(:patient_location, session: session1, patient: patient1)
+    create(:patient_location, session: session2, patient: patient2)
+    create(:patient_location, session: session3, patient: patient3)
 
     create(
       :consent,
diff --git a/spec/features/cli_stats_organisations_spec.rb b/spec/features/cli_stats_organisations_spec.rb
index 2b34480558..1f450d4a9a 100644
--- a/spec/features/cli_stats_organisations_spec.rb
+++ b/spec/features/cli_stats_organisations_spec.rb
@@ -145,7 +145,7 @@ def given_organisation_has_complete_data_with_filters
     )
     create(:patient, :consent_no_response, year_group: 11, session: session1)
 
-    create(:patient_session, patient: patient_year_9, session: session1)
+    create(:patient_location, patient: patient_year_9, session: session1)
     create(
       :consent,
       :refused,
@@ -154,7 +154,7 @@ def given_organisation_has_complete_data_with_filters
     )
 
     create(
-      :patient_session,
+      :patient_location,
       patient: patient_year_8,
       session: session_last_year
     )
diff --git a/spec/features/download_vaccination_reports_spec.rb b/spec/features/download_vaccination_reports_spec.rb
index 9ac6e35e5e..7b81f6ed44 100644
--- a/spec/features/download_vaccination_reports_spec.rb
+++ b/spec/features/download_vaccination_reports_spec.rb
@@ -75,8 +75,8 @@ def given_an_hpv_programme_is_underway
         team: @team
       )
 
-    @patient_session =
-      create(:patient_session, patient: @patient, session: @session)
+    @patient_location =
+      create(:patient_location, patient: @patient, session: @session)
   end
 
   def given_a_menacwy_programme_is_underway
@@ -95,8 +95,8 @@ def given_a_menacwy_programme_is_underway
         team: @team
       )
 
-    @patient_session =
-      create(:patient_session, patient: @patient, session: @session)
+    @patient_location =
+      create(:patient_location, patient: @patient, session: @session)
   end
 
   def and_an_administered_vaccination_record_exists
diff --git a/spec/features/import_vaccination_records_with_duplicates_spec.rb b/spec/features/import_vaccination_records_with_duplicates_spec.rb
index 88e35808c5..c8a1a8d642 100644
--- a/spec/features/import_vaccination_records_with_duplicates_spec.rb
+++ b/spec/features/import_vaccination_records_with_duplicates_spec.rb
@@ -85,14 +85,14 @@ def and_an_existing_patient_record_exists
         address_postcode: "LE8 2DA",
         school: @location
       )
-    @patient_session =
+    @patient_location =
       create(
-        :patient_session,
+        :patient_location,
         patient: @already_vaccinated_patient,
         session: @session
       )
-    @third_patient_session =
-      create(:patient_session, patient: @third_patient, session: @session)
+    @third_patient_location =
+      create(:patient_location, patient: @third_patient, session: @session)
     @vaccine = @programme.vaccines.find_by(nivs_name: "Gardasil9")
     @other_vaccine = @programme.vaccines.find_by(nivs_name: "Cervarix")
     @batch = create(:batch, vaccine: @vaccine, name: "SomethingElse")
diff --git a/spec/features/programme_cohorts_spec.rb b/spec/features/programme_cohorts_spec.rb
index 635e3f3ac0..0782a4ad95 100644
--- a/spec/features/programme_cohorts_spec.rb
+++ b/spec/features/programme_cohorts_spec.rb
@@ -41,7 +41,7 @@ def and_there_are_patients_in_different_year_groups
     # To make it realistic we'll also add patients to clinics.
     Patient.find_each do |patient|
       create(
-        :patient_session,
+        :patient_location,
         patient:,
         session:
           @team.generic_clinic_session(academic_year: AcademicYear.current)
diff --git a/spec/forms/patient_search_form_spec.rb b/spec/forms/patient_search_form_spec.rb
index ead80a660b..c8485df99e 100644
--- a/spec/forms/patient_search_form_spec.rb
+++ b/spec/forms/patient_search_form_spec.rb
@@ -350,7 +350,7 @@
   end
 
   context "for patient sessions" do
-    let(:scope) { PatientSession.all }
+    let(:scope) { PatientLocation.all }
 
     let(:session) { create(:session, programmes:, team:) }
 
@@ -376,20 +376,20 @@
       context "with a patient session eligible for the programme" do
         let(:patient) { create(:patient, year_group: 9) }
 
-        let(:patient_session) { create(:patient_session, patient:, session:) }
+        let(:patient_location) { create(:patient_location, patient:, session:) }
 
         it "is included" do
-          expect(form.apply(scope)).to include(patient_session)
+          expect(form.apply(scope)).to include(patient_location)
         end
       end
 
       context "with a patient session not eligible for the programme" do
         let(:patient) { create(:patient, year_group: 8) }
 
-        let(:patient_session) { create(:patient_session, patient:, session:) }
+        let(:patient_location) { create(:patient_location, patient:, session:) }
 
         it "is not included" do
-          expect(form.apply(scope)).not_to include(patient_session)
+          expect(form.apply(scope)).not_to include(patient_location)
         end
       end
     end
@@ -414,8 +414,8 @@
         patient_refused = create(:patient, :consent_refused, session:)
 
         expect(form.apply(scope)).to contain_exactly(
-          patient_given.patient_sessions.first,
-          patient_refused.patient_sessions.first
+          patient_given.patient_locations.first,
+          patient_refused.patient_locations.first
         )
       end
 
@@ -423,12 +423,12 @@
         let(:consent_statuses) { %w[given_nasal] }
 
         it "filters on consent status" do
-          patient_session_given_nasal =
+          patient_location_given_nasal =
             create(
               :patient,
               :consent_given_nasal_only_triage_not_needed,
               session:
-            ).patient_sessions.first
+            ).patient_locations.first
 
           create(
             :patient,
@@ -437,7 +437,7 @@
           )
 
           expect(form.apply(scope)).to contain_exactly(
-            patient_session_given_nasal
+            patient_location_given_nasal
           )
         end
       end
@@ -457,8 +457,8 @@
 
       it "filters on register status" do
         patient = create(:patient, :in_attendance, session:)
-        patient_session = patient.patient_sessions.first
-        expect(form.apply(scope)).to include(patient_session)
+        patient_location = patient.patient_locations.first
+        expect(form.apply(scope)).to include(patient_location)
       end
     end
 
@@ -477,9 +477,9 @@
 
       it "filters on triage status" do
         patient = create(:patient, :consent_given_triage_needed, session:)
-        patient_session = patient.patient_sessions.first
+        patient_location = patient.patient_locations.first
 
-        expect(form.apply(scope)).to include(patient_session)
+        expect(form.apply(scope)).to include(patient_location)
       end
     end
 
@@ -496,24 +496,28 @@
       let(:triage_status) { nil }
       let(:year_groups) { nil }
 
-      let!(:patient_session_with_psd) do
-        create(:patient_session, session:).tap do |patient_session|
+      let!(:patient_location_with_psd) do
+        create(:patient_location, session:).tap do |patient_location|
           create(
             :patient_specific_direction,
-            patient: patient_session.patient,
+            patient: patient_location.patient,
             programme: programmes.first,
             team:
           )
         end
       end
 
-      let!(:patient_session_without_psd) { create(:patient_session, session:) }
+      let!(:patient_location_without_psd) do
+        create(:patient_location, session:)
+      end
 
       context "when status is 'added'" do
         let(:patient_specific_direction_status) { "added" }
 
         it "finds the patient with the PSD" do
-          expect(form.apply(scope)).to contain_exactly(patient_session_with_psd)
+          expect(form.apply(scope)).to contain_exactly(
+            patient_location_with_psd
+          )
         end
       end
 
@@ -522,7 +526,7 @@
 
         it "finds the patient that has no PSD" do
           expect(form.apply(scope)).to contain_exactly(
-            patient_session_without_psd
+            patient_location_without_psd
           )
         end
       end
@@ -570,7 +574,7 @@
         )
 
         expect(form.apply(scope)).to contain_exactly(
-          nasal_patient.patient_sessions.first
+          nasal_patient.patient_locations.first
         )
       end
     end
diff --git a/spec/jobs/enqueue_clinic_session_invitations_job_spec.rb b/spec/jobs/enqueue_clinic_session_invitations_job_spec.rb
index 63fc459314..0a0971513a 100644
--- a/spec/jobs/enqueue_clinic_session_invitations_job_spec.rb
+++ b/spec/jobs/enqueue_clinic_session_invitations_job_spec.rb
@@ -11,7 +11,7 @@
   let(:patient) { create(:patient, parents:, year_group: 8) }
   let(:location) { create(:generic_clinic, team:) }
 
-  before { create(:patient_session, patient:, session:) }
+  before { create(:patient_location, patient:, session:) }
 
   context "for a scheduled clinic session in 3 weeks" do
     let(:date) { 3.weeks.from_now.to_date }
diff --git a/spec/jobs/patient_nhs_number_lookup_job_spec.rb b/spec/jobs/patient_nhs_number_lookup_job_spec.rb
index 92607ba75b..3e795cffbc 100644
--- a/spec/jobs/patient_nhs_number_lookup_job_spec.rb
+++ b/spec/jobs/patient_nhs_number_lookup_job_spec.rb
@@ -74,10 +74,10 @@
 
       let!(:existing_patient) { create(:patient, nhs_number: "9449306168") }
 
-      let(:patient_session) do
-        create(:patient_session, patient:, programmes: [programme])
+      let(:patient_location) do
+        create(:patient_location, patient:, programmes: [programme])
       end
-      let(:session) { patient_session.session }
+      let(:session) { patient_location.session }
       let(:gillick_assessment) do
         create(:gillick_assessment, :competent, patient:, session:)
       end
@@ -114,9 +114,9 @@
       context "when the existing patient is already in the session" do
         before do
           create(
-            :patient_session,
+            :patient_location,
             patient: existing_patient,
-            session: patient_session.session
+            session: patient_location.session
           )
         end
 
diff --git a/spec/jobs/send_automatic_school_consent_reminders_job_spec.rb b/spec/jobs/send_automatic_school_consent_reminders_job_spec.rb
index 894f80aa9e..5d0ba42cde 100644
--- a/spec/jobs/send_automatic_school_consent_reminders_job_spec.rb
+++ b/spec/jobs/send_automatic_school_consent_reminders_job_spec.rb
@@ -69,7 +69,7 @@
   end
 
   before do
-    patients.each { |patient| create(:patient_session, patient:, session:) }
+    patients.each { |patient| create(:patient_location, patient:, session:) }
     ConsentNotification.request.update_all(sent_at: dates.first - 1.week)
     ConsentNotification.reminder.update_all(sent_at: dates.first)
 
diff --git a/spec/jobs/send_manual_school_consent_reminders_job_spec.rb b/spec/jobs/send_manual_school_consent_reminders_job_spec.rb
index 372268d858..4be5a21d7a 100644
--- a/spec/jobs/send_manual_school_consent_reminders_job_spec.rb
+++ b/spec/jobs/send_manual_school_consent_reminders_job_spec.rb
@@ -42,7 +42,7 @@
 
   before do
     create(:parent_relationship, patient:, parent:)
-    create(:patient_session, patient:, session:, programmes:)
+    create(:patient_location, patient:, session:, programmes:)
     patient.reload
   end
 
diff --git a/spec/jobs/send_school_consent_requests_job_spec.rb b/spec/jobs/send_school_consent_requests_job_spec.rb
index 6cd7656ccc..a422973356 100644
--- a/spec/jobs/send_school_consent_requests_job_spec.rb
+++ b/spec/jobs/send_school_consent_requests_job_spec.rb
@@ -28,7 +28,7 @@
   end
 
   before do
-    patients.each { |patient| create(:patient_session, patient:, session:) }
+    patients.each { |patient| create(:patient_location, patient:, session:) }
   end
 
   around { |example| travel_to(today) { example.run } }
diff --git a/spec/jobs/send_school_session_reminders_job_spec.rb b/spec/jobs/send_school_session_reminders_job_spec.rb
index 873786af83..ccff0b242c 100644
--- a/spec/jobs/send_school_session_reminders_job_spec.rb
+++ b/spec/jobs/send_school_session_reminders_job_spec.rb
@@ -9,7 +9,7 @@
     create(:patient, :consent_given_triage_not_needed, parents:, programmes:)
   end
 
-  before { create(:patient_session, patient:, session:) }
+  before { create(:patient_location, patient:, session:) }
 
   context "for an active session tomorrow" do
     let(:session) { create(:session, :tomorrow, programmes:) }
diff --git a/spec/lib/patient_archiver_spec.rb b/spec/lib/patient_archiver_spec.rb
index 046ad667d0..965f0466a0 100644
--- a/spec/lib/patient_archiver_spec.rb
+++ b/spec/lib/patient_archiver_spec.rb
@@ -22,7 +22,7 @@
   context "when in upcoming sessions" do
     let(:session) { create(:session, :tomorrow, team:) }
 
-    before { create(:patient_session, patient:, session:) }
+    before { create(:patient_location, patient:, session:) }
 
     it "removes the patient from the sessions" do
       expect(patient.sessions).to include(session)
diff --git a/spec/lib/patient_merger_spec.rb b/spec/lib/patient_merger_spec.rb
index 41d426435b..2cefe5f772 100644
--- a/spec/lib/patient_merger_spec.rb
+++ b/spec/lib/patient_merger_spec.rb
@@ -58,8 +58,8 @@
     let(:parent_relationship) do
       create(:parent_relationship, patient: patient_to_destroy)
     end
-    let(:patient_session) do
-      create(:patient_session, session:, patient: patient_to_destroy)
+    let(:patient_location) do
+      create(:patient_location, session:, patient: patient_to_destroy)
     end
     let(:patient_specific_direction) do
       create(
@@ -162,7 +162,7 @@
     end
 
     it "moves patient sessions" do
-      expect { call }.to change { patient_session.reload.patient }.to(
+      expect { call }.to change { patient_location.reload.patient }.to(
         patient_to_keep
       )
     end
diff --git a/spec/lib/reports/offline_session_exporter_spec.rb b/spec/lib/reports/offline_session_exporter_spec.rb
index 251ef42c28..20a3de2efa 100644
--- a/spec/lib/reports/offline_session_exporter_spec.rb
+++ b/spec/lib/reports/offline_session_exporter_spec.rb
@@ -119,7 +119,7 @@ def validation_formula(worksheet:, column_name:, row: 1)
         let(:batch) do
           create(:batch, :not_expired, vaccine: programme.vaccines.active.first)
         end
-        let(:patient_session) { create(:patient_session, patient:, session:) }
+        let(:patient_location) { create(:patient_location, patient:, session:) }
         let(:patient) do
           create(:patient, year_group: programme.default_year_groups.first)
         end
@@ -225,7 +225,7 @@ def validation_formula(worksheet:, column_name:, row: 1)
         end
 
         context "with a vaccinated patient" do
-          before { create(:patient_session, patient:, session:) }
+          before { create(:patient_location, patient:, session:) }
 
           let!(:vaccination_record) do
             create(
@@ -340,7 +340,7 @@ def validation_formula(worksheet:, column_name:, row: 1)
         end
 
         context "with a vaccinated patient outside the session" do
-          before { create(:patient_session, patient:, session:) }
+          before { create(:patient_location, patient:, session:) }
 
           let!(:vaccination_record) do
             create(
@@ -430,8 +430,8 @@ def validation_formula(worksheet:, column_name:, row: 1)
           end
 
           before do
-            create(:patient_session, patient:, session:)
-            create(:patient_session, patient:, session: clinic_session)
+            create(:patient_location, patient:, session:)
+            create(:patient_location, patient:, session: clinic_session)
           end
 
           it "adds a row with the vaccination details" do
@@ -493,7 +493,7 @@ def validation_formula(worksheet:, column_name:, row: 1)
 
         context "with a vaccinated patient for a different programme" do
           before do
-            create(:patient_session, patient:, session:)
+            create(:patient_location, patient:, session:)
 
             other_programme = (Programme.types.keys - [programme.type]).sample
             create(
@@ -558,7 +558,7 @@ def validation_formula(worksheet:, column_name:, row: 1)
         end
 
         context "with a patient who couldn't be vaccinated" do
-          before { create(:patient_session, patient:, session:) }
+          before { create(:patient_location, patient:, session:) }
 
           let!(:vaccination_record) do
             create(
@@ -875,7 +875,7 @@ def validation_formula(worksheet:, column_name:, row: 1)
             )
           end
 
-          before { create(:patient_session, patient:, session:) }
+          before { create(:patient_location, patient:, session:) }
 
           it "adds a row to fill in" do
             expect(rows.count).to eq(1)
diff --git a/spec/lib/reports/programme_vaccinations_exporter_spec.rb b/spec/lib/reports/programme_vaccinations_exporter_spec.rb
index 996b83a4ec..dc80368500 100644
--- a/spec/lib/reports/programme_vaccinations_exporter_spec.rb
+++ b/spec/lib/reports/programme_vaccinations_exporter_spec.rb
@@ -211,7 +211,7 @@
         end
 
         context "with a vaccinated patient outside the date range" do
-          let(:patient) { create(:patient_session, session:).patient }
+          let(:patient) { create(:patient_location, session:).patient }
           let(:start_date) { Date.current }
 
           before do
@@ -230,7 +230,7 @@
         end
 
         context "with a vaccination for a different programme" do
-          let(:patient) { create(:patient_session, session:).patient }
+          let(:patient) { create(:patient_location, session:).patient }
 
           let(:other_programme) do
             create(
@@ -252,7 +252,7 @@
         end
 
         context "with a vaccinated patient that was updated in the date range" do
-          let(:patient) { create(:patient_session, session:).patient }
+          let(:patient) { create(:patient_location, session:).patient }
           let(:start_date) { 1.day.ago }
 
           before do
diff --git a/spec/lib/stats/consents_by_school_spec.rb b/spec/lib/stats/consents_by_school_spec.rb
index 862cb89968..0f2c4a14dd 100644
--- a/spec/lib/stats/consents_by_school_spec.rb
+++ b/spec/lib/stats/consents_by_school_spec.rb
@@ -21,7 +21,7 @@
 
     context "when there are consent responses" do
       before do
-        patient_session
+        patient_location
         consent
       end
 
@@ -37,7 +37,7 @@
       end
 
       let!(:patient) { create(:patient, team:) }
-      let(:patient_session) { create(:patient_session, session:, patient:) }
+      let(:patient_location) { create(:patient_location, session:, patient:) }
 
       let(:consent) do
         create(
@@ -169,7 +169,7 @@
     end
 
     context "when there are multiple consents for a patient" do
-      before { patient_session }
+      before { patient_location }
 
       let!(:session) do
         create(
@@ -183,8 +183,8 @@
       end
 
       let!(:patient) { create(:patient, team: team) }
-      let(:patient_session) do
-        create(:patient_session, session: session, patient: patient)
+      let(:patient_location) do
+        create(:patient_location, session: session, patient: patient)
       end
 
       let!(:flu_consent) do
diff --git a/spec/lib/status_generator/registration_spec.rb b/spec/lib/status_generator/registration_spec.rb
index 16e653fddb..242087a091 100644
--- a/spec/lib/status_generator/registration_spec.rb
+++ b/spec/lib/status_generator/registration_spec.rb
@@ -20,7 +20,7 @@
   let(:session) do
     create(:session, dates: [Date.yesterday, Date.current], programmes:)
   end
-  let(:patient_session) { create(:patient_session, patient:, session:) }
+  let(:patient_location) { create(:patient_location, patient:, session:) }
 
   describe "#status" do
     subject { generator.status }
diff --git a/spec/lib/status_generator/session_spec.rb b/spec/lib/status_generator/session_spec.rb
index d70f37da5e..e68fb4d5b5 100644
--- a/spec/lib/status_generator/session_spec.rb
+++ b/spec/lib/status_generator/session_spec.rb
@@ -3,8 +3,8 @@
 describe StatusGenerator::Session do
   subject(:generator) do
     described_class.new(
-      session_id: patient_session.session_id,
-      academic_year: patient_session.academic_year,
+      session_id: patient_location.session_id,
+      academic_year: patient_location.academic_year,
       attendance_record: patient.attendance_records.last,
       programme:,
       patient:,
@@ -14,14 +14,14 @@
     )
   end
 
-  let(:patient_session) { create(:patient_session, programmes: [programme]) }
+  let(:patient_location) { create(:patient_location, programmes: [programme]) }
   let(:programme) { create(:programme) }
 
   describe "#status" do
     subject(:status) { generator.status }
 
-    let(:patient) { patient_session.patient }
-    let(:session) { patient_session.session }
+    let(:patient) { patient_location.patient }
+    let(:session) { patient_location.session }
 
     context "with no vaccination record" do
       it { should be(:none_yet) }
@@ -90,8 +90,8 @@
 
     around { |example| travel_to(Time.zone.now) { example.run } }
 
-    let(:patient) { patient_session.patient }
-    let(:session) { patient_session.session }
+    let(:patient) { patient_location.patient }
+    let(:session) { patient_location.session }
     let(:performed_at) { 1.day.ago.beginning_of_minute }
     let(:created_at) { 2.days.ago.midday }
 
diff --git a/spec/lib/status_updater_spec.rb b/spec/lib/status_updater_spec.rb
index cb3ed7c6a4..16ff077716 100644
--- a/spec/lib/status_updater_spec.rb
+++ b/spec/lib/status_updater_spec.rb
@@ -5,7 +5,7 @@
 
   around { |example| travel_to(Date.new(2025, 7, 31)) { example.run } }
 
-  before { create(:patient_session, patient:, programmes:) }
+  before { create(:patient_location, patient:, programmes:) }
 
   context "with an HPV session and ineligible patient" do
     let(:programmes) { [create(:programme, :hpv)] }
diff --git a/spec/lib/tasks/status_update_spec.rb b/spec/lib/tasks/status_update_spec.rb
index 7ae92df287..0cea9d343d 100644
--- a/spec/lib/tasks/status_update_spec.rb
+++ b/spec/lib/tasks/status_update_spec.rb
@@ -4,7 +4,7 @@
   context "with all patients" do
     subject(:invoke) { Rake::Task["status:update:all"].invoke }
 
-    before { create(:patient_session) }
+    before { create(:patient_location) }
 
     after { Rake.application["status:update:all"].reenable }
 
@@ -25,7 +25,7 @@
 
     let(:patient) { create(:patient) }
 
-    before { create(:patient_session, patient:) }
+    before { create(:patient_location, patient:) }
 
     it "doesn't raise an error" do
       expect { invoke }.not_to raise_error
@@ -46,7 +46,7 @@
 
     let(:session) { create(:session) }
 
-    before { create(:patient_session, session:) }
+    before { create(:patient_location, session:) }
 
     it "doesn't raise an error" do
       expect { invoke }.not_to raise_error
diff --git a/spec/models/cohort_import_spec.rb b/spec/models/cohort_import_spec.rb
index a5403ef090..749de3a29b 100644
--- a/spec/models/cohort_import_spec.rb
+++ b/spec/models/cohort_import_spec.rb
@@ -403,7 +403,7 @@
 
       before do
         team.sessions.each do |session|
-          create(:patient_session, session:, patient: existing_patient)
+          create(:patient_location, session:, patient: existing_patient)
         end
       end
 
diff --git a/spec/models/immunisation_import_spec.rb b/spec/models/immunisation_import_spec.rb
index 6606c24455..7b18cb7e5b 100644
--- a/spec/models/immunisation_import_spec.rb
+++ b/spec/models/immunisation_import_spec.rb
@@ -143,7 +143,7 @@
           .and change(immunisation_import.vaccination_records, :count).by(11)
           .and change(immunisation_import.patients, :count).by(11)
           .and change(immunisation_import.batches, :count).by(4)
-          .and not_change(immunisation_import.patient_sessions, :count)
+          .and not_change(immunisation_import.patient_locations, :count)
 
         # Second import should not duplicate the vaccination records if they're
         # identical.
@@ -153,7 +153,7 @@
           .to not_change(immunisation_import, :processed_at)
           .and not_change(VaccinationRecord, :count)
           .and not_change(Patient, :count)
-          .and not_change(PatientSession, :count)
+          .and not_change(PatientLocation, :count)
           .and not_change(Batch, :count)
       end
 
@@ -197,7 +197,7 @@
           .and change(immunisation_import.vaccination_records, :count).by(11)
           .and change(immunisation_import.patients, :count).by(10)
           .and change(immunisation_import.batches, :count).by(8)
-          .and not_change(immunisation_import.patient_sessions, :count)
+          .and not_change(immunisation_import.patient_locations, :count)
 
         # Second import should not duplicate the vaccination records if they're
         # identical.
@@ -207,7 +207,7 @@
           .to not_change(immunisation_import, :processed_at)
           .and not_change(VaccinationRecord, :count)
           .and not_change(Patient, :count)
-          .and not_change(PatientSession, :count)
+          .and not_change(PatientLocation, :count)
           .and not_change(Batch, :count)
       end
 
@@ -257,7 +257,7 @@
           .and change(immunisation_import.vaccination_records, :count).by(4)
           .and change(immunisation_import.patients, :count).by(4)
           .and change(immunisation_import.batches, :count).by(1)
-          .and not_change(immunisation_import.patient_sessions, :count)
+          .and not_change(immunisation_import.patient_locations, :count)
 
         # Second import should not duplicate the vaccination records if they're
         # identical.
@@ -267,7 +267,7 @@
           .to not_change(immunisation_import, :processed_at)
           .and not_change(VaccinationRecord, :count)
           .and not_change(Patient, :count)
-          .and not_change(PatientSession, :count)
+          .and not_change(PatientLocation, :count)
           .and not_change(Batch, :count)
       end
     end
diff --git a/spec/models/patient/vaccination_status_spec.rb b/spec/models/patient/vaccination_status_spec.rb
index 1269e493df..b0bfb62f42 100644
--- a/spec/models/patient/vaccination_status_spec.rb
+++ b/spec/models/patient/vaccination_status_spec.rb
@@ -105,7 +105,7 @@
 
     before do
       patient.strict_loading!(false)
-      create(:patient_session, patient:, session:)
+      create(:patient_location, patient:, session:)
     end
 
     let(:session) { create(:session, programmes: [programme]) }
diff --git a/spec/models/patient_session_spec.rb b/spec/models/patient_location_spec.rb
similarity index 82%
rename from spec/models/patient_session_spec.rb
rename to spec/models/patient_location_spec.rb
index 10c12f8005..a255be577e 100644
--- a/spec/models/patient_session_spec.rb
+++ b/spec/models/patient_location_spec.rb
@@ -2,7 +2,7 @@
 
 # == Schema Information
 #
-# Table name: patient_sessions
+# Table name: patient_locations
 #
 #  id         :bigint           not null, primary key
 #  created_at :datetime         not null
@@ -12,8 +12,8 @@
 #
 # Indexes
 #
-#  index_patient_sessions_on_patient_id_and_session_id  (patient_id,session_id) UNIQUE
-#  index_patient_sessions_on_session_id                 (session_id)
+#  index_patient_locations_on_patient_id_and_session_id  (patient_id,session_id) UNIQUE
+#  index_patient_locations_on_session_id                 (session_id)
 #
 # Foreign Keys
 #
@@ -21,8 +21,8 @@
 #  fk_rails_...  (session_id => sessions.id)
 #
 
-describe PatientSession do
-  subject(:patient_session) { create(:patient_session, session:) }
+describe PatientLocation do
+  subject(:patient_location) { create(:patient_location, session:) }
 
   let(:programme) { create(:programme) }
   let(:session) { create(:session, programmes: [programme]) }
@@ -43,20 +43,20 @@
       let(:programmes) { create_list(:programme, 1, :td_ipv) }
       let(:session) { create(:session, programmes:) }
 
-      let(:patient_session) { create(:patient_session, patient:, session:) }
+      let(:patient_location) { create(:patient_location, patient:, session:) }
 
       it { should be_empty }
 
       context "in a session with the right year group" do
         let(:patient) { create(:patient, year_group: 9) }
 
-        it { should include(patient_session) }
+        it { should include(patient_location) }
       end
 
       context "in a session but the wrong year group" do
         let(:patient) { create(:patient, year_group: 8) }
 
-        it { should_not include(patient_session) }
+        it { should_not include(patient_location) }
       end
 
       context "in a session with the right year group for the programme but not the location" do
@@ -75,7 +75,7 @@
           end
         end
 
-        it { should_not include(patient_session) }
+        it { should_not include(patient_location) }
       end
     end
 
@@ -91,7 +91,7 @@
       let(:session) { create(:session, programmes:) }
       let(:academic_year) { Date.current.academic_year }
       let(:vaccine_method) { nil }
-      let(:patient_session) { patient.patient_sessions.first }
+      let(:patient_location) { patient.patient_locations.first }
 
       it { should be_empty }
 
@@ -100,7 +100,7 @@
           create(:patient, :consent_given_triage_not_needed, session:)
         end
 
-        it { should include(patient_session) }
+        it { should include(patient_location) }
       end
 
       context "when filtering on nasal spray" do
@@ -118,7 +118,7 @@
             ).update!(vaccine_methods: %w[nasal injection])
           end
 
-          it { should include(patient_session) }
+          it { should include(patient_location) }
 
           context "when the patient has been vaccinated for flu" do
             before do
@@ -131,7 +131,7 @@
               StatusUpdater.call(session:, patient:)
             end
 
-            it { should_not include(patient_session) }
+            it { should_not include(patient_location) }
           end
         end
       end
@@ -139,10 +139,10 @@
   end
 
   describe "#safe_to_destroy?" do
-    subject(:safe_to_destroy?) { patient_session.safe_to_destroy? }
+    subject(:safe_to_destroy?) { patient_location.safe_to_destroy? }
 
-    let(:patient_session) { create(:patient_session, session:) }
-    let(:patient) { patient_session.patient }
+    let(:patient_location) { create(:patient_location, session:) }
+    let(:patient) { patient_location.patient }
 
     context "when safe to destroy" do
       it { should be true }
diff --git a/spec/models/patient_spec.rb b/spec/models/patient_spec.rb
index 2f71102d67..f97c7519fc 100644
--- a/spec/models/patient_spec.rb
+++ b/spec/models/patient_spec.rb
@@ -173,16 +173,16 @@
         end
 
         before do
-          create(:patient_session, patient:, session: flu_session)
-          create(:patient_session, patient:, session: hpv_session)
+          create(:patient_location, patient:, session: flu_session)
+          create(:patient_location, patient:, session: hpv_session)
 
           create(
-            :patient_session,
+            :patient_location,
             patient: another_patient,
             session: flu_session
           )
           create(
-            :patient_session,
+            :patient_location,
             patient: another_patient,
             session: hpv_session
           )
@@ -275,16 +275,16 @@
         end
 
         before do
-          create(:patient_session, patient:, session: flu_session)
-          create(:patient_session, patient:, session: hpv_session)
+          create(:patient_location, patient:, session: flu_session)
+          create(:patient_location, patient:, session: hpv_session)
 
           create(
-            :patient_session,
+            :patient_location,
             patient: another_patient,
             session: flu_session
           )
           create(
-            :patient_session,
+            :patient_location,
             patient: another_patient,
             session: hpv_session
           )
@@ -896,7 +896,7 @@
           )
         end
 
-        before { create(:patient_session, patient:, session:) }
+        before { create(:patient_location, patient:, session:) }
 
         it "removes the patient from the session" do
           expect(session.patients).to include(patient)
@@ -1134,11 +1134,11 @@
         )
       end
 
-      before { create(:patient_session, patient: old_patient, session:) }
+      before { create(:patient_location, patient: old_patient, session:) }
 
       it "adds the new patient to any upcoming sessions" do
-        expect(new_patient.patient_sessions.size).to eq(1)
-        expect(new_patient.patient_sessions.first.session).to eq(session)
+        expect(new_patient.patient_locations.size).to eq(1)
+        expect(new_patient.patient_locations.first.session).to eq(session)
       end
     end
 
diff --git a/spec/policies/patient_policy_spec.rb b/spec/policies/patient_policy_spec.rb
index ed4e184f34..a3c4d7a8cc 100644
--- a/spec/policies/patient_policy_spec.rb
+++ b/spec/policies/patient_policy_spec.rb
@@ -38,12 +38,12 @@
 
       before do
         create(
-          :patient_session,
+          :patient_location,
           patient: patient_in_session,
           session: create(:session, team:, programmes:)
         )
         create(
-          :patient_session,
+          :patient_location,
           patient: patient_not_in_session,
           session: create(:session, team: another_team, programmes:)
         )

From 3ab34838e3ffa8979c0343c80233466d7d74d5fe Mon Sep 17 00:00:00 2001
From: Thomas Leese <thomas@leese.io>
Date: Wed, 10 Sep 2025 07:50:21 +0100
Subject: [PATCH 2/3] Remove session association on `PatientSession`

This reworks the `PatientLocation` model to no longer have a direct
association with a session and instead have a separate `location_id` and
`academic_year`, which represents the equivelant information since
that's all that is needed to get the sessions for the patient.

Jira-Issue: MAV-1822
---
 app/components/app_activity_log_component.rb  |  15 +-
 ...patient_pds_discrepancy_table_component.rb |   4 +-
 .../app_patient_programmes_table_component.rb |   3 +-
 .../app_programme_session_table_component.rb  |   5 +-
 .../app_session_actions_component.rb          |   9 +-
 .../app_session_details_summary_component.rb  |   5 +-
 ..._session_needs_review_warning_component.rb |   2 +-
 .../api/testing/teams_controller.rb           |   4 +-
 app/controllers/consent_forms_controller.rb   |   6 +-
 app/controllers/imports/issues_controller.rb  |   1 -
 .../patient_sessions/base_controller.rb       |   6 +-
 app/controllers/patients_controller.rb        |  18 ++-
 app/controllers/programmes/base_controller.rb |   5 +-
 .../sessions/consent_controller.rb            |   1 -
 .../patient_specific_directions_controller.rb |   2 +-
 .../sessions/patients_controller.rb           |   2 +-
 app/controllers/sessions/record_controller.rb |   7 +-
 .../sessions/register_controller.rb           |   2 +-
 app/controllers/sessions/triage_controller.rb |   1 -
 app/controllers/sessions_controller.rb        |   7 +-
 app/forms/patient_search_form.rb              |   4 +-
 ...end_school_consent_notification_concern.rb |   1 -
 .../enqueue_vaccinations_search_in_nhs_job.rb |  15 +-
 app/lib/clinic_patient_locations_factory.rb   |   5 +-
 app/lib/generate/vaccination_records.rb       |  90 ++++++-----
 app/lib/location_sessions_factory.rb          |  13 +-
 app/lib/mavis_cli/schools/move_patients.rb    |  13 +-
 app/lib/patient_merger.rb                     |   3 +-
 app/lib/stats/organisations.rb                |   6 +-
 app/lib/status_updater.rb                     |  25 ++--
 app/lib/team_sessions_factory.rb              |   4 +-
 app/models/class_import.rb                    |   4 +-
 app/models/immunisation_import_row.rb         |   4 +-
 app/models/location.rb                        |   1 +
 app/models/patient.rb                         |  54 ++++---
 app/models/patient_location.rb                | 140 +++++++++---------
 app/models/school_move.rb                     |  24 +--
 app/models/session.rb                         |  30 ++--
 app/models/team.rb                            |  12 +-
 app/policies/patient_policy.rb                |   4 +-
 app/policies/school_move_policy.rb            |  23 +--
 app/policies/vaccination_record_policy.rb     |  11 +-
 app/views/sessions/consent/show.html.erb      |   2 +-
 .../patient_specific_directions/show.html.erb |   2 +-
 app/views/sessions/patients/show.html.erb     |   2 +-
 app/views/sessions/record/show.html.erb       |   2 +-
 app/views/sessions/register/show.html.erb     |   2 +-
 app/views/sessions/triage/show.html.erb       |   2 +-
 ...e_patient_session_session_with_location.rb |  41 +++++
 db/schema.rb                                  |  11 +-
 db/seeds.rb                                   |  17 ++-
 spec/factories/patient_locations.rb           |  23 +--
 spec/factories/patients.rb                    |  10 +-
 spec/factories/sessions.rb                    |   7 +-
 spec/features/cli_generate_consents_spec.rb   |  14 +-
 ...port_child_pds_lookup_extravaganza_spec.rb |   9 +-
 spec/features/manage_children_spec.rb         |   2 +
 ...eue_vaccinations_search_in_nhs_job_spec.rb |   5 +-
 .../patient_nhs_number_lookup_job_spec.rb     |   9 +-
 ...anual_school_consent_reminders_job_spec.rb |   2 +-
 spec/lib/generate/vaccination_records_spec.rb |   2 +
 spec/lib/status_generator/session_spec.rb     |  20 +--
 spec/lib/status_updater_spec.rb               |   4 +-
 spec/models/cohort_import_spec.rb             |  12 +-
 spec/models/patient_location_spec.rb          |  25 ++--
 spec/models/patient_spec.rb                   |  53 +++----
 spec/models/session_spec.rb                   |   7 +-
 spec/policies/school_move_policy_spec.rb      |  34 +++++
 68 files changed, 500 insertions(+), 410 deletions(-)
 create mode 100644 db/migrate/20250909145402_replace_patient_session_session_with_location.rb
 create mode 100644 spec/policies/school_move_policy_spec.rb

diff --git a/app/components/app_activity_log_component.rb b/app/components/app_activity_log_component.rb
index 72b7b751b0..e0a914c2c0 100644
--- a/app/components/app_activity_log_component.rb
+++ b/app/components/app_activity_log_component.rb
@@ -66,9 +66,10 @@ def initialize(team:, patient:, session: nil)
     @patient_locations =
       @patient
         .patient_locations
-        .includes_programmes
-        .includes(session: :location)
-        .then { |scope| session ? scope.where(session:) : scope }
+        .includes(:location)
+        .then do |scope|
+          session ? scope.where(location: session.location) : scope
+        end
 
     @patient_specific_directions =
       @patient
@@ -347,14 +348,10 @@ def pre_screening_events
 
   def session_events
     patient_locations.map do |patient_location|
-      patient = patient_location.patient
-      session = patient_location.session
-
       [
         {
-          title: "Added to the session at #{session.location.name}",
-          at: patient_location.created_at,
-          programmes: session.programmes_for(patient:)
+          title: "Added to the session at #{patient_location.location.name}",
+          at: patient_location.created_at
         }
       ]
     end
diff --git a/app/components/app_patient_pds_discrepancy_table_component.rb b/app/components/app_patient_pds_discrepancy_table_component.rb
index d8d9738d8e..247fb2d9a5 100644
--- a/app/components/app_patient_pds_discrepancy_table_component.rb
+++ b/app/components/app_patient_pds_discrepancy_table_component.rb
@@ -12,9 +12,7 @@ def initialize(discrepancies:, current_user:)
 
   delegate :format_nhs_number, :govuk_table, to: :helpers
 
-  def can_link_to?(record)
-    allowed_ids.include?(record.id)
-  end
+  def can_link_to?(record) = allowed_ids.include?(record.id)
 
   def allowed_ids
     @allowed_ids ||= PatientPolicy::Scope.new(current_user, Patient).resolve.ids
diff --git a/app/components/app_patient_programmes_table_component.rb b/app/components/app_patient_programmes_table_component.rb
index 6c011b5b98..e2e8ccf29d 100644
--- a/app/components/app_patient_programmes_table_component.rb
+++ b/app/components/app_patient_programmes_table_component.rb
@@ -258,8 +258,7 @@ def vaccination_records_for(programme:, academic_year: nil)
   end
 
   def eligible_year_groups_for(programme:)
-    location_ids =
-      patient.patient_locations.joins(:session).select(:location_id)
+    location_ids = patient.patient_locations.select(:location_id)
 
     LocationProgrammeYearGroup
       .where(location_id: location_ids)
diff --git a/app/components/app_programme_session_table_component.rb b/app/components/app_programme_session_table_component.rb
index ec0b252b23..8ecb7aa4cc 100644
--- a/app/components/app_programme_session_table_component.rb
+++ b/app/components/app_programme_session_table_component.rb
@@ -53,10 +53,7 @@ def vaccinated_percentage(session:)
   end
 
   def patient_locations(session:)
-    session
-      .patient_locations
-      .joins(:patient, :session)
-      .appear_in_programmes([programme])
+    session.patient_locations.joins(:patient).appear_in_programmes([programme])
   end
 
   def format_number(count) = count.to_s
diff --git a/app/components/app_session_actions_component.rb b/app/components/app_session_actions_component.rb
index 3af1f7eec2..c79a3d52cf 100644
--- a/app/components/app_session_actions_component.rb
+++ b/app/components/app_session_actions_component.rb
@@ -20,10 +20,7 @@ def render? = rows.any?
   delegate :academic_year, :programmes, to: :session
 
   def patient_locations
-    session
-      .patient_locations
-      .joins(:patient, :session)
-      .appear_in_programmes(programmes)
+    session.patient_locations.joins(:patient).appear_in_programmes(programmes)
   end
 
   def rows
@@ -80,7 +77,7 @@ def register_attendance_row
     return nil unless session.requires_registration? && session.today?
 
     status = "unknown"
-    count = patient_locations.has_registration_status(status).count
+    count = patient_locations.has_registration_status(status, session:).count
     href = session_register_path(session, register_status: status)
 
     generate_row(:children_to_register, count:, href:)
@@ -92,7 +89,7 @@ def ready_for_vaccinator_row
     counts_by_programme =
       session.programmes.index_with do |programme|
         patient_locations
-          .has_registration_status(%w[attending completed])
+          .has_registration_status(%w[attending completed], session:)
           .includes(
             patient: %i[consent_statuses triage_statuses vaccination_statuses]
           )
diff --git a/app/components/app_session_details_summary_component.rb b/app/components/app_session_details_summary_component.rb
index e776f9dbf4..f1f176667b 100644
--- a/app/components/app_session_details_summary_component.rb
+++ b/app/components/app_session_details_summary_component.rb
@@ -17,10 +17,7 @@ def call
   delegate :programmes, to: :session
 
   def patient_locations
-    session
-      .patient_locations
-      .joins(:patient, :session)
-      .appear_in_programmes(programmes)
+    session.patient_locations.joins(:patient).appear_in_programmes(programmes)
   end
 
   def cohort_row
diff --git a/app/components/app_session_needs_review_warning_component.rb b/app/components/app_session_needs_review_warning_component.rb
index 2b5066db8b..7aae02f179 100644
--- a/app/components/app_session_needs_review_warning_component.rb
+++ b/app/components/app_session_needs_review_warning_component.rb
@@ -45,7 +45,7 @@ def make_row_from_warning(warning)
   def patient_locations
     @session
       .patient_locations
-      .joins(:patient, :session)
+      .joins(:patient)
       .appear_in_programmes(@session.programmes)
   end
 end
diff --git a/app/controllers/api/testing/teams_controller.rb b/app/controllers/api/testing/teams_controller.rb
index 9e91ecc6c4..3041075d73 100644
--- a/app/controllers/api/testing/teams_controller.rb
+++ b/app/controllers/api/testing/teams_controller.rb
@@ -28,7 +28,9 @@ def destroy
         patient_ids = team.patients.pluck(:id)
         consent_form_ids = team.consent_forms.pluck(:id)
 
-        log_destroy(PatientLocation.where(session: sessions))
+        log_destroy(
+          PatientLocation.where(location_id: sessions.select(:location_id))
+        )
 
         log_destroy(AccessLogEntry.where(patient_id: patient_ids))
         log_destroy(ArchiveReason.where(patient_id: patient_ids))
diff --git a/app/controllers/consent_forms_controller.rb b/app/controllers/consent_forms_controller.rb
index 85dbb28b3f..6f50912688 100644
--- a/app/controllers/consent_forms_controller.rb
+++ b/app/controllers/consent_forms_controller.rb
@@ -37,10 +37,11 @@ def update_match
 
     session =
       @patient
-        .pending_sessions
+        .sessions
         .includes(:location_programme_year_groups, :programmes)
         .has_programmes(@consent_form.programmes)
-        .first || @consent_form.original_session
+        .find_by(academic_year: AcademicYear.pending) ||
+        @consent_form.original_session
 
     programme = session.programmes_for(patient: @patient).first
 
@@ -136,7 +137,6 @@ def set_patient
     @patient =
       policy_scope(Patient).includes(
         parent_relationships: :parent,
-        pending_sessions: :programmes,
         vaccination_records: :programme
       ).find(params[:patient_id])
   end
diff --git a/app/controllers/imports/issues_controller.rb b/app/controllers/imports/issues_controller.rb
index c768c964da..684ba85de6 100644
--- a/app/controllers/imports/issues_controller.rb
+++ b/app/controllers/imports/issues_controller.rb
@@ -40,7 +40,6 @@ def set_import_issues
     @patients =
       policy_scope(Patient).with_pending_changes.includes(
         :gp_practice,
-        :pending_sessions,
         :school,
         :school_moves
       )
diff --git a/app/controllers/patient_sessions/base_controller.rb b/app/controllers/patient_sessions/base_controller.rb
index e247c8b6fd..35d4e04adb 100644
--- a/app/controllers/patient_sessions/base_controller.rb
+++ b/app/controllers/patient_sessions/base_controller.rb
@@ -36,7 +36,11 @@ def set_patient
 
   def set_patient_location
     @patient_location =
-      PatientLocation.find_by!(patient: @patient, session: @session)
+      PatientLocation.find_by!(
+        patient: @patient,
+        location: @session.location,
+        academic_year: @session.academic_year
+      )
   end
 
   def set_programme
diff --git a/app/controllers/patients_controller.rb b/app/controllers/patients_controller.rb
index 850efd6827..41ace8abdd 100644
--- a/app/controllers/patients_controller.rb
+++ b/app/controllers/patients_controller.rb
@@ -26,10 +26,11 @@ def edit
   end
 
   def invite_to_clinic
-    session =
-      current_team.generic_clinic_session(academic_year: AcademicYear.pending)
-
-    PatientLocation.find_or_create_by!(patient: @patient, session:)
+    PatientLocation.find_or_create_by!(
+      patient: @patient,
+      location: current_team.generic_clinic,
+      academic_year: AcademicYear.pending
+    )
 
     redirect_to patient_path(@patient),
                 flash: {
@@ -46,15 +47,16 @@ def set_patient
         :school,
         consents: %i[parent patient],
         parent_relationships: :parent,
-        sessions: :location,
         vaccination_records: :programme
       ).find(params[:id])
   end
 
   def set_in_generic_clinic
-    generic_clinic_session =
-      current_team.generic_clinic_session(academic_year: AcademicYear.pending)
-    @in_generic_clinic = @patient.sessions.include?(generic_clinic_session)
+    @in_generic_clinic =
+      @patient.patient_locations.exists?(
+        location: current_team.generic_clinic,
+        academic_year: AcademicYear.pending
+      )
   end
 
   def record_access_log_entry
diff --git a/app/controllers/programmes/base_controller.rb b/app/controllers/programmes/base_controller.rb
index 0aacc493c4..0e73d2fcf8 100644
--- a/app/controllers/programmes/base_controller.rb
+++ b/app/controllers/programmes/base_controller.rb
@@ -24,8 +24,9 @@ def patient_ids
     @patient_ids ||=
       PatientLocation
         .distinct
-        .joins(:patient, :session)
-        .where(session_id: session_ids)
+        .joins(:patient)
+        .joins_sessions
+        .where("sessions.id IN (?)", session_ids)
         .appear_in_programmes([@programme])
         .not_archived(team: current_team)
         .pluck(:patient_id)
diff --git a/app/controllers/sessions/consent_controller.rb b/app/controllers/sessions/consent_controller.rb
index 4dbf089c96..83fe3e1aad 100644
--- a/app/controllers/sessions/consent_controller.rb
+++ b/app/controllers/sessions/consent_controller.rb
@@ -28,7 +28,6 @@ def show
     scope =
       @session
         .patient_locations
-        .includes_programmes
         .includes(patient: [:consent_statuses, { notes: :created_by }])
         .has_consent_status(
           statuses_except_not_required,
diff --git a/app/controllers/sessions/patient_specific_directions_controller.rb b/app/controllers/sessions/patient_specific_directions_controller.rb
index b6da1d0471..1347a71773 100644
--- a/app/controllers/sessions/patient_specific_directions_controller.rb
+++ b/app/controllers/sessions/patient_specific_directions_controller.rb
@@ -10,7 +10,7 @@ class Sessions::PatientSpecificDirectionsController < ApplicationController
 
   def show
     scope =
-      @session.patient_locations.includes_programmes.includes(
+      @session.patient_locations.includes(
         patient: {
           patient_specific_directions: :programme
         }
diff --git a/app/controllers/sessions/patients_controller.rb b/app/controllers/sessions/patients_controller.rb
index 538063ac00..3b41de97ef 100644
--- a/app/controllers/sessions/patients_controller.rb
+++ b/app/controllers/sessions/patients_controller.rb
@@ -12,7 +12,7 @@ def show
     @statuses = Patient::VaccinationStatus.statuses.keys
 
     scope =
-      @session.patient_locations.includes_programmes.includes(
+      @session.patient_locations.includes(
         patient: [:vaccination_statuses, { notes: :created_by }]
       )
 
diff --git a/app/controllers/sessions/record_controller.rb b/app/controllers/sessions/record_controller.rb
index 3f99f7c5fd..263ca42d61 100644
--- a/app/controllers/sessions/record_controller.rb
+++ b/app/controllers/sessions/record_controller.rb
@@ -25,7 +25,11 @@ def show
       )
 
     if @session.requires_registration?
-      scope = scope.has_registration_status(%w[attending completed])
+      scope =
+        scope.has_registration_status(
+          %w[attending completed],
+          session: @session
+        )
     end
 
     patient_locations =
@@ -33,6 +37,7 @@ def show
         @form.apply(scope)
       ).consent_given_and_ready_to_vaccinate(
         programmes: @form.programmes,
+        academic_year: @session.academic_year,
         vaccine_method: @form.vaccine_method.presence
       )
 
diff --git a/app/controllers/sessions/register_controller.rb b/app/controllers/sessions/register_controller.rb
index 1e473d006f..3c86885616 100644
--- a/app/controllers/sessions/register_controller.rb
+++ b/app/controllers/sessions/register_controller.rb
@@ -14,7 +14,7 @@ def show
     @statuses = Patient::RegistrationStatus.statuses.keys
 
     scope =
-      @session.patient_locations.includes_programmes.includes(
+      @session.patient_locations.includes(
         patient: [
           :consent_statuses,
           :registration_statuses,
diff --git a/app/controllers/sessions/triage_controller.rb b/app/controllers/sessions/triage_controller.rb
index c37eb46705..959bc497a1 100644
--- a/app/controllers/sessions/triage_controller.rb
+++ b/app/controllers/sessions/triage_controller.rb
@@ -14,7 +14,6 @@ def show
     scope =
       @session
         .patient_locations
-        .includes_programmes
         .includes(patient: [:triage_statuses, { notes: :created_by }])
         .has_triage_status(@statuses, programme: @form.programmes)
 
diff --git a/app/controllers/sessions_controller.rb b/app/controllers/sessions_controller.rb
index 92960ffbdb..81f0f532e0 100644
--- a/app/controllers/sessions_controller.rb
+++ b/app/controllers/sessions_controller.rb
@@ -18,10 +18,11 @@ def index
 
     @patient_count_by_session_id =
       PatientLocation
-        .where(session_id: sessions.map(&:id))
-        .joins(:patient, :session)
+        .joins_sessions
+        .where("sessions.id IN (?)", sessions.pluck(:id))
+        .joins(:patient)
         .appear_in_programmes(@programmes)
-        .group(:session_id)
+        .group("sessions.id")
         .count
 
     @pagy, @sessions = pagy_array(sessions)
diff --git a/app/forms/patient_search_form.rb b/app/forms/patient_search_form.rb
index 25a22b7301..b5ab4586dd 100644
--- a/app/forms/patient_search_form.rb
+++ b/app/forms/patient_search_form.rb
@@ -129,7 +129,7 @@ def filter_nhs_number(scope)
   def filter_programmes(scope)
     if programmes.present?
       if @session
-        scope.joins(:patient, :session).appear_in_programmes(programmes)
+        scope.joins(:patient).appear_in_programmes(programmes)
       else
         scope.appear_in_programmes(programmes, academic_year:)
       end
@@ -218,7 +218,7 @@ def filter_patient_specific_direction_status(scope)
 
   def filter_register_status(scope)
     if (status = register_status&.to_sym).present?
-      scope.has_registration_status(status)
+      scope.has_registration_status(status, session: @session)
     else
       scope
     end
diff --git a/app/jobs/concerns/send_school_consent_notification_concern.rb b/app/jobs/concerns/send_school_consent_notification_concern.rb
index caaecf6584..c297e1985d 100644
--- a/app/jobs/concerns/send_school_consent_notification_concern.rb
+++ b/app/jobs/concerns/send_school_consent_notification_concern.rb
@@ -10,7 +10,6 @@ def patient_programmes_eligible_for_notification(session:)
 
     session
       .patient_locations
-      .includes_programmes
       .includes(patient: %i[consent_notifications consents vaccination_records])
       .find_each do |patient_location|
         patient = patient_location.patient
diff --git a/app/jobs/enqueue_vaccinations_search_in_nhs_job.rb b/app/jobs/enqueue_vaccinations_search_in_nhs_job.rb
index 5fbba861fa..e52c3937d5 100644
--- a/app/jobs/enqueue_vaccinations_search_in_nhs_job.rb
+++ b/app/jobs/enqueue_vaccinations_search_in_nhs_job.rb
@@ -4,8 +4,10 @@ class EnqueueVaccinationsSearchInNHSJob < ApplicationJob
   queue_as :immunisations_api
 
   def perform(sessions = nil)
-    sessions ||=
-      begin
+    scope =
+      if sessions
+        Session.where(id: sessions.map(&:id))
+      else
         flu = Programme.flu.sole
         Session
           .includes(:session_dates)
@@ -15,10 +17,11 @@ def perform(sessions = nil)
           .references(:session_dates)
       end
 
-    patient_ids = PatientLocation.where(session: sessions).pluck(:patient_id)
+    scope.find_each do |session|
+      ids = session.patients.pluck(:id)
+      next if ids.empty?
 
-    return if patient_ids.empty?
-
-    SearchVaccinationRecordsInNHSJob.perform_bulk(patient_ids.zip)
+      SearchVaccinationRecordsInNHSJob.perform_bulk(ids.zip)
+    end
   end
 end
diff --git a/app/lib/clinic_patient_locations_factory.rb b/app/lib/clinic_patient_locations_factory.rb
index e32f1ea434..ef81d452e9 100644
--- a/app/lib/clinic_patient_locations_factory.rb
+++ b/app/lib/clinic_patient_locations_factory.rb
@@ -21,9 +21,10 @@ def patient_locations_to_create
            programmes:,
            session_date:
          )
-        PatientLocation.includes(:session_notifications).find_or_initialize_by(
+        PatientLocation.new(
           patient:,
-          session: generic_clinic_session
+          academic_year: generic_clinic_session.academic_year,
+          location: generic_clinic_session.location
         )
       end
     end
diff --git a/app/lib/generate/vaccination_records.rb b/app/lib/generate/vaccination_records.rb
index bac14d456a..f806cd99ce 100644
--- a/app/lib/generate/vaccination_records.rb
+++ b/app/lib/generate/vaccination_records.rb
@@ -8,9 +8,7 @@ def initialize(team:, programme: nil, session: nil, administered: nil)
     @administered = administered
   end
 
-  def call
-    create_vaccinations
-  end
+  def call = create_vaccinations
 
   def self.call(...) = new(...).call
 
@@ -22,34 +20,34 @@ def create_vaccinations
     attendance_records = []
     vaccination_records = []
 
-    random_patient_locations.each do |patient_location|
-      patient = patient_location.patient
-      session = patient_location.session
+    sessions.each do |session|
+      location = session.location
+
+      random_patients_for(session:).each do |patient|
+        unless AttendanceRecord.exists?(patient:, location:)
+          attendance_records << FactoryBot.build(
+            :attendance_record,
+            :present,
+            patient:,
+            session:
+          )
+        end
+
+        location_name = location.name if session.clinic?
 
-      unless AttendanceRecord.exists?(patient:, location: session.location)
-        attendance_records << FactoryBot.build(
-          :attendance_record,
-          :present,
+        vaccination_records << FactoryBot.build(
+          :vaccination_record,
+          :administered,
           patient:,
-          session:
+          programme:,
+          team:,
+          performed_by:,
+          session:,
+          vaccine:,
+          batch:,
+          location_name:
         )
       end
-
-      location_name =
-        patient_location.location.name if patient_location.session.clinic?
-
-      vaccination_records << FactoryBot.build(
-        :vaccination_record,
-        :administered,
-        patient: patient_location.patient,
-        programme:,
-        team:,
-        performed_by:,
-        session: patient_location.session,
-        vaccine:,
-        batch:,
-        location_name:
-      )
     end
 
     AttendanceRecord.import!(attendance_records)
@@ -58,9 +56,9 @@ def create_vaccinations
     StatusUpdater.call(patient: vaccination_records.map(&:patient))
   end
 
-  def random_patient_locations
+  def random_patients_for(session:)
     if administered&.positive?
-      patient_locations
+      patients_for(session:)
         .sample(administered)
         .tap do |selected|
           if selected.size < administered
@@ -70,27 +68,27 @@ def random_patient_locations
           end
         end
     else
-      patient_locations
+      patients_for(session:)
     end
   end
 
-  def patient_locations
-    (session.presence || team)
-      .patient_locations
-      .joins(:patient)
-      .includes(
-        :session,
-        :location,
-        session: :session_dates,
-        patient: %i[consent_statuses vaccination_statuses triage_statuses]
-      )
-      .appear_in_programmes([programme])
-      .has_consent_status("given", programme:)
+  def sessions
+    (
+      @sessions ||=
+        session ? [session] : team.sessions.includes(:location, :session_dates)
+    )
+  end
+
+  def patients_for(session:)
+    academic_year = session.academic_year
+
+    session
+      .patients
+      .includes(:consent_statuses, :vaccination_statuses, :triage_statuses)
+      .appear_in_programmes([programme], academic_year:)
+      .has_consent_status("given", programme:, academic_year:)
       .select do
-        it.patient.consent_given_and_safe_to_vaccinate?(
-          programme:,
-          academic_year: it.session.academic_year
-        )
+        it.consent_given_and_safe_to_vaccinate?(programme:, academic_year:)
       end
   end
 
diff --git a/app/lib/location_sessions_factory.rb b/app/lib/location_sessions_factory.rb
index 97210c92c0..483a17d573 100644
--- a/app/lib/location_sessions_factory.rb
+++ b/app/lib/location_sessions_factory.rb
@@ -9,17 +9,16 @@ def initialize(location, academic_year:)
   def call
     ActiveRecord::Base.transaction do
       if location.generic_clinic?
-        add_patients!(
-          session: find_or_create_session!(programmes: location.programmes)
-        )
+        find_or_create_session!(programmes: location.programmes)
       else
         ProgrammeGrouper
           .call(location.programmes)
           .values
           .reject { |programmes| already_exists?(programmes:) }
           .map { |programmes| create_session!(programmes:) }
-          .each { |session| add_patients!(session:) }
       end
+
+      add_patients!
     end
   end
 
@@ -55,10 +54,10 @@ def find_or_create_session!(programmes:)
       end
   end
 
-  def add_patients!(session:)
+  def add_patients!
     PatientLocation.import!(
-      %i[patient_id session_id],
-      patient_ids.map { [it, session.id] },
+      %i[patient_id location_id academic_year],
+      patient_ids.map { [it, location.id, academic_year] },
       on_duplicate_key_ignore: true
     )
   end
diff --git a/app/lib/mavis_cli/schools/move_patients.rb b/app/lib/mavis_cli/schools/move_patients.rb
index 43312fdda4..c8289cb5e4 100644
--- a/app/lib/mavis_cli/schools/move_patients.rb
+++ b/app/lib/mavis_cli/schools/move_patients.rb
@@ -11,6 +11,8 @@ class MovePatients < Dry::CLI::Command
       def call(source_urn:, target_urn:)
         MavisCLI.load_rails
 
+        academic_year = AcademicYear.pending
+
         old_loc = Location.school.find_by_urn_and_site(source_urn)
         new_loc = Location.school.find_by_urn_and_site(target_urn)
 
@@ -20,14 +22,13 @@ def call(source_urn:, target_urn:)
         end
 
         unless PatientLocation
-                 .joins(:patient, :session)
+                 .joins(:patient)
                  .where(
                    patient: {
                      school: old_loc
                    },
-                   session: {
-                     location: old_loc
-                   }
+                   academic_year:,
+                   location: old_loc
                  )
                  .all?(&:safe_to_destroy?)
           raise "Some patient sessions at #{old_loc.urn} are not safe to destroy. Cannot complete transfer."
@@ -42,6 +43,10 @@ def call(source_urn:, target_urn:)
           location_id: new_loc.id
         )
         Patient.where(school_id: old_loc.id).update_all(school_id: new_loc.id)
+        PatientLocation.where(
+          academic_year:,
+          location_id: old_loc.id
+        ).update_all(location_id: new_loc.id)
         ConsentForm.where(location_id: old_loc.id).update_all(
           location_id: new_loc.id
         )
diff --git a/app/lib/patient_merger.rb b/app/lib/patient_merger.rb
index ae96097a5a..f8b21acf26 100644
--- a/app/lib/patient_merger.rb
+++ b/app/lib/patient_merger.rb
@@ -102,7 +102,8 @@ def call
 
       patient_to_destroy.patient_locations.each do |patient_location|
         if patient_to_keep.patient_locations.exists?(
-             session_id: patient_location.session_id
+             academic_year: patient_location.academic_year,
+             location_id: patient_location.location_id
            )
           next
         end
diff --git a/app/lib/stats/organisations.rb b/app/lib/stats/organisations.rb
index df907af5d9..da08fbb8a6 100644
--- a/app/lib/stats/organisations.rb
+++ b/app/lib/stats/organisations.rb
@@ -20,7 +20,11 @@ def self.call(...) = new(...).call
   attr_reader :organisation, :teams, :programmes, :academic_year, :patients
 
   def build_patients_scope
-    Patient.joins(:teams).where(teams: { id: teams.pluck(:id) }).distinct
+    Patient.distinct.joins_sessions.where(
+      sessions: {
+        team_id: teams.map(&:id)
+      }
+    )
   end
 
   def calculate_organisation_stats
diff --git a/app/lib/status_updater.rb b/app/lib/status_updater.rb
index b85c0625dd..6e33e4cc78 100644
--- a/app/lib/status_updater.rb
+++ b/app/lib/status_updater.rb
@@ -2,10 +2,15 @@
 
 class StatusUpdater
   def initialize(patient: nil, session: nil)
-    scope = PatientLocation
+    scope = PatientLocation.joins_sessions
 
     scope = scope.where(patient:) if patient
-    scope = scope.where(session:) if session
+
+    if session.is_a?(Session)
+      scope = scope.where(sessions: { id: session.id })
+    elsif session
+      scope = scope.where(sessions: { id: session.pluck(:id) })
+    end
 
     @patient_locations = scope
   end
@@ -57,8 +62,8 @@ def update_registration_statuses!
 
     Patient::RegistrationStatus
       .where(
-        patient: patient_locations.select(:patient_id),
-        session: patient_locations.select(:session_id)
+        "(patient_id, session_id) IN (?)",
+        patient_locations.select("patient_id", "sessions.id")
       )
       .includes(
         :patient,
@@ -166,13 +171,13 @@ def vaccination_statuses_to_import
 
   def patient_location_statuses_to_import
     patient_locations
-      .joins(:patient, :session)
+      .joins(:patient)
       .pluck(
-        :"patients.id",
-        :"sessions.id",
-        :"sessions.location_id",
-        :"sessions.academic_year",
-        :"patients.birth_academic_year"
+        "patients.id",
+        "sessions.id",
+        "sessions.location_id",
+        "sessions.academic_year",
+        "patients.birth_academic_year"
       )
       .filter_map do |patient_id, session_id, location_id, academic_year, birth_academic_year|
         year_group = birth_academic_year.to_year_group(academic_year:)
diff --git a/app/lib/team_sessions_factory.rb b/app/lib/team_sessions_factory.rb
index 9b5d0e33b6..d65a4dc034 100644
--- a/app/lib/team_sessions_factory.rb
+++ b/app/lib/team_sessions_factory.rb
@@ -36,9 +36,7 @@ def destroy_orphaned_sessions!
         .unscheduled
         .where(academic_year:)
         .where.not(location: team.locations)
-        .where
-        .missing(:patient_locations)
-        .destroy_all
+        .find_each { |session| session.destroy! if session.patients.empty? }
     end
   end
 end
diff --git a/app/models/class_import.rb b/app/models/class_import.rb
index 834fb3adfb..8fe3a99613 100644
--- a/app/models/class_import.rb
+++ b/app/models/class_import.rb
@@ -57,9 +57,9 @@ def postprocess_rows!
     existing_patients =
       Patient.where(birth_academic_year: birth_academic_years).where(
         PatientLocation
-          .joins(session: :location)
+          .joins(:location)
           .where("patient_id = patients.id")
-          .where(session: { academic_year:, location: })
+          .where(academic_year:, location:)
           .arel
           .exists
       )
diff --git a/app/models/immunisation_import_row.rb b/app/models/immunisation_import_row.rb
index 6a3e902cd7..b1ad69ee23 100644
--- a/app/models/immunisation_import_row.rb
+++ b/app/models/immunisation_import_row.rb
@@ -157,7 +157,9 @@ def to_vaccination_record
   end
 
   def to_patient_location
-    PatientLocation.new(patient:, session:) if patient && session
+    if patient && session
+      PatientLocation.new(patient:, location: session.location, academic_year:)
+    end
   end
 
   def batch_expiry = @data[:batch_expiry_date]
diff --git a/app/models/location.rb b/app/models/location.rb
index 7b5f08207e..8abe5bdd2e 100644
--- a/app/models/location.rb
+++ b/app/models/location.rb
@@ -56,6 +56,7 @@ class Location < ApplicationRecord
   has_many :attendance_records
   has_many :consent_forms
   has_many :location_programme_year_groups
+  has_many :patient_locations
   has_many :patients, foreign_key: :school_id
   has_many :sessions
 
diff --git a/app/models/patient.rb b/app/models/patient.rb
index 35db2e22c4..1e18884e7e 100644
--- a/app/models/patient.rb
+++ b/app/models/patient.rb
@@ -84,15 +84,8 @@ class Patient < ApplicationRecord
   has_many :vaccination_statuses
   has_many :patient_specific_directions
 
+  has_many :locations, through: :patient_locations
   has_many :parents, through: :parent_relationships
-  has_many :patient_specific_directions
-  has_many :sessions, through: :patient_locations
-  has_many :teams, -> { distinct }, through: :sessions
-
-  has_many :pending_sessions,
-           -> { where(academic_year: AcademicYear.pending) },
-           through: :patient_locations,
-           source: :session
 
   has_and_belongs_to_many :class_imports
   has_and_belongs_to_many :cohort_imports
@@ -104,12 +97,18 @@ class Patient < ApplicationRecord
   scope :joins_archive_reasons,
         ->(team:) do
           joins(
-            "LEFT JOIN archive_reasons " \
+            "LEFT OUTER JOIN archive_reasons " \
               "ON archive_reasons.patient_id = patients.id " \
               "AND archive_reasons.team_id = #{team.id}"
           )
         end
 
+  scope :joins_sessions, -> { joins(:patient_locations).joins(<<-SQL) }
+      INNER JOIN sessions
+      ON sessions.location_id = patient_locations.location_id
+      AND sessions.academic_year = patient_locations.academic_year
+    SQL
+
   scope :archived,
         ->(team:) do
           joins_archive_reasons(team:).where("archive_reasons.id IS NOT NULL")
@@ -143,8 +142,7 @@ class Patient < ApplicationRecord
         ->(programmes, academic_year:) do
           where(
             PatientLocation
-              .joins(:session)
-              .where(sessions: { academic_year: })
+              .where(academic_year:)
               .where("patient_id = patients.id")
               .appear_in_programmes(programmes)
               .arel
@@ -156,8 +154,7 @@ class Patient < ApplicationRecord
         ->(programmes, academic_year:) do
           where.not(
             PatientLocation
-              .joins(:session)
-              .where(sessions: { academic_year: })
+              .where(academic_year:)
               .where("patient_id = patients.id")
               .appear_in_programmes(programmes)
               .arel
@@ -277,6 +274,10 @@ class Patient < ApplicationRecord
 
   delegate :fhir_record, to: :fhir_mapper
 
+  def sessions
+    Session.joins_patient_locations.where(patient_locations: { patient_id: id })
+  end
+
   def self.match_existing(
     nhs_number:,
     given_name:,
@@ -346,6 +347,15 @@ def self.match_existing(
     results
   end
 
+  def teams
+    Team.left_outer_joins(:sessions).joins(<<-SQL)
+        INNER JOIN patient_locations
+        ON patient_locations.patient_id = #{id}
+        AND patient_locations.location_id = sessions.location_id
+        AND patient_locations.academic_year = sessions.academic_year 
+      SQL
+  end
+
   def archived?(team:)
     archive_reasons.exists?(team:)
   end
@@ -504,8 +514,8 @@ def invalidate!
 
   def not_in_team?(team:, academic_year:)
     patient_locations
-      .joins(:session)
-      .where(session: { academic_year:, team: })
+      .joins(location: :subteam)
+      .where(academic_year:, subteams: { team_id: team.id })
       .empty?
   end
 
@@ -513,8 +523,10 @@ def dup_for_pending_changes
     dup.tap do |new_patient|
       new_patient.nhs_number = nil
 
-      pending_sessions.each do |session|
-        new_patient.patient_locations.build(session:)
+      patient_locations.pending.find_each do |patient_location|
+        new_patient.patient_locations.build(
+          **patient_location.slice(:academic_year, :location_id)
+        )
       end
 
       school_moves.each do |school_move|
@@ -530,11 +542,13 @@ def dup_for_pending_changes
   end
 
   def clear_pending_sessions!(team: nil)
-    sessions = pending_sessions
+    scope = patient_locations.pending
 
-    sessions = sessions.where(team_id: team.id) unless team.nil?
+    unless team.nil?
+      scope = scope.joins_sessions.where("sessions.team_id = ?", team.id)
+    end
 
-    patient_locations.where(session: sessions).destroy_all_if_safe
+    scope.destroy_all_if_safe
   end
 
   def self.from_consent_form(consent_form)
diff --git a/app/models/patient_location.rb b/app/models/patient_location.rb
index 8480a142dc..ab6b36b8c1 100644
--- a/app/models/patient_location.rb
+++ b/app/models/patient_location.rb
@@ -4,80 +4,81 @@
 #
 # Table name: patient_locations
 #
-#  id         :bigint           not null, primary key
-#  created_at :datetime         not null
-#  updated_at :datetime         not null
-#  patient_id :bigint           not null
-#  session_id :bigint           not null
+#  id            :bigint           not null, primary key
+#  academic_year :integer          not null
+#  created_at    :datetime         not null
+#  updated_at    :datetime         not null
+#  location_id   :bigint           not null
+#  patient_id    :bigint           not null
 #
 # Indexes
 #
-#  index_patient_locations_on_patient_id_and_session_id  (patient_id,session_id) UNIQUE
-#  index_patient_locations_on_session_id                 (session_id)
+#  idx_on_patient_id_location_id_academic_year_08a1dc4afe    (patient_id,location_id,academic_year) UNIQUE
+#  index_patient_locations_on_location_id                    (location_id)
+#  index_patient_locations_on_location_id_and_academic_year  (location_id,academic_year)
 #
 # Foreign Keys
 #
+#  fk_rails_...  (location_id => locations.id)
 #  fk_rails_...  (patient_id => patients.id)
-#  fk_rails_...  (session_id => sessions.id)
 #
 
-# The patient session model represents a patient who goes to the school or
-# clinic location represented by the session. This doesn't necessarily mean
-# that the patient is eligible for any of the programmes administered in any
-# particular session they belong to.
-#
-# This is designed to support programmes being dynamically added or removed to
-# sessions without needing to also create or destroy patient session
-# instances. While also adding support for patients becoming eligible if year
-# groups are added or removed to locations, again without needing to also
-# create or destroy patient session instances.
-#
-# It also supports the scenario where a patient belongs to a session but is
-# only eligible for one of many programmes administered in the session. In
-# that case, the list of programmes they appear in won't be the same as the
-# complete list of programmes administered in the session.
-
 class PatientLocation < ApplicationRecord
   audited associated_with: :patient
   has_associated_audits
 
   belongs_to :patient
-  belongs_to :session
+  belongs_to :location
 
-  has_one :location, through: :session
-  has_one :subteam, through: :session
-  has_one :team, through: :session
-  has_one :organisation, through: :team
+  has_many :sessions,
+           -> { where(academic_year: it.academic_year) },
+           through: :location,
+           class_name: "Session"
 
-  has_many :gillick_assessments,
+  has_one :organisation, through: :location
+  has_one :subteam, through: :location
+  has_one :team, through: :location
+
+  has_many :attendance_records,
            -> { where(patient_id: it.patient_id) },
-           through: :session
+           through: :location
 
-  has_many :pre_screenings,
+  has_many :gillick_assessments,
            -> { where(patient_id: it.patient_id) },
-           through: :session
+           through: :sessions
 
-  has_many :attendance_records,
+  has_many :pre_screenings,
            -> { where(patient_id: it.patient_id) },
-           through: :location
+           through: :sessions
 
   has_many :vaccination_records,
-           -> { where(session_id: it.session_id) },
-           through: :patient
+           -> { where(patient_id: it.patient_id) },
+           through: :sessions
 
   has_and_belongs_to_many :immunisation_imports
 
+  scope :current, -> { where(academic_year: AcademicYear.current) }
+  scope :pending, -> { where(academic_year: AcademicYear.pending) }
+
   scope :archived, ->(team:) { merge(Patient.archived(team:)) }
 
   scope :not_archived, ->(team:) { merge(Patient.not_archived(team:)) }
 
+  scope :joins_sessions, -> { joins(<<-SQL) }
+      INNER JOIN sessions
+      ON sessions.location_id = patient_locations.location_id
+      AND sessions.academic_year = patient_locations.academic_year
+    SQL
+
   scope :appear_in_programmes,
         ->(programmes) do
           # Are any of the programmes administered in the session?
           programme_in_session =
             SessionProgramme
+              .joins(:session)
               .where(programme: programmes)
-              .where("session_programmes.session_id = sessions.id")
+              .where("sessions.location_id = patient_locations.location_id")
+              .where("sessions.academic_year = patient_locations.academic_year")
               .arel
               .exists
 
@@ -85,9 +86,11 @@ class PatientLocation < ApplicationRecord
           patient_in_administered_year_groups =
             LocationProgrammeYearGroup
               .where(programme: programmes)
-              .where("location_id = sessions.location_id")
               .where(
-                "year_group = sessions.academic_year " \
+                "location_programme_year_groups.location_id = patient_locations.location_id"
+              )
+              .where(
+                "year_group = patient_locations.academic_year " \
                   "- patients.birth_academic_year " \
                   "- #{Integer::AGE_CHILDREN_START_SCHOOL}"
               )
@@ -131,20 +134,12 @@ class PatientLocation < ApplicationRecord
           )
         end
 
-  scope :includes_programmes,
-        -> do
-          preload(
-            :patient,
-            session: %i[programmes location_programme_year_groups]
-          )
-        end
-
   scope :has_consent_status,
         ->(status, programme:, vaccine_method: nil) do
           consent_status_scope =
             Patient::ConsentStatus
               .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = sessions.academic_year")
+              .where("academic_year = patient_locations.academic_year")
               .where(status:, programme:)
 
           if vaccine_method
@@ -152,16 +147,15 @@ class PatientLocation < ApplicationRecord
               consent_status_scope.has_vaccine_method(vaccine_method)
           end
 
-          joins(:session).where(consent_status_scope.arel.exists)
+          where(consent_status_scope.arel.exists)
         end
 
   scope :has_registration_status,
-        ->(status) do
+        ->(status, session:) do
           where(
             Patient::RegistrationStatus
               .where("patient_id = patient_locations.patient_id")
-              .where("session_id = patient_locations.session_id")
-              .where(status:)
+              .where(session:, status:)
               .arel
               .exists
           )
@@ -169,10 +163,10 @@ class PatientLocation < ApplicationRecord
 
   scope :has_triage_status,
         ->(status, programme:) do
-          joins(:session).where(
+          where(
             Patient::TriageStatus
               .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = sessions.academic_year")
+              .where("academic_year = patient_locations.academic_year")
               .where(status:, programme:)
               .arel
               .exists
@@ -181,10 +175,10 @@ class PatientLocation < ApplicationRecord
 
   scope :has_vaccination_status,
         ->(status, programme:) do
-          joins(:session).where(
+          where(
             Patient::VaccinationStatus
               .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = sessions.academic_year")
+              .where("academic_year = patient_locations.academic_year")
               .where(status:, programme:)
               .arel
               .exists
@@ -193,25 +187,25 @@ class PatientLocation < ApplicationRecord
 
   scope :has_vaccine_method,
         ->(vaccine_method, programme:) do
-          joins(:session).where(
+          where(
             Patient::TriageStatus
               .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = sessions.academic_year")
+              .where("academic_year = patient_locations.academic_year")
               .where(vaccine_method:, programme:)
               .arel
               .exists
           ).or(
-            joins(:session).where(
+            where(
               Patient::TriageStatus
                 .where("patient_id = patient_locations.patient_id")
-                .where("academic_year = sessions.academic_year")
+                .where("academic_year = patient_locations.academic_year")
                 .where(status: "not_required", programme:)
                 .arel
                 .exists
             ).where(
               Patient::ConsentStatus
                 .where("patient_id = patient_locations.patient_id")
-                .where("academic_year = sessions.academic_year")
+                .where("academic_year = patient_locations.academic_year")
                 .where(programme:)
                 .has_vaccine_method(vaccine_method)
                 .arel
@@ -221,15 +215,14 @@ class PatientLocation < ApplicationRecord
         end
 
   scope :consent_given_and_ready_to_vaccinate,
-        ->(programmes:, vaccine_method:) do
+        ->(programmes:, academic_year:, vaccine_method:) do
           select do |patient_location|
             patient = patient_location.patient
-            session = patient_location.session
 
             programmes.any? do |programme|
               patient.consent_given_and_safe_to_vaccinate?(
                 programme:,
-                academic_year: session.academic_year,
+                academic_year:,
                 vaccine_method:
               )
             end
@@ -238,10 +231,10 @@ class PatientLocation < ApplicationRecord
 
   scope :without_patient_specific_direction,
         ->(programme:, team:) do
-          joins(:session).where.not(
+          where.not(
             PatientSpecificDirection
               .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = sessions.academic_year")
+              .where("academic_year = patient_locations.academic_year")
               .where(programme:, team:)
               .not_invalidated
               .arel
@@ -251,10 +244,10 @@ class PatientLocation < ApplicationRecord
 
   scope :has_patient_specific_direction,
         ->(programme:, team:) do
-          joins(:session).where(
+          where(
             PatientSpecificDirection
               .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = sessions.academic_year")
+              .where("academic_year = patient_locations.academic_year")
               .where(programme:, team:)
               .not_invalidated
               .arel
@@ -265,17 +258,16 @@ class PatientLocation < ApplicationRecord
   scope :destroy_all_if_safe,
         -> do
           includes(
-            :gillick_assessments,
             :attendance_records,
+            :gillick_assessments,
+            :pre_screenings,
             :vaccination_records
           ).find_each(&:destroy_if_safe!)
         end
 
-  delegate :academic_year, to: :session
-
   def safe_to_destroy?
-    vaccination_records.empty? && gillick_assessments.empty? &&
-      attendance_records.none?(&:attending?)
+    attendance_records.none?(&:attending?) && gillick_assessments.empty? &&
+      pre_screenings.empty? && vaccination_records.empty?
   end
 
   def destroy_if_safe!
diff --git a/app/models/school_move.rb b/app/models/school_move.rb
index 179dfbee88..1461f6e424 100644
--- a/app/models/school_move.rb
+++ b/app/models/school_move.rb
@@ -99,32 +99,14 @@ def update_archive_reasons!(user:)
   def update_sessions!
     patient
       .patient_locations
-      .joins(:session)
       .where("academic_year >= ?", academic_year)
       .destroy_all_if_safe
 
-    sessions_to_add.find_each do |session|
-      PatientLocation.find_or_create_by!(patient:, session:)
-    end
+    location = school || team.generic_clinic
 
-    StatusUpdater.call(patient:)
-  end
+    PatientLocation.find_or_create_by!(patient:, location:, academic_year:)
 
-  def sessions_to_add
-    @sessions_to_add ||=
-      begin
-        scope =
-          Session.includes(:location, :session_dates).where(
-            "academic_year >= ?",
-            academic_year
-          )
-
-        if school
-          scope.where(team: school.team, location: school)
-        else
-          scope.where(team:, locations: { type: "generic_clinic" })
-        end
-      end
+    StatusUpdater.call(patient:)
   end
 
   def create_log_entry!(user:)
diff --git a/app/models/session.rb b/app/models/session.rb
index a9a25c319b..28253dce5d 100644
--- a/app/models/session.rb
+++ b/app/models/session.rb
@@ -20,9 +20,10 @@
 #
 # Indexes
 #
-#  index_sessions_on_location_id                (location_id)
-#  index_sessions_on_team_id_and_academic_year  (team_id,academic_year)
-#  index_sessions_on_team_id_and_location_id    (team_id,location_id)
+#  index_sessions_on_location_id                                (location_id)
+#  index_sessions_on_location_id_and_academic_year_and_team_id  (location_id,academic_year,team_id)
+#  index_sessions_on_team_id_and_academic_year                  (team_id,academic_year)
+#  index_sessions_on_team_id_and_location_id                    (team_id,location_id)
 #
 # Foreign Keys
 #
@@ -39,7 +40,6 @@ class Session < ApplicationRecord
 
   has_many :consent_notifications
   has_many :notes
-  has_many :patient_locations
   has_many :session_dates, -> { order(:value) }
   has_many :session_notifications
   has_many :session_programmes,
@@ -49,6 +49,10 @@ class Session < ApplicationRecord
 
   has_and_belongs_to_many :immunisation_imports
 
+  has_many :patient_locations,
+           -> { where(academic_year: it.academic_year) },
+           through: :location
+
   has_one :organisation, through: :team
   has_one :subteam, through: :location
   has_many :pre_screenings, through: :session_dates
@@ -63,6 +67,12 @@ class Session < ApplicationRecord
 
   accepts_nested_attributes_for :session_dates, allow_destroy: true
 
+  scope :joins_patient_locations, -> { joins(<<-SQL) }
+      INNER JOIN patient_locations
+      ON patient_locations.location_id = sessions.location_id
+      AND patient_locations.academic_year = sessions.academic_year
+    SQL
+
   scope :has_date,
         ->(value) { where(SessionDate.for_session.where(value:).arel.exists) }
 
@@ -174,17 +184,11 @@ class Session < ApplicationRecord
 
   delegate :clinic?, :generic_clinic?, :school?, to: :location
 
-  def to_param
-    slug
-  end
+  def to_param = slug
 
-  def today?
-    dates.any?(&:today?)
-  end
+  def today? = dates.any?(&:today?)
 
-  def unscheduled?
-    dates.empty?
-  end
+  def unscheduled? = dates.empty?
 
   def completed?
     return false if dates.empty?
diff --git a/app/models/team.rb b/app/models/team.rb
index c58316cf98..3e67de8a6d 100644
--- a/app/models/team.rb
+++ b/app/models/team.rb
@@ -52,8 +52,6 @@ class Team < ApplicationRecord
 
   has_many :community_clinics, through: :subteams
   has_many :locations, through: :subteams
-  has_many :patient_locations, through: :sessions
-  has_many :patients, -> { distinct }, through: :patient_locations
   has_many :programmes, through: :team_programmes
   has_many :schools, through: :subteams
   has_many :vaccination_records, through: :sessions
@@ -76,13 +74,17 @@ class Team < ApplicationRecord
   validates :privacy_policy_url, presence: true
   validates :workgroup, presence: true, uniqueness: true
 
+  def patients
+    Patient.joins_sessions.where(sessions: { team_id: id })
+  end
+
   def year_groups
     @year_groups ||= location_programme_year_groups.pluck_year_groups
   end
 
-  def generic_clinic_session(academic_year:)
-    location = locations.generic_clinic.first
+  def generic_clinic = locations.generic_clinic.first
 
+  def generic_clinic_session(academic_year:)
     sessions
       .includes(
         :location,
@@ -91,7 +93,7 @@ def generic_clinic_session(academic_year:)
         :session_dates
       )
       .create_with(programmes:)
-      .find_or_create_by!(academic_year:, location:)
+      .find_or_create_by!(academic_year:, location: generic_clinic)
   end
 
   def weeks_before_consent_reminders
diff --git a/app/policies/patient_policy.rb b/app/policies/patient_policy.rb
index 0c84d437f9..89263f38c4 100644
--- a/app/policies/patient_policy.rb
+++ b/app/policies/patient_policy.rb
@@ -11,9 +11,9 @@ def resolve
       existence_criteria = [
         PatientLocation
           .select("1")
-          .joins(:session)
+          .joins_sessions
           .where("patient_locations.patient_id = patients.id")
-          .where(sessions: { team_id: team.id })
+          .where("sessions.team_id = ?", team.id)
           .arel,
         ArchiveReason
           .select("1")
diff --git a/app/policies/school_move_policy.rb b/app/policies/school_move_policy.rb
index 078f26f3c9..7bded900f2 100644
--- a/app/policies/school_move_policy.rb
+++ b/app/policies/school_move_policy.rb
@@ -6,23 +6,16 @@ def resolve
       team = user.selected_team
       return scope.none if team.nil?
 
-      patient_subquery =
-        Patient
-          .joins(patient_locations: :session)
-          .select(:id)
-          .distinct
-          .where(sessions: { team_id: team.id })
+      patient_in_team =
+        team
+          .patients
+          .select("1")
+          .where("patients.id = school_moves.patient_id")
           .arel
-          .as("patients")
+          .exists
+
       scope
-        .joins(
-          SchoolMove
-            .arel_table
-            .join(patient_subquery, Arel::Nodes::OuterJoin)
-            .on(SchoolMove.arel_table[:patient_id].eq(patient_subquery[:id]))
-            .join_sources
-        )
-        .where(patient_subquery[:id].not_eq(nil))
+        .where(patient_in_team)
         .or(scope.where(school: team.schools))
         .or(scope.where(team:))
     end
diff --git a/app/policies/vaccination_record_policy.rb b/app/policies/vaccination_record_policy.rb
index f8556cfe2f..a4d19d4764 100644
--- a/app/policies/vaccination_record_policy.rb
+++ b/app/policies/vaccination_record_policy.rb
@@ -67,17 +67,16 @@ def resolve
       team = user.selected_team
       return scope.none if team.nil?
 
-      relevant_patients =
-        Patient
+      patient_in_team =
+        team
+          .patients
           .select("1")
-          .joins(patient_locations: :session)
           .where("patients.id = vaccination_records.patient_id")
-          .where(sessions: { team_id: team.id })
           .arel
-
+          .exists
       scope
         .kept
-        .where(relevant_patients.exists)
+        .where(patient_in_team)
         .or(scope.kept.where(session: team.sessions))
         .or(
           scope.kept.where(
diff --git a/app/views/sessions/consent/show.html.erb b/app/views/sessions/consent/show.html.erb
index b3ca8aa8e1..f7a8a9ff02 100644
--- a/app/views/sessions/consent/show.html.erb
+++ b/app/views/sessions/consent/show.html.erb
@@ -25,7 +25,7 @@
       <% @patient_locations.each do |patient_location| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
               patient: patient_location.patient,
-              session: patient_location.session,
+              session: @session,
               context: :consent,
               programmes: @form.programmes,
             ) %>
diff --git a/app/views/sessions/patient_specific_directions/show.html.erb b/app/views/sessions/patient_specific_directions/show.html.erb
index 4aa9d0b076..a297d0e3fc 100644
--- a/app/views/sessions/patient_specific_directions/show.html.erb
+++ b/app/views/sessions/patient_specific_directions/show.html.erb
@@ -41,7 +41,7 @@
       <% @patient_locations.each do |patient_location| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
               patient: patient_location.patient,
-              session: patient_location.session,
+              session: @session,
               context: :patient_specific_direction,
             ) %>
       <% end %>
diff --git a/app/views/sessions/patients/show.html.erb b/app/views/sessions/patients/show.html.erb
index d4ea5a8005..3259ca93f0 100644
--- a/app/views/sessions/patients/show.html.erb
+++ b/app/views/sessions/patients/show.html.erb
@@ -25,7 +25,7 @@
       <% @patient_locations.each do |patient_location| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
               patient: patient_location.patient,
-              session: patient_location.session,
+              session: @session,
               context: :patients,
               programmes: @form.programmes,
             ) %>
diff --git a/app/views/sessions/record/show.html.erb b/app/views/sessions/record/show.html.erb
index ff95b77896..3899d686c7 100644
--- a/app/views/sessions/record/show.html.erb
+++ b/app/views/sessions/record/show.html.erb
@@ -27,7 +27,7 @@
         <% @patient_locations.each do |patient_location| %>
           <%= render AppPatientSessionSearchResultCardComponent.new(
                 patient: patient_location.patient,
-                session: patient_location.session,
+                session: @session,
                 context: :record,
                 programmes: @form.programmes,
               ) %>
diff --git a/app/views/sessions/register/show.html.erb b/app/views/sessions/register/show.html.erb
index ad98be5335..9e8a087409 100644
--- a/app/views/sessions/register/show.html.erb
+++ b/app/views/sessions/register/show.html.erb
@@ -27,7 +27,7 @@
         <% @patient_locations.each do |patient_location| %>
           <%= render AppPatientSessionSearchResultCardComponent.new(
                 patient: patient_location.patient,
-                session: patient_location.session,
+                session: @session,
                 context: :register,
                 programmes: @form.programmes,
               ) %>
diff --git a/app/views/sessions/triage/show.html.erb b/app/views/sessions/triage/show.html.erb
index a88df021fa..3e56b5514a 100644
--- a/app/views/sessions/triage/show.html.erb
+++ b/app/views/sessions/triage/show.html.erb
@@ -25,7 +25,7 @@
       <% @patient_locations.each do |patient_location| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
               patient: patient_location.patient,
-              session: patient_location.session,
+              session: @session,
               context: :triage,
               programmes: @form.programmes,
             ) %>
diff --git a/db/migrate/20250909145402_replace_patient_session_session_with_location.rb b/db/migrate/20250909145402_replace_patient_session_session_with_location.rb
new file mode 100644
index 0000000000..456e42fae2
--- /dev/null
+++ b/db/migrate/20250909145402_replace_patient_session_session_with_location.rb
@@ -0,0 +1,41 @@
+# frozen_string_literal: true
+
+class ReplacePatientSessionSessionWithLocation < ActiveRecord::Migration[8.0]
+  def up
+    change_table :patient_locations, bulk: true do |t|
+      t.integer :academic_year
+      t.references :location, foreign_key: true
+    end
+
+    execute <<-SQL
+      UPDATE patient_locations
+      SET academic_year = sessions.academic_year, location_id = sessions.location_id
+      FROM sessions
+      WHERE patient_locations.session_id = sessions.id
+    SQL
+
+    change_table :patient_locations, bulk: true do |t|
+      t.change_null :academic_year, false
+      t.change_null :location_id, false
+    end
+
+    remove_column :patient_locations, :session_id
+
+    execute <<-SQL
+      DELETE FROM patient_locations a
+      USING patient_locations b 
+      WHERE a.id > b.id
+        AND a.patient_id = b.patient_id
+        AND a.location_id = b.location_id
+        AND a.academic_year = b.academic_year
+    SQL
+
+    add_index :patient_locations, %i[location_id academic_year]
+
+    add_index :patient_locations,
+              %i[patient_id location_id academic_year],
+              unique: true
+
+    add_index :sessions, %i[location_id academic_year team_id]
+  end
+end
diff --git a/db/schema.rb b/db/schema.rb
index 9a601887d7..bbc4396eff 100644
--- a/db/schema.rb
+++ b/db/schema.rb
@@ -537,12 +537,14 @@
   end
 
   create_table "patient_locations", force: :cascade do |t|
-    t.bigint "session_id", null: false
     t.bigint "patient_id", null: false
     t.datetime "created_at", null: false
     t.datetime "updated_at", null: false
-    t.index ["patient_id", "session_id"], name: "index_patient_locations_on_patient_id_and_session_id", unique: true
-    t.index ["session_id"], name: "index_patient_locations_on_session_id"
+    t.integer "academic_year", null: false
+    t.bigint "location_id", null: false
+    t.index ["location_id", "academic_year"], name: "index_patient_locations_on_location_id_and_academic_year"
+    t.index ["location_id"], name: "index_patient_locations_on_location_id"
+    t.index ["patient_id", "location_id", "academic_year"], name: "idx_on_patient_id_location_id_academic_year_08a1dc4afe", unique: true
   end
 
   create_table "patient_registration_statuses", force: :cascade do |t|
@@ -796,6 +798,7 @@
     t.boolean "requires_registration", default: true, null: false
     t.boolean "psd_enabled", default: false, null: false
     t.boolean "national_protocol_enabled", default: false, null: false
+    t.index ["location_id", "academic_year", "team_id"], name: "index_sessions_on_location_id_and_academic_year_and_team_id"
     t.index ["location_id"], name: "index_sessions_on_location_id"
     t.index ["team_id", "academic_year"], name: "index_sessions_on_team_id_and_academic_year"
     t.index ["team_id", "location_id"], name: "index_sessions_on_team_id_and_location_id"
@@ -1037,8 +1040,8 @@
   add_foreign_key "patient_changesets", "patients"
   add_foreign_key "patient_consent_statuses", "patients", on_delete: :cascade
   add_foreign_key "patient_consent_statuses", "programmes"
+  add_foreign_key "patient_locations", "locations"
   add_foreign_key "patient_locations", "patients"
-  add_foreign_key "patient_locations", "sessions"
   add_foreign_key "patient_registration_statuses", "patients", on_delete: :cascade
   add_foreign_key "patient_registration_statuses", "sessions", on_delete: :cascade
   add_foreign_key "patient_specific_directions", "patients"
diff --git a/db/seeds.rb b/db/seeds.rb
index d5c481705b..d1837659dc 100644
--- a/db/seeds.rb
+++ b/db/seeds.rb
@@ -167,13 +167,20 @@ def setup_clinic(team)
 
   clinic_session.update!(send_invitations_at: Date.current - 3.weeks)
 
-  # All patients belong to the community clinic. This is normally
-  # handled by school moves, but here we need to do it manually.
+  # All unknown school or home-schooled patients belong to the community clinic.
+  # This is normally handled by school moves, but here we need to do it manually.
 
   PatientLocation.import(
-    team.patients.map do
-      PatientLocation.new(patient: it, session: clinic_session)
-    end,
+    team
+      .patients
+      .where(school: nil)
+      .map do
+        PatientLocation.new(
+          patient: it,
+          location: clinic_session.location,
+          academic_year: clinic_session.academic_year
+        )
+      end,
     on_duplicate_key_ignore: :all
   )
 end
diff --git a/spec/factories/patient_locations.rb b/spec/factories/patient_locations.rb
index b93048c674..60a091798e 100644
--- a/spec/factories/patient_locations.rb
+++ b/spec/factories/patient_locations.rb
@@ -4,27 +4,30 @@
 #
 # Table name: patient_locations
 #
-#  id         :bigint           not null, primary key
-#  created_at :datetime         not null
-#  updated_at :datetime         not null
-#  patient_id :bigint           not null
-#  session_id :bigint           not null
+#  id            :bigint           not null, primary key
+#  academic_year :integer          not null
+#  created_at    :datetime         not null
+#  updated_at    :datetime         not null
+#  location_id   :bigint           not null
+#  patient_id    :bigint           not null
 #
 # Indexes
 #
-#  index_patient_locations_on_patient_id_and_session_id  (patient_id,session_id) UNIQUE
-#  index_patient_locations_on_session_id                 (session_id)
+#  idx_on_patient_id_location_id_academic_year_08a1dc4afe    (patient_id,location_id,academic_year) UNIQUE
+#  index_patient_locations_on_location_id                    (location_id)
+#  index_patient_locations_on_location_id_and_academic_year  (location_id,academic_year)
 #
 # Foreign Keys
 #
+#  fk_rails_...  (location_id => locations.id)
 #  fk_rails_...  (patient_id => patients.id)
-#  fk_rails_...  (session_id => sessions.id)
 #
 FactoryBot.define do
   factory :patient_location do
-    transient { programmes { [association(:programme)] } }
+    transient { session { association(:session) } }
 
     patient
-    session { association :session, programmes: }
+    location { session.location }
+    academic_year { session.academic_year }
   end
 end
diff --git a/spec/factories/patients.rb b/spec/factories/patients.rb
index 97c75f6844..dc6ae867b0 100644
--- a/spec/factories/patients.rb
+++ b/spec/factories/patients.rb
@@ -124,8 +124,14 @@
     end
 
     after(:create) do |patient, evaluator|
-      if evaluator.session
-        PatientLocation.find_or_create_by!(patient:, session: evaluator.session)
+      if (session = evaluator.session)
+        location_id = session.location_id
+        academic_year = session.academic_year
+        PatientLocation.find_or_create_by!(
+          patient:,
+          location_id:,
+          academic_year:
+        )
       end
     end
 
diff --git a/spec/factories/sessions.rb b/spec/factories/sessions.rb
index e1c0e7783f..b4756a4e03 100644
--- a/spec/factories/sessions.rb
+++ b/spec/factories/sessions.rb
@@ -20,9 +20,10 @@
 #
 # Indexes
 #
-#  index_sessions_on_location_id                (location_id)
-#  index_sessions_on_team_id_and_academic_year  (team_id,academic_year)
-#  index_sessions_on_team_id_and_location_id    (team_id,location_id)
+#  index_sessions_on_location_id                                (location_id)
+#  index_sessions_on_location_id_and_academic_year_and_team_id  (location_id,academic_year,team_id)
+#  index_sessions_on_team_id_and_academic_year                  (team_id,academic_year)
+#  index_sessions_on_team_id_and_location_id                    (team_id,location_id)
 #
 # Foreign Keys
 #
diff --git a/spec/features/cli_generate_consents_spec.rb b/spec/features/cli_generate_consents_spec.rb
index 42f330495c..f4bf3df6e0 100644
--- a/spec/features/cli_generate_consents_spec.rb
+++ b/spec/features/cli_generate_consents_spec.rb
@@ -56,9 +56,17 @@ def then_consents_are_created_with_the_given_statuses
 
     expect(
       @team
-        .patient_locations
-        .has_consent_status(:given, programme: @programme)
-        .has_triage_status(:not_required, programme: @programme)
+        .patients
+        .has_consent_status(
+          :given,
+          programme: @programme,
+          academic_year: AcademicYear.current
+        )
+        .has_triage_status(
+          :not_required,
+          programme: @programme,
+          academic_year: AcademicYear.current
+        )
         .count
     ).to eq 1
   end
diff --git a/spec/features/import_child_pds_lookup_extravaganza_spec.rb b/spec/features/import_child_pds_lookup_extravaganza_spec.rb
index 8eb9d89679..6e21140023 100644
--- a/spec/features/import_child_pds_lookup_extravaganza_spec.rb
+++ b/spec/features/import_child_pds_lookup_extravaganza_spec.rb
@@ -101,13 +101,8 @@
 
   def given_i_am_signed_in
     @programme = create(:programme, :hpv)
-    @team =
-      create(
-        :team,
-        :with_generic_clinic,
-        :with_one_nurse,
-        programmes: [@programme]
-      )
+    @team = create(:team, :with_one_nurse, programmes: [@programme])
+
     sign_in @team.users.first
   end
 
diff --git a/spec/features/manage_children_spec.rb b/spec/features/manage_children_spec.rb
index d53e0db518..20c8aa32af 100644
--- a/spec/features/manage_children_spec.rb
+++ b/spec/features/manage_children_spec.rb
@@ -163,6 +163,8 @@ def given_my_team_exists
         :with_one_nurse,
         programmes: [@programme]
       )
+
+    TeamSessionsFactory.call(@team, academic_year: AcademicYear.current)
   end
 
   def given_patients_exist
diff --git a/spec/jobs/enqueue_vaccinations_search_in_nhs_job_spec.rb b/spec/jobs/enqueue_vaccinations_search_in_nhs_job_spec.rb
index 2c461c00af..ac2116ae8f 100644
--- a/spec/jobs/enqueue_vaccinations_search_in_nhs_job_spec.rb
+++ b/spec/jobs/enqueue_vaccinations_search_in_nhs_job_spec.rb
@@ -7,7 +7,7 @@
   let(:flu) { create(:programme, :flu) }
   let(:location) { create(:school, team:, programmes: [flu]) }
   let(:school) { location }
-  let!(:patient) { create(:patient, team:, school:) }
+  let!(:patient) { create(:patient, team:, school:, session:) }
 
   describe "#perform", :within_academic_year do
     subject { SearchVaccinationRecordsInNHSJob }
@@ -23,8 +23,7 @@
         dates:,
         send_invitations_at:,
         team:,
-        location:,
-        patients: [patient]
+        location:
       )
     end
 
diff --git a/spec/jobs/patient_nhs_number_lookup_job_spec.rb b/spec/jobs/patient_nhs_number_lookup_job_spec.rb
index 3e795cffbc..8a5d315447 100644
--- a/spec/jobs/patient_nhs_number_lookup_job_spec.rb
+++ b/spec/jobs/patient_nhs_number_lookup_job_spec.rb
@@ -74,10 +74,8 @@
 
       let!(:existing_patient) { create(:patient, nhs_number: "9449306168") }
 
-      let(:patient_location) do
-        create(:patient_location, patient:, programmes: [programme])
-      end
-      let(:session) { patient_location.session }
+      let(:session) { create(:session, programmes: [programme]) }
+      let(:patient_location) { create(:patient_location, patient:, session:) }
       let(:gillick_assessment) do
         create(:gillick_assessment, :competent, patient:, session:)
       end
@@ -116,7 +114,8 @@
           create(
             :patient_location,
             patient: existing_patient,
-            session: patient_location.session
+            location: patient_location.location,
+            academic_year: patient_location.academic_year
           )
         end
 
diff --git a/spec/jobs/send_manual_school_consent_reminders_job_spec.rb b/spec/jobs/send_manual_school_consent_reminders_job_spec.rb
index 4be5a21d7a..6bea4d41d0 100644
--- a/spec/jobs/send_manual_school_consent_reminders_job_spec.rb
+++ b/spec/jobs/send_manual_school_consent_reminders_job_spec.rb
@@ -42,7 +42,7 @@
 
   before do
     create(:parent_relationship, patient:, parent:)
-    create(:patient_location, patient:, session:, programmes:)
+    create(:patient_location, patient:, session:)
     patient.reload
   end
 
diff --git a/spec/lib/generate/vaccination_records_spec.rb b/spec/lib/generate/vaccination_records_spec.rb
index 381916b6de..f19c8fe1b2 100644
--- a/spec/lib/generate/vaccination_records_spec.rb
+++ b/spec/lib/generate/vaccination_records_spec.rb
@@ -37,6 +37,8 @@
 
     context "no patients without vaccinations" do
       it "raises an error" do
+        session
+
         expect { described_class.call(team:, administered: 1) }.to raise_error(
           RuntimeError
         )
diff --git a/spec/lib/status_generator/session_spec.rb b/spec/lib/status_generator/session_spec.rb
index e68fb4d5b5..f7dc565e74 100644
--- a/spec/lib/status_generator/session_spec.rb
+++ b/spec/lib/status_generator/session_spec.rb
@@ -3,8 +3,8 @@
 describe StatusGenerator::Session do
   subject(:generator) do
     described_class.new(
-      session_id: patient_location.session_id,
-      academic_year: patient_location.academic_year,
+      session_id: session.id,
+      academic_year: session.academic_year,
       attendance_record: patient.attendance_records.last,
       programme:,
       patient:,
@@ -14,15 +14,13 @@
     )
   end
 
-  let(:patient_location) { create(:patient_location, programmes: [programme]) }
   let(:programme) { create(:programme) }
+  let(:session) { create(:session, programmes: [programme]) }
+  let(:patient) { create(:patient, session:) }
 
   describe "#status" do
     subject(:status) { generator.status }
 
-    let(:patient) { patient_location.patient }
-    let(:session) { patient_location.session }
-
     context "with no vaccination record" do
       it { should be(:none_yet) }
     end
@@ -90,8 +88,6 @@
 
     around { |example| travel_to(Time.zone.now) { example.run } }
 
-    let(:patient) { patient_location.patient }
-    let(:session) { patient_location.session }
     let(:performed_at) { 1.day.ago.beginning_of_minute }
     let(:created_at) { 2.days.ago.midday }
 
@@ -99,10 +95,10 @@
       before do
         create(
           :vaccination_record,
-          patient: patient,
-          session: session,
-          programme: programme,
-          performed_at: performed_at
+          patient:,
+          session:,
+          programme:,
+          performed_at:
         )
       end
 
diff --git a/spec/lib/status_updater_spec.rb b/spec/lib/status_updater_spec.rb
index 16ff077716..811b525dde 100644
--- a/spec/lib/status_updater_spec.rb
+++ b/spec/lib/status_updater_spec.rb
@@ -5,7 +5,9 @@
 
   around { |example| travel_to(Date.new(2025, 7, 31)) { example.run } }
 
-  before { create(:patient_location, patient:, programmes:) }
+  let(:session) { create(:session, programmes:) }
+
+  before { create(:patient_location, patient:, session:) }
 
   context "with an HPV session and ineligible patient" do
     let(:programmes) { [create(:programme, :hpv)] }
diff --git a/spec/models/cohort_import_spec.rb b/spec/models/cohort_import_spec.rb
index 749de3a29b..341d61b41a 100644
--- a/spec/models/cohort_import_spec.rb
+++ b/spec/models/cohort_import_spec.rb
@@ -39,11 +39,12 @@
 
   let(:file) { "valid.csv" }
   let(:csv) { fixture_file_upload("spec/fixtures/cohort_import/#{file}") }
+  let(:academic_year) { AcademicYear.current }
 
   # Ensure location URN matches the URN in our fixture files
   let!(:location) { create(:school, urn: "123456", team:) }
 
-  before { TeamSessionsFactory.call(team, academic_year: AcademicYear.current) }
+  before { TeamSessionsFactory.call(team, academic_year:) }
 
   it_behaves_like "a CSVImportable model"
 
@@ -402,8 +403,13 @@
       end
 
       before do
-        team.sessions.each do |session|
-          create(:patient_location, session:, patient: existing_patient)
+        team.locations.each do |location|
+          create(
+            :patient_location,
+            patient: existing_patient,
+            location:,
+            academic_year:
+          )
         end
       end
 
diff --git a/spec/models/patient_location_spec.rb b/spec/models/patient_location_spec.rb
index a255be577e..6b18071ad8 100644
--- a/spec/models/patient_location_spec.rb
+++ b/spec/models/patient_location_spec.rb
@@ -4,21 +4,23 @@
 #
 # Table name: patient_locations
 #
-#  id         :bigint           not null, primary key
-#  created_at :datetime         not null
-#  updated_at :datetime         not null
-#  patient_id :bigint           not null
-#  session_id :bigint           not null
+#  id            :bigint           not null, primary key
+#  academic_year :integer          not null
+#  created_at    :datetime         not null
+#  updated_at    :datetime         not null
+#  location_id   :bigint           not null
+#  patient_id    :bigint           not null
 #
 # Indexes
 #
-#  index_patient_locations_on_patient_id_and_session_id  (patient_id,session_id) UNIQUE
-#  index_patient_locations_on_session_id                 (session_id)
+#  idx_on_patient_id_location_id_academic_year_08a1dc4afe    (patient_id,location_id,academic_year) UNIQUE
+#  index_patient_locations_on_location_id                    (location_id)
+#  index_patient_locations_on_location_id_and_academic_year  (location_id,academic_year)
 #
 # Foreign Keys
 #
+#  fk_rails_...  (location_id => locations.id)
 #  fk_rails_...  (patient_id => patients.id)
-#  fk_rails_...  (session_id => sessions.id)
 #
 
 describe PatientLocation do
@@ -28,16 +30,16 @@
   let(:session) { create(:session, programmes: [programme]) }
 
   describe "associations" do
+    it { should have_many(:attendance_records) }
     it { should have_many(:gillick_assessments) }
     it { should have_many(:pre_screenings) }
+    it { should have_many(:vaccination_records) }
   end
 
   describe "scopes" do
     describe "#appear_in_programmes" do
       subject(:scope) do
-        described_class.joins(:patient, :session).appear_in_programmes(
-          programmes
-        )
+        described_class.joins(:patient).appear_in_programmes(programmes)
       end
 
       let(:programmes) { create_list(:programme, 1, :td_ipv) }
@@ -83,6 +85,7 @@
       subject(:scope) do
         described_class.consent_given_and_ready_to_vaccinate(
           programmes:,
+          academic_year:,
           vaccine_method:
         )
       end
diff --git a/spec/models/patient_spec.rb b/spec/models/patient_spec.rb
index f97c7519fc..8e06e7f1ec 100644
--- a/spec/models/patient_spec.rb
+++ b/spec/models/patient_spec.rb
@@ -158,6 +158,7 @@
         let(:location) do
           create(:school, programmes: [flu_programme, hpv_programme])
         end
+        let(:academic_year) { AcademicYear.current }
 
         # Year 4 is eligible for flu only.
         let(:patient) { create(:patient, year_group: 4) }
@@ -165,26 +166,16 @@
         # Year 9 is eligible for flu and HPV only.
         let(:another_patient) { create(:patient, year_group: 9) }
 
-        let(:flu_session) do
+        before do
           create(:session, location:, programmes: [flu_programme])
-        end
-        let(:hpv_session) do
           create(:session, location:, programmes: [hpv_programme])
-        end
-
-        before do
-          create(:patient_location, patient:, session: flu_session)
-          create(:patient_location, patient:, session: hpv_session)
 
+          create(:patient_location, patient:, location:, academic_year:)
           create(
             :patient_location,
             patient: another_patient,
-            session: flu_session
-          )
-          create(
-            :patient_location,
-            patient: another_patient,
-            session: hpv_session
+            location:,
+            academic_year:
           )
         end
 
@@ -260,6 +251,7 @@
         let(:location) do
           create(:school, programmes: [flu_programme, hpv_programme])
         end
+        let(:academic_year) { AcademicYear.current }
 
         # Year 4 is eligible for flu only.
         let!(:patient) { create(:patient, year_group: 4) }
@@ -267,26 +259,16 @@
         # Year 9 is eligible for flu and HPV only.
         let(:another_patient) { create(:patient, year_group: 9) }
 
-        let(:flu_session) do
+        before do
           create(:session, location:, programmes: [flu_programme])
-        end
-        let(:hpv_session) do
           create(:session, location:, programmes: [hpv_programme])
-        end
-
-        before do
-          create(:patient_location, patient:, session: flu_session)
-          create(:patient_location, patient:, session: hpv_session)
 
+          create(:patient_location, patient:, location:, academic_year:)
           create(
             :patient_location,
             patient: another_patient,
-            session: flu_session
-          )
-          create(
-            :patient_location,
-            patient: another_patient,
-            session: hpv_session
+            location:,
+            academic_year:
           )
         end
 
@@ -1126,19 +1108,20 @@
     end
 
     context "when the old patient has upcoming sessions" do
-      let(:session) do
+      let(:location) { create(:school) }
+
+      before do
         create(
-          :session,
-          academic_year: AcademicYear.pending,
-          date: AcademicYear.pending.to_academic_year_date_range.begin
+          :patient_location,
+          patient: old_patient,
+          location:,
+          academic_year: AcademicYear.pending
         )
       end
 
-      before { create(:patient_location, patient: old_patient, session:) }
-
       it "adds the new patient to any upcoming sessions" do
         expect(new_patient.patient_locations.size).to eq(1)
-        expect(new_patient.patient_locations.first.session).to eq(session)
+        expect(new_patient.patient_locations.first.location).to eq(location)
       end
     end
 
diff --git a/spec/models/session_spec.rb b/spec/models/session_spec.rb
index 42064d0d26..9f8436decf 100644
--- a/spec/models/session_spec.rb
+++ b/spec/models/session_spec.rb
@@ -20,9 +20,10 @@
 #
 # Indexes
 #
-#  index_sessions_on_location_id                (location_id)
-#  index_sessions_on_team_id_and_academic_year  (team_id,academic_year)
-#  index_sessions_on_team_id_and_location_id    (team_id,location_id)
+#  index_sessions_on_location_id                                (location_id)
+#  index_sessions_on_location_id_and_academic_year_and_team_id  (location_id,academic_year,team_id)
+#  index_sessions_on_team_id_and_academic_year                  (team_id,academic_year)
+#  index_sessions_on_team_id_and_location_id                    (team_id,location_id)
 #
 # Foreign Keys
 #
diff --git a/spec/policies/school_move_policy_spec.rb b/spec/policies/school_move_policy_spec.rb
new file mode 100644
index 0000000000..7757a405d7
--- /dev/null
+++ b/spec/policies/school_move_policy_spec.rb
@@ -0,0 +1,34 @@
+# frozen_string_literal: true
+
+describe SchoolMovePolicy do
+  describe SchoolMovePolicy::Scope do
+    describe "#resolve" do
+      subject { described_class.new(user, SchoolMove).resolve }
+
+      let(:programme) { create(:programme) }
+      let(:organisation) { create(:organisation) }
+
+      let(:team) { create(:team, organisation:, programmes: [programme]) }
+      let(:other_team) { create(:team, organisation:, programmes: [programme]) }
+      let(:user) { create(:user, team:) }
+
+      let(:session) { create(:session, team:, programmes: [programme]) }
+      let(:other_session) { create(:session, team:, programmes: [programme]) }
+
+      context "patient belonging to two sessions" do
+        let(:patient) { create(:patient) }
+        let(:patient_session) { create(:patient_session, patient:, session:) }
+        let(:other_patient_session) do
+          create(:patient_session, patient:, session: other_session)
+        end
+
+        let(:school) { create(:school, team:) }
+        let(:school_move) do
+          create(:school_move, :to_school, patient:, school:)
+        end
+
+        it { should contain_exactly(school_move) }
+      end
+    end
+  end
+end

From a00739269ffe9f109b7e15c05a3f8e7f42db40a5 Mon Sep 17 00:00:00 2001
From: Thomas Leese <thomas@leese.io>
Date: Fri, 12 Sep 2025 09:50:37 +0100
Subject: [PATCH 3/3] Simplify patient and session lookups

This simplifies the lookups for patients and sessions by removing the
duplicate scopes between patient locations and patients, instead using
the scopes on the patient only, and making sure to filter out patients
who shouldn't belong in the session before we need to query for this.

Jira-Issue: MAV-1822
---
 .../app_programme_session_table_component.rb  |  37 +-
 .../app_session_actions_component.rb          |  36 +-
 .../app_session_details_summary_component.rb  |  14 +-
 ..._session_needs_review_warning_component.rb |  10 +-
 app/controllers/programmes/base_controller.rb |  19 +-
 .../sessions/consent_controller.rb            |  11 +-
 .../patient_specific_directions_controller.rb |  35 +-
 .../sessions/patients_controller.rb           |   8 +-
 app/controllers/sessions/record_controller.rb |  40 +--
 .../sessions/register_controller.rb           |  18 +-
 app/controllers/sessions/triage_controller.rb |  16 +-
 app/forms/patient_search_form.rb              | 102 +++---
 app/lib/programme_birth_academic_years.rb     |  18 +
 app/lib/stats/organisations.rb                |   2 +-
 app/lib/status_updater.rb                     |   1 -
 app/models/location_programme_year_group.rb   |   5 +
 app/models/patient.rb                         | 142 ++++++--
 app/models/patient_location.rb                | 212 ++----------
 app/models/session.rb                         |  35 +-
 app/views/programmes/sessions/index.html.erb  |   2 +-
 app/views/sessions/consent/show.html.erb      |   4 +-
 .../patient_specific_directions/show.html.erb |   4 +-
 app/views/sessions/patients/show.html.erb     |   4 +-
 app/views/sessions/record/show.html.erb       |   4 +-
 app/views/sessions/register/show.html.erb     |   4 +-
 app/views/sessions/triage/show.html.erb       |   4 +-
 ..._programme_session_table_component_spec.rb |   3 +-
 spec/features/parental_consent_flu_spec.rb    |   2 +-
 spec/forms/patient_search_form_spec.rb        | 317 ++++++++----------
 ...eue_vaccinations_search_in_nhs_job_spec.rb |   7 -
 .../patients_aged_out_of_school_job_spec.rb   |   7 +-
 spec/lib/patient_archiver_spec.rb             |   3 +-
 spec/models/patient_location_spec.rb          |  64 +---
 spec/models/patient_spec.rb                   |  66 +++-
 spec/models/school_move_spec.rb               |   4 +-
 35 files changed, 604 insertions(+), 656 deletions(-)
 create mode 100644 app/lib/programme_birth_academic_years.rb

diff --git a/app/components/app_programme_session_table_component.rb b/app/components/app_programme_session_table_component.rb
index 8ecb7aa4cc..e7e181fc4c 100644
--- a/app/components/app_programme_session_table_component.rb
+++ b/app/components/app_programme_session_table_component.rb
@@ -1,23 +1,28 @@
 # frozen_string_literal: true
 
 class AppProgrammeSessionTableComponent < ViewComponent::Base
-  def initialize(sessions, programme:)
+  def initialize(sessions, programme:, academic_year:)
     @sessions = sessions
     @programme = programme
+    @academic_year = academic_year
   end
 
   private
 
-  attr_reader :sessions, :programme
+  attr_reader :sessions, :programme, :academic_year
 
   delegate :govuk_table, to: :helpers
 
   def cohort_count(session:)
-    format_number(patient_locations(session:).count)
+    format_number(patients(session:).count)
   end
 
   def no_response_scope(session:)
-    patient_locations(session:).has_consent_status(:no_response, programme:)
+    patients(session:).has_consent_status(
+      :no_response,
+      programme:,
+      academic_year:
+    )
   end
 
   def no_response_count(session:)
@@ -27,13 +32,17 @@ def no_response_count(session:)
   def no_response_percentage(session:)
     format_percentage(
       no_response_scope(session:).count,
-      patient_locations(session:).count
+      patients(session:).count
     )
   end
 
   def triage_needed_count(session:)
     format_number(
-      patient_locations(session:).has_triage_status(:required, programme:).count
+      patients(session:).has_triage_status(
+        :required,
+        programme:,
+        academic_year:
+      ).count
     )
   end
 
@@ -48,12 +57,22 @@ def vaccinated_count(session:)
   def vaccinated_percentage(session:)
     format_percentage(
       vaccinated_scope(session:).count,
-      patient_locations(session:).count
+      patients(session:).count
+    )
+  end
+
+  def patients(session:)
+    @patients ||= {}
+    @patients[session] = session.patients.where(
+      birth_academic_year: birth_academic_years(session:)
     )
   end
 
-  def patient_locations(session:)
-    session.patient_locations.joins(:patient).appear_in_programmes([programme])
+  def birth_academic_years(session:)
+    @birth_academic_years ||= {}
+    @birth_academic_years[session] = session.programme_birth_academic_years[
+      programme
+    ]
   end
 
   def format_number(count) = count.to_s
diff --git a/app/components/app_session_actions_component.rb b/app/components/app_session_actions_component.rb
index c79a3d52cf..59f8cb729f 100644
--- a/app/components/app_session_actions_component.rb
+++ b/app/components/app_session_actions_component.rb
@@ -19,9 +19,7 @@ def render? = rows.any?
   delegate :govuk_summary_list, to: :helpers
   delegate :academic_year, :programmes, to: :session
 
-  def patient_locations
-    session.patient_locations.joins(:patient).appear_in_programmes(programmes)
-  end
+  def patients = session.patients
 
   def rows
     @rows ||= [
@@ -35,7 +33,7 @@ def rows
   end
 
   def no_nhs_number_row
-    count = patient_locations.merge(Patient.without_nhs_number).count
+    count = patients.without_nhs_number.count
     href = session_patients_path(session, missing_nhs_number: true)
 
     generate_row(:children_without_nhs_number, count:, href:)
@@ -44,7 +42,11 @@ def no_nhs_number_row
   def no_consent_response_row
     status = "no_response"
     count =
-      patient_locations.has_consent_status(status, programme: programmes).count
+      patients.has_consent_status(
+        status,
+        programme: programmes,
+        academic_year:
+      ).count
     href = session_consent_path(session, consent_statuses: [status])
     actions = [
       {
@@ -58,7 +60,11 @@ def no_consent_response_row
   def conflicting_consent_row
     status = "conflicts"
     count =
-      patient_locations.has_consent_status(status, programme: programmes).count
+      patients.has_consent_status(
+        status,
+        programme: programmes,
+        academic_year:
+      ).count
     href = session_consent_path(session, consent_statuses: [status])
 
     generate_row(:children_with_conflicting_consent_response, count:, href:)
@@ -67,7 +73,11 @@ def conflicting_consent_row
   def triage_required_row
     status = "required"
     count =
-      patient_locations.has_triage_status(status, programme: programmes).count
+      patients.has_triage_status(
+        status,
+        programme: programmes,
+        academic_year:
+      ).count
     href = session_triage_path(session, triage_status: status)
 
     generate_row(:children_requiring_triage, count:, href:)
@@ -77,7 +87,7 @@ def register_attendance_row
     return nil unless session.requires_registration? && session.today?
 
     status = "unknown"
-    count = patient_locations.has_registration_status(status, session:).count
+    count = patients.has_registration_status(status, session:).count
     href = session_register_path(session, register_status: status)
 
     generate_row(:children_to_register, count:, href:)
@@ -88,13 +98,11 @@ def ready_for_vaccinator_row
 
     counts_by_programme =
       session.programmes.index_with do |programme|
-        patient_locations
+        patients
           .has_registration_status(%w[attending completed], session:)
-          .includes(
-            patient: %i[consent_statuses triage_statuses vaccination_statuses]
-          )
-          .count do |patient_location|
-            patient_location.patient.consent_given_and_safe_to_vaccinate?(
+          .includes(:consent_statuses, :triage_statuses, :vaccination_statuses)
+          .count do |patient|
+            patient.consent_given_and_safe_to_vaccinate?(
               programme:,
               academic_year:
             )
diff --git a/app/components/app_session_details_summary_component.rb b/app/components/app_session_details_summary_component.rb
index f1f176667b..e9d3aadef3 100644
--- a/app/components/app_session_details_summary_component.rb
+++ b/app/components/app_session_details_summary_component.rb
@@ -14,14 +14,12 @@ def call
   attr_reader :session
 
   delegate :govuk_summary_list, to: :helpers
-  delegate :programmes, to: :session
+  delegate :programmes, :academic_year, to: :session
 
-  def patient_locations
-    session.patient_locations.joins(:patient).appear_in_programmes(programmes)
-  end
+  def patients = session.patients
 
   def cohort_row
-    count = patient_locations.count
+    count = patients.count
 
     { key: { text: "Cohort" }, value: { text: I18n.t("children", count:) } }
   end
@@ -30,7 +28,11 @@ def consent_refused_row
     status = "refused"
 
     count =
-      patient_locations.has_consent_status(status, programme: programmes).count
+      patients.has_consent_status(
+        status,
+        programme: programmes,
+        academic_year:
+      ).count
 
     href = session_consent_path(session, consent_statuses: [status])
 
diff --git a/app/components/app_session_needs_review_warning_component.rb b/app/components/app_session_needs_review_warning_component.rb
index 7aae02f179..3f902ea1da 100644
--- a/app/components/app_session_needs_review_warning_component.rb
+++ b/app/components/app_session_needs_review_warning_component.rb
@@ -32,8 +32,7 @@ def warning_href
 
   def warning_counts
     @warning_counts ||= {
-      children_without_nhs_number:
-        patient_locations.merge(Patient.without_nhs_number).count
+      children_without_nhs_number: patients.without_nhs_number.count
     }
   end
 
@@ -42,10 +41,5 @@ def make_row_from_warning(warning)
     link_to(t(warning, count: warning_counts[warning]), warning_href[warning])
   end
 
-  def patient_locations
-    @session
-      .patient_locations
-      .joins(:patient)
-      .appear_in_programmes(@session.programmes)
-  end
+  def patients = @session.patients
 end
diff --git a/app/controllers/programmes/base_controller.rb b/app/controllers/programmes/base_controller.rb
index 0e73d2fcf8..6f499e7fc8 100644
--- a/app/controllers/programmes/base_controller.rb
+++ b/app/controllers/programmes/base_controller.rb
@@ -22,22 +22,11 @@ def set_academic_year
 
   def patient_ids
     @patient_ids ||=
-      PatientLocation
-        .distinct
-        .joins(:patient)
-        .joins_sessions
-        .where("sessions.id IN (?)", session_ids)
-        .appear_in_programmes([@programme])
-        .not_archived(team: current_team)
-        .pluck(:patient_id)
-  end
-
-  def session_ids
-    @session_ids ||=
       current_team
-        .sessions
-        .where(academic_year: @academic_year)
-        .has_programmes([@programme])
+        .patients
+        .appear_in_programmes([@programme], academic_year: @academic_year)
+        .not_archived(team: current_team)
         .pluck(:id)
+        .uniq
   end
 end
diff --git a/app/controllers/sessions/consent_controller.rb b/app/controllers/sessions/consent_controller.rb
index 83fe3e1aad..8e2f419622 100644
--- a/app/controllers/sessions/consent_controller.rb
+++ b/app/controllers/sessions/consent_controller.rb
@@ -27,15 +27,16 @@ def show
 
     scope =
       @session
-        .patient_locations
-        .includes(patient: [:consent_statuses, { notes: :created_by }])
+        .patients
+        .includes(:consent_statuses, { notes: :created_by })
         .has_consent_status(
           statuses_except_not_required,
-          programme: @form.programmes
+          programme: @form.programmes,
+          academic_year: @session.academic_year
         )
 
-    patient_locations = @form.apply(scope)
-    @pagy, @patient_locations = pagy(patient_locations)
+    patients = @form.apply(scope)
+    @pagy, @patients = pagy(patients)
   end
 
   private
diff --git a/app/controllers/sessions/patient_specific_directions_controller.rb b/app/controllers/sessions/patient_specific_directions_controller.rb
index 1347a71773..04d959a4c7 100644
--- a/app/controllers/sessions/patient_specific_directions_controller.rb
+++ b/app/controllers/sessions/patient_specific_directions_controller.rb
@@ -9,21 +9,18 @@ class Sessions::PatientSpecificDirectionsController < ApplicationController
   before_action :set_patient_search_form
 
   def show
-    scope =
-      @session.patient_locations.includes(
-        patient: {
-          patient_specific_directions: :programme
-        }
-      )
-    @eligible_for_bulk_psd_count = patient_locations_allowed_psd.count
-    patient_locations = @form.apply(scope)
-    @pagy, @patient_locations = pagy(patient_locations)
+    scope = @session.patients.includes(patient_specific_directions: :programme)
+
+    @eligible_for_bulk_psd_count = patients_allowed_psd.count
+
+    patients = @form.apply(scope)
+    @pagy, @patients = pagy(patients)
 
     render layout: "full"
   end
 
   def new
-    @eligible_for_bulk_psd_count = patient_locations_allowed_psd.count
+    @eligible_for_bulk_psd_count = patients_allowed_psd.count
   end
 
   def create
@@ -56,12 +53,12 @@ def set_vaccine
   end
 
   def psds_to_create
-    patient_locations_allowed_psd.map do |patient_location|
+    patients_allowed_psd.map do |patient|
       PatientSpecificDirection.new(
         academic_year: @session.academic_year,
         created_by: current_user,
         delivery_site: "nose",
-        patient_id: patient_location.patient_id,
+        patient:,
         programme: @programme,
         team: current_team,
         vaccine: @vaccine,
@@ -70,18 +67,24 @@ def psds_to_create
     end
   end
 
-  def patient_locations_allowed_psd
-    @patient_locations_allowed_psd ||=
+  def patients_allowed_psd
+    @patients_allowed_psd ||=
       @session
-        .patient_locations
+        .patients
         .has_consent_status(
           "given",
           programme: @programme,
+          academic_year: @session.academic_year,
           vaccine_method: "nasal"
         )
-        .has_triage_status("not_required", programme: @programme)
+        .has_triage_status(
+          "not_required",
+          programme: @programme,
+          academic_year: @session.academic_year
+        )
         .without_patient_specific_direction(
           programme: @programme,
+          academic_year: @session.academic_year,
           team: current_team
         )
   end
diff --git a/app/controllers/sessions/patients_controller.rb b/app/controllers/sessions/patients_controller.rb
index 3b41de97ef..6c52fb2d99 100644
--- a/app/controllers/sessions/patients_controller.rb
+++ b/app/controllers/sessions/patients_controller.rb
@@ -12,12 +12,10 @@ def show
     @statuses = Patient::VaccinationStatus.statuses.keys
 
     scope =
-      @session.patient_locations.includes(
-        patient: [:vaccination_statuses, { notes: :created_by }]
-      )
+      @session.patients.includes(:vaccination_statuses, notes: :created_by)
 
-    patient_locations = @form.apply(scope)
-    @pagy, @patient_locations = pagy(patient_locations)
+    patients = @form.apply(scope)
+    @pagy, @patients = pagy(patients)
   end
 
   private
diff --git a/app/controllers/sessions/record_controller.rb b/app/controllers/sessions/record_controller.rb
index 263ca42d61..e54c09add3 100644
--- a/app/controllers/sessions/record_controller.rb
+++ b/app/controllers/sessions/record_controller.rb
@@ -15,13 +15,11 @@ class Sessions::RecordController < ApplicationController
 
   def show
     scope =
-      @session.patient_locations.includes(
-        patient: [
-          :consent_statuses,
-          :triage_statuses,
-          :vaccination_statuses,
-          { notes: :created_by }
-        ]
+      @session.patients.includes(
+        :consent_statuses,
+        :triage_statuses,
+        :vaccination_statuses,
+        notes: :created_by
       )
 
     if @session.requires_registration?
@@ -32,7 +30,7 @@ def show
         )
     end
 
-    patient_locations =
+    patients =
       filter_on_vaccine_method_or_patient_specific_direction(
         @form.apply(scope)
       ).consent_given_and_ready_to_vaccinate(
@@ -41,7 +39,7 @@ def show
         vaccine_method: @form.vaccine_method.presence
       )
 
-    @pagy, @patient_locations = pagy_array(patient_locations)
+    @pagy, @patients = pagy_array(patients)
 
     render layout: "full"
   end
@@ -108,28 +106,32 @@ def filter_on_vaccine_method_or_patient_specific_direction(scope)
 
     original_scope = scope
 
+    programme = @session.programmes
+    academic_year = @session.academic_year
+    team = current_team
+
     if @session.psd_enabled? && @session.national_protocol_enabled?
-      original_scope.has_patient_specific_direction(
-        programme: @session.programmes,
-        team: current_team
+      original_scope.with_patient_specific_direction(
+        programme:,
+        academic_year:,
+        team:
       ).or(
         original_scope.has_vaccine_method(
           "injection",
-          programme: @session.programmes
+          programme:,
+          academic_year:
         )
       )
     elsif @session.pgd_supply_enabled? && @session.national_protocol_enabled?
       original_scope.has_vaccine_method(
         %w[nasal injection],
-        programme: @session.programmes
+        programme:,
+        academic_year:
       )
     elsif @session.pgd_supply_enabled?
-      original_scope.has_vaccine_method("nasal", programme: @session.programmes)
+      original_scope.has_vaccine_method("nasal", programme:, academic_year:)
     elsif @session.national_protocol_enabled?
-      original_scope.has_vaccine_method(
-        "injection",
-        programme: @session.programmes
-      )
+      original_scope.has_vaccine_method("injection", programme:, academic_year:)
     else
       original_scope.none
     end
diff --git a/app/controllers/sessions/register_controller.rb b/app/controllers/sessions/register_controller.rb
index 3c86885616..8a717d855b 100644
--- a/app/controllers/sessions/register_controller.rb
+++ b/app/controllers/sessions/register_controller.rb
@@ -14,18 +14,16 @@ def show
     @statuses = Patient::RegistrationStatus.statuses.keys
 
     scope =
-      @session.patient_locations.includes(
-        patient: [
-          :consent_statuses,
-          :registration_statuses,
-          :triage_statuses,
-          :vaccination_statuses,
-          { notes: :created_by }
-        ]
+      @session.patients.includes(
+        :consent_statuses,
+        :registration_statuses,
+        :triage_statuses,
+        :vaccination_statuses,
+        notes: :created_by
       )
 
-    patient_locations = @form.apply(scope)
-    @pagy, @patient_locations = pagy(patient_locations)
+    patients = @form.apply(scope)
+    @pagy, @patients = pagy(patients)
   end
 
   def create
diff --git a/app/controllers/sessions/triage_controller.rb b/app/controllers/sessions/triage_controller.rb
index 959bc497a1..e159a965d9 100644
--- a/app/controllers/sessions/triage_controller.rb
+++ b/app/controllers/sessions/triage_controller.rb
@@ -13,12 +13,16 @@ def show
 
     scope =
       @session
-        .patient_locations
-        .includes(patient: [:triage_statuses, { notes: :created_by }])
-        .has_triage_status(@statuses, programme: @form.programmes)
-
-    patient_locations = @form.apply(scope)
-    @pagy, @patient_locations = pagy(patient_locations)
+        .patients
+        .includes(:triage_statuses, notes: :created_by)
+        .has_triage_status(
+          @statuses,
+          programme: @form.programmes,
+          academic_year: @session.academic_year
+        )
+
+    patients = @form.apply(scope)
+    @pagy, @patients = pagy(patients)
   end
 
   private
diff --git a/app/forms/patient_search_form.rb b/app/forms/patient_search_form.rb
index b5ab4586dd..4d4222f213 100644
--- a/app/forms/patient_search_form.rb
+++ b/app/forms/patient_search_form.rb
@@ -1,7 +1,6 @@
 # frozen_string_literal: true
 
 class PatientSearchForm < SearchForm
-  attr_accessor :current_user
   attr_writer :academic_year
 
   attribute :aged_out_of_programmes, :boolean
@@ -43,7 +42,7 @@ def programmes
       if programme_types.present?
         Programme.where(type: programme_types)
       else
-        @session&.programmes
+        session&.programmes
       end
   end
 
@@ -67,10 +66,12 @@ def apply(scope)
 
   private
 
+  attr_reader :current_user, :session
+
   def academic_year =
-    @session&.academic_year || @academic_year || AcademicYear.pending
+    session&.academic_year || @academic_year || AcademicYear.pending
 
-  def team = @session&.team || @current_user.selected_team
+  def team = session&.team || current_user.selected_team
 
   def filter_name(scope)
     q.present? ? scope.search_by_name(q) : scope
@@ -87,11 +88,11 @@ def filter_year_groups(scope)
   def filter_aged_out_of_programmes(scope)
     if aged_out_of_programmes
       scope.not_appear_in_programmes(team.programmes, academic_year:)
-    elsif @session || archived
-      scope
-    else
+    elsif session || archived
       # Archived patients won't appear in programmes, so we need to
       # skip this check if we're trying to view archived patients.
+      scope
+    else
       scope.appear_in_programmes(team.programmes, academic_year:)
     end
   end
@@ -99,7 +100,7 @@ def filter_aged_out_of_programmes(scope)
   def filter_archived(scope)
     if archived
       scope.archived(team:)
-    elsif @session
+    elsif session
       scope
     else
       scope.not_archived(team:)
@@ -127,9 +128,14 @@ def filter_nhs_number(scope)
   end
 
   def filter_programmes(scope)
-    if programmes.present?
-      if @session
-        scope.joins(:patient).appear_in_programmes(programmes)
+    if programme_types.present?
+      if session
+        birth_academic_years =
+          programmes.flat_map do |programme|
+            session.programme_birth_academic_years[programme]
+          end
+
+        scope.where(birth_academic_year: birth_academic_years)
       else
         scope.appear_in_programmes(programmes, academic_year:)
       end
@@ -148,33 +154,21 @@ def filter_consent_statuses(scope)
           vaccine_methods =
             given_with_vaccine_method_statuses.map { it.sub("given_", "") }
 
-          if @session
-            scope.has_consent_status(
-              "given",
-              programme: programmes,
-              vaccine_method: vaccine_methods
-            )
-          else
-            scope.has_consent_status(
-              "given",
-              programme: programmes,
-              academic_year:,
-              vaccine_method: vaccine_methods
-            )
-          end
+          scope.has_consent_status(
+            "given",
+            programme: programmes,
+            academic_year:,
+            vaccine_method: vaccine_methods
+          )
         end
 
       other_status_scope =
         if other_statuses.any?
-          if @session
-            scope.has_consent_status(other_statuses, programme: programmes)
-          else
-            scope.has_consent_status(
-              other_statuses,
-              programme: programmes,
-              academic_year:
-            )
-          end
+          scope.has_consent_status(
+            other_statuses,
+            programme: programmes,
+            academic_year:
+          )
         end
 
       if given_with_vaccine_method_scope && other_status_scope
@@ -189,15 +183,11 @@ def filter_consent_statuses(scope)
 
   def filter_vaccination_statuses(scope)
     if (status = vaccination_status&.to_sym).present?
-      if @session
-        scope.has_vaccination_status(status, programme: programmes)
-      else
-        scope.has_vaccination_status(
-          status,
-          programme: programmes,
-          academic_year:
-        )
-      end
+      scope.has_vaccination_status(
+        status,
+        programme: programmes,
+        academic_year:
+      )
     else
       scope
     end
@@ -208,9 +198,17 @@ def filter_patient_specific_direction_status(scope)
 
     case status
     when :added
-      scope.has_patient_specific_direction(programme: programmes, team:)
+      scope.with_patient_specific_direction(
+        programme: programmes,
+        academic_year:,
+        team:
+      )
     when :not_added
-      scope.without_patient_specific_direction(programme: programmes, team:)
+      scope.without_patient_specific_direction(
+        programme: programmes,
+        academic_year:,
+        team:
+      )
     else
       scope
     end
@@ -218,7 +216,7 @@ def filter_patient_specific_direction_status(scope)
 
   def filter_register_status(scope)
     if (status = register_status&.to_sym).present?
-      scope.has_registration_status(status, session: @session)
+      scope.has_registration_status(status, session:)
     else
       scope
     end
@@ -226,11 +224,7 @@ def filter_register_status(scope)
 
   def filter_triage_status(scope)
     if (status = triage_status&.to_sym).present?
-      if @session
-        scope.has_triage_status(status, programme: programmes)
-      else
-        scope.has_triage_status(status, programme: programmes, academic_year:)
-      end
+      scope.has_triage_status(status, programme: programmes, academic_year:)
     else
       scope
     end
@@ -238,7 +232,11 @@ def filter_triage_status(scope)
 
   def filter_vaccine_method(scope)
     if vaccine_method.present?
-      scope.has_vaccine_method(vaccine_method, programme: programmes)
+      scope.has_vaccine_method(
+        vaccine_method,
+        programme: programmes,
+        academic_year:
+      )
     else
       scope
     end
diff --git a/app/lib/programme_birth_academic_years.rb b/app/lib/programme_birth_academic_years.rb
new file mode 100644
index 0000000000..3c71c09b8d
--- /dev/null
+++ b/app/lib/programme_birth_academic_years.rb
@@ -0,0 +1,18 @@
+# frozen_string_literal: true
+
+class ProgrammeBirthAcademicYears
+  def initialize(programme_year_groups, academic_year:)
+    @programme_year_groups = programme_year_groups
+    @academic_year = academic_year
+  end
+
+  def [](programme)
+    programme_year_groups[programme].map do
+      it.to_birth_academic_year(academic_year:)
+    end
+  end
+
+  private
+
+  attr_reader :programme_year_groups, :academic_year
+end
diff --git a/app/lib/stats/organisations.rb b/app/lib/stats/organisations.rb
index da08fbb8a6..4d80f98714 100644
--- a/app/lib/stats/organisations.rb
+++ b/app/lib/stats/organisations.rb
@@ -186,6 +186,6 @@ def calculate_vaccination_stats(programme)
   end
 
   def get_eligible_patients(programme)
-    patients.appear_in_programmes([programme], academic_year: academic_year)
+    patients.appear_in_programmes([programme], academic_year:)
   end
 end
diff --git a/app/lib/status_updater.rb b/app/lib/status_updater.rb
index 6e33e4cc78..8ae1281d56 100644
--- a/app/lib/status_updater.rb
+++ b/app/lib/status_updater.rb
@@ -207,7 +207,6 @@ def programme_ids_per_year_group
   def programme_ids_per_location_id_and_year_group
     @programme_ids_per_location_id_and_year_group ||=
       LocationProgrammeYearGroup
-        .distinct
         .pluck(:location_id, :programme_id, :year_group)
         .each_with_object({}) do |(location_id, programme_id, year_group), hash|
           hash[location_id] ||= {}
diff --git a/app/models/location_programme_year_group.rb b/app/models/location_programme_year_group.rb
index 845f2e282a..6129e9d1d4 100644
--- a/app/models/location_programme_year_group.rb
+++ b/app/models/location_programme_year_group.rb
@@ -29,6 +29,11 @@ class LocationProgrammeYearGroup < ApplicationRecord
   scope :pluck_year_groups,
         -> { distinct.order(:year_group).pluck(:year_group) }
 
+  scope :pluck_birth_academic_years,
+        ->(academic_year:) do
+          pluck_year_groups.map { it.to_birth_academic_year(academic_year:) }
+        end
+
   def birth_academic_year(academic_year: nil)
     year_group.to_birth_academic_year(academic_year:)
   end
diff --git a/app/models/patient.rb b/app/models/patient.rb
index 1e18884e7e..c4fa6ba76c 100644
--- a/app/models/patient.rb
+++ b/app/models/patient.rb
@@ -104,10 +104,22 @@ class Patient < ApplicationRecord
         end
 
   scope :joins_sessions, -> { joins(:patient_locations).joins(<<-SQL) }
-      INNER JOIN sessions
-      ON sessions.location_id = patient_locations.location_id
-      AND sessions.academic_year = patient_locations.academic_year
-    SQL
+    INNER JOIN sessions
+    ON sessions.location_id = patient_locations.location_id
+    AND sessions.academic_year = patient_locations.academic_year
+  SQL
+
+  scope :joins_session_programmes, -> { joins(<<-SQL) }
+    INNER JOIN session_programmes
+    ON session_programmes.session_id = sessions.id
+  SQL
+
+  scope :joins_location_programme_year_groups, -> { joins(<<-SQL) }
+    INNER JOIN location_programme_year_groups
+    ON location_programme_year_groups.location_id = sessions.location_id
+    AND location_programme_year_groups.programme_id = session_programmes.programme_id
+    AND location_programme_year_groups.year_group = sessions.academic_year - patients.birth_academic_year - #{Integer::AGE_CHILDREN_START_SCHOOL}
+  SQL
 
   scope :archived,
         ->(team:) do
@@ -141,24 +153,34 @@ class Patient < ApplicationRecord
   scope :appear_in_programmes,
         ->(programmes, academic_year:) do
           where(
-            PatientLocation
-              .where(academic_year:)
-              .where("patient_id = patients.id")
-              .appear_in_programmes(programmes)
-              .arel
-              .exists
+            id:
+              joins_sessions
+                .joins_session_programmes
+                .joins_location_programme_year_groups
+                .where(sessions: { academic_year: })
+                .where(
+                  session_programmes: {
+                    programme_id: programmes.map(&:id)
+                  }
+                )
+                .select("patients.id")
           )
         end
 
   scope :not_appear_in_programmes,
         ->(programmes, academic_year:) do
           where.not(
-            PatientLocation
-              .where(academic_year:)
-              .where("patient_id = patients.id")
-              .appear_in_programmes(programmes)
-              .arel
-              .exists
+            id:
+              joins_sessions
+                .joins_session_programmes
+                .joins_location_programme_year_groups
+                .where(sessions: { academic_year: })
+                .where(
+                  session_programmes: {
+                    programme_id: programmes.map(&:id)
+                  }
+                )
+                .select("patients.id")
           )
         end
 
@@ -243,6 +265,80 @@ class Patient < ApplicationRecord
           )
         end
 
+  scope :has_vaccine_method,
+        ->(vaccine_method, programme:, academic_year:) do
+          where(
+            Patient::TriageStatus
+              .where("patient_id = patients.id")
+              .where(vaccine_method:, programme:, academic_year:)
+              .arel
+              .exists
+          ).or(
+            where(
+              Patient::TriageStatus
+                .where("patient_id = patients.id")
+                .where(status: "not_required", programme:, academic_year:)
+                .arel
+                .exists
+            ).where(
+              Patient::ConsentStatus
+                .where("patient_id = patients.id")
+                .where(programme:, academic_year:)
+                .has_vaccine_method(vaccine_method)
+                .arel
+                .exists
+            )
+          )
+        end
+
+  scope :has_registration_status,
+        ->(status, session:) do
+          where(
+            Patient::RegistrationStatus
+              .where("patient_id = patients.id")
+              .where(session:, status:)
+              .arel
+              .exists
+          )
+        end
+
+  scope :with_patient_specific_direction,
+        ->(programme:, academic_year:, team:) do
+          where(
+            PatientSpecificDirection
+              .where("patient_id = patients.id")
+              .where(programme:, academic_year:, team:)
+              .not_invalidated
+              .arel
+              .exists
+          )
+        end
+
+  scope :without_patient_specific_direction,
+        ->(programme:, academic_year:, team:) do
+          where.not(
+            PatientSpecificDirection
+              .where("patient_id = patients.id")
+              .where(programme:, academic_year:, team:)
+              .not_invalidated
+              .arel
+              .exists
+          )
+        end
+
+  scope :consent_given_and_ready_to_vaccinate,
+        ->(programmes:, academic_year:, vaccine_method:) do
+          select do |patient|
+            programmes.any? do |programme|
+              patient.consent_given_and_safe_to_vaccinate?(
+                programme:,
+                academic_year:,
+                vaccine_method:
+              )
+            end
+          end
+        end
+
   validates :given_name, :family_name, :date_of_birth, presence: true
 
   validates :birth_academic_year, comparison: { greater_than_or_equal_to: 1990 }
@@ -274,10 +370,6 @@ class Patient < ApplicationRecord
 
   delegate :fhir_record, to: :fhir_mapper
 
-  def sessions
-    Session.joins_patient_locations.where(patient_locations: { patient_id: id })
-  end
-
   def self.match_existing(
     nhs_number:,
     given_name:,
@@ -347,6 +439,16 @@ def self.match_existing(
     results
   end
 
+  def sessions
+    Session
+      .joins_patient_locations
+      .joins_patients
+      .joins(:session_programmes)
+      .joins_location_programme_year_groups
+      .where(patients: { id: })
+      .distinct
+  end
+
   def teams
     Team.left_outer_joins(:sessions).joins(<<-SQL)
         INNER JOIN patient_locations
diff --git a/app/models/patient_location.rb b/app/models/patient_location.rb
index ab6b36b8c1..e23f0acaec 100644
--- a/app/models/patient_location.rb
+++ b/app/models/patient_location.rb
@@ -60,198 +60,36 @@ class PatientLocation < ApplicationRecord
   scope :current, -> { where(academic_year: AcademicYear.current) }
   scope :pending, -> { where(academic_year: AcademicYear.pending) }
 
-  scope :archived, ->(team:) { merge(Patient.archived(team:)) }
-
-  scope :not_archived, ->(team:) { merge(Patient.not_archived(team:)) }
-
   scope :joins_sessions, -> { joins(<<-SQL) }
-      INNER JOIN sessions
-      ON sessions.location_id = patient_locations.location_id
-      AND sessions.academic_year = patient_locations.academic_year
-    SQL
+    INNER JOIN sessions
+    ON sessions.location_id = patient_locations.location_id
+    AND sessions.academic_year = patient_locations.academic_year
+  SQL
+
+  scope :joins_session_programmes, -> { joins(<<-SQL) }
+    INNER JOIN session_programmes
+    ON session_programmes.session_id = sessions.id
+  SQL
+
+  scope :joins_location_programme_year_groups, -> { joins(<<-SQL) }
+    INNER JOIN location_programme_year_groups
+    ON location_programme_year_groups.location_id = patient_locations.location_id
+    AND location_programme_year_groups.programme_id = session_programmes.programme_id
+    AND location_programme_year_groups.year_group = patient_locations.academic_year - patients.birth_academic_year - #{Integer::AGE_CHILDREN_START_SCHOOL}
+  SQL
 
   scope :appear_in_programmes,
         ->(programmes) do
-          # Are any of the programmes administered in the session?
-          programme_in_session =
-            SessionProgramme
-              .joins(:session)
-              .where(programme: programmes)
-              .where("sessions.location_id = patient_locations.location_id")
-              .where("sessions.academic_year = patient_locations.academic_year")
-              .arel
-              .exists
-
-          # Is the patient eligible for any of those programmes by year group?
-          patient_in_administered_year_groups =
-            LocationProgrammeYearGroup
-              .where(programme: programmes)
-              .where(
-                "location_programme_year_groups.location_id = patient_locations.location_id"
-              )
-              .where(
-                "year_group = patient_locations.academic_year " \
-                  "- patients.birth_academic_year " \
-                  "- #{Integer::AGE_CHILDREN_START_SCHOOL}"
-              )
-              .arel
-              .exists
-
-          where(programme_in_session).where(patient_in_administered_year_groups)
-        end
-
-  scope :search_by_name,
-        ->(name) { joins(:patient).merge(Patient.search_by_name(name)) }
-
-  scope :search_by_year_groups,
-        ->(year_groups, academic_year:) do
-          joins(:patient).merge(
-            Patient.search_by_year_groups(year_groups, academic_year:)
-          )
-        end
-
-  scope :search_by_date_of_birth_year,
-        ->(year) do
-          where("extract(year from patients.date_of_birth) = ?", year)
-        end
-
-  scope :search_by_date_of_birth_month,
-        ->(month) do
-          where("extract(month from patients.date_of_birth) = ?", month)
-        end
-
-  scope :search_by_date_of_birth_day,
-        ->(day) { where("extract(day from patients.date_of_birth) = ?", day) }
-
-  scope :search_by_nhs_number,
-        ->(nhs_number) { merge(Patient.search_by_nhs_number(nhs_number)) }
-
-  scope :order_by_name,
-        -> do
-          joins(:patient).order(
-            "LOWER(patients.family_name)",
-            "LOWER(patients.given_name)"
-          )
-        end
-
-  scope :has_consent_status,
-        ->(status, programme:, vaccine_method: nil) do
-          consent_status_scope =
-            Patient::ConsentStatus
-              .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = patient_locations.academic_year")
-              .where(status:, programme:)
-
-          if vaccine_method
-            consent_status_scope =
-              consent_status_scope.has_vaccine_method(vaccine_method)
-          end
-
-          where(consent_status_scope.arel.exists)
-        end
-
-  scope :has_registration_status,
-        ->(status, session:) do
-          where(
-            Patient::RegistrationStatus
-              .where("patient_id = patient_locations.patient_id")
-              .where(session:, status:)
-              .arel
-              .exists
-          )
-        end
-
-  scope :has_triage_status,
-        ->(status, programme:) do
-          where(
-            Patient::TriageStatus
-              .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = patient_locations.academic_year")
-              .where(status:, programme:)
-              .arel
-              .exists
-          )
-        end
-
-  scope :has_vaccination_status,
-        ->(status, programme:) do
-          where(
-            Patient::VaccinationStatus
-              .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = patient_locations.academic_year")
-              .where(status:, programme:)
-              .arel
-              .exists
-          )
-        end
-
-  scope :has_vaccine_method,
-        ->(vaccine_method, programme:) do
-          where(
-            Patient::TriageStatus
-              .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = patient_locations.academic_year")
-              .where(vaccine_method:, programme:)
-              .arel
-              .exists
-          ).or(
-            where(
-              Patient::TriageStatus
-                .where("patient_id = patient_locations.patient_id")
-                .where("academic_year = patient_locations.academic_year")
-                .where(status: "not_required", programme:)
-                .arel
-                .exists
-            ).where(
-              Patient::ConsentStatus
-                .where("patient_id = patient_locations.patient_id")
-                .where("academic_year = patient_locations.academic_year")
-                .where(programme:)
-                .has_vaccine_method(vaccine_method)
-                .arel
-                .exists
-            )
-          )
-        end
-
-  scope :consent_given_and_ready_to_vaccinate,
-        ->(programmes:, academic_year:, vaccine_method:) do
-          select do |patient_location|
-            patient = patient_location.patient
-
-            programmes.any? do |programme|
-              patient.consent_given_and_safe_to_vaccinate?(
-                programme:,
-                academic_year:,
-                vaccine_method:
-              )
-            end
-          end
-        end
-
-  scope :without_patient_specific_direction,
-        ->(programme:, team:) do
-          where.not(
-            PatientSpecificDirection
-              .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = patient_locations.academic_year")
-              .where(programme:, team:)
-              .not_invalidated
-              .arel
-              .exists
-          )
-        end
-
-  scope :has_patient_specific_direction,
-        ->(programme:, team:) do
           where(
-            PatientSpecificDirection
-              .where("patient_id = patient_locations.patient_id")
-              .where("academic_year = patient_locations.academic_year")
-              .where(programme:, team:)
-              .not_invalidated
-              .arel
-              .exists
+            id:
+              joins_session_programmes
+                .joins_location_programme_year_groups
+                .where(
+                  session_programmes: {
+                    programme_id: programmes.map(&:id)
+                  }
+                )
+                .select("patient_locations.id")
           )
         end
 
diff --git a/app/models/session.rb b/app/models/session.rb
index 28253dce5d..d07e92e260 100644
--- a/app/models/session.rb
+++ b/app/models/session.rb
@@ -68,10 +68,22 @@ class Session < ApplicationRecord
   accepts_nested_attributes_for :session_dates, allow_destroy: true
 
   scope :joins_patient_locations, -> { joins(<<-SQL) }
-      INNER JOIN patient_locations
-      ON patient_locations.location_id = sessions.location_id
-      AND patient_locations.academic_year = sessions.academic_year
-    SQL
+    INNER JOIN patient_locations
+    ON patient_locations.location_id = sessions.location_id
+    AND patient_locations.academic_year = sessions.academic_year
+  SQL
+
+  scope :joins_patients, -> { joins(<<-SQL) }
+    INNER JOIN patients
+    ON patients.id = patient_locations.patient_id
+  SQL
+
+  scope :joins_location_programme_year_groups, -> { joins(<<-SQL) }
+    INNER JOIN location_programme_year_groups
+    ON location_programme_year_groups.location_id = sessions.location_id
+    AND location_programme_year_groups.programme_id = session_programmes.programme_id
+    AND location_programme_year_groups.year_group = sessions.academic_year - patients.birth_academic_year - #{Integer::AGE_CHILDREN_START_SCHOOL}
+  SQL
 
   scope :has_date,
         ->(value) { where(SessionDate.for_session.where(value:).arel.exists) }
@@ -184,6 +196,21 @@ class Session < ApplicationRecord
 
   delegate :clinic?, :generic_clinic?, :school?, to: :location
 
+  def programme_birth_academic_years
+    @programme_birth_academic_years ||=
+      ProgrammeBirthAcademicYears.new(programme_year_groups, academic_year:)
+  end
+
+  def patients
+    birth_academic_years =
+      location_programme_year_groups.pluck_birth_academic_years(academic_year:)
+
+    Patient
+      .joins_sessions
+      .where(sessions: { id: })
+      .where(birth_academic_year: birth_academic_years)
+  end
+
   def to_param = slug
 
   def today? = dates.any?(&:today?)
diff --git a/app/views/programmes/sessions/index.html.erb b/app/views/programmes/sessions/index.html.erb
index 7f85f6ff85..6aeffa0992 100644
--- a/app/views/programmes/sessions/index.html.erb
+++ b/app/views/programmes/sessions/index.html.erb
@@ -12,4 +12,4 @@
 
 <%= render AppProgrammeNavigationComponent.new(@programme, @academic_year, active: :sessions) %>
 
-<%= render AppProgrammeSessionTableComponent.new(@sessions, programme: @programme) %>
+<%= render AppProgrammeSessionTableComponent.new(@sessions, programme: @programme, academic_year: @academic_year) %>
diff --git a/app/views/sessions/consent/show.html.erb b/app/views/sessions/consent/show.html.erb
index f7a8a9ff02..8094ee63ee 100644
--- a/app/views/sessions/consent/show.html.erb
+++ b/app/views/sessions/consent/show.html.erb
@@ -22,9 +22,9 @@
   <div class="app-grid-column-results">
     <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
     <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-      <% @patient_locations.each do |patient_location| %>
+      <% @patients.each do |patient| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
-              patient: patient_location.patient,
+              patient:,
               session: @session,
               context: :consent,
               programmes: @form.programmes,
diff --git a/app/views/sessions/patient_specific_directions/show.html.erb b/app/views/sessions/patient_specific_directions/show.html.erb
index a297d0e3fc..c73e654abe 100644
--- a/app/views/sessions/patient_specific_directions/show.html.erb
+++ b/app/views/sessions/patient_specific_directions/show.html.erb
@@ -38,9 +38,9 @@
 
     <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
     <%= render AppSearchResultsComponent.new(@pagy, label: "children", heading: "Review PSDs") do %>
-      <% @patient_locations.each do |patient_location| %>
+      <% @patients.each do |patient| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
-              patient: patient_location.patient,
+              patient:,
               session: @session,
               context: :patient_specific_direction,
             ) %>
diff --git a/app/views/sessions/patients/show.html.erb b/app/views/sessions/patients/show.html.erb
index 3259ca93f0..76bc9d1e1c 100644
--- a/app/views/sessions/patients/show.html.erb
+++ b/app/views/sessions/patients/show.html.erb
@@ -22,9 +22,9 @@
   <div class="app-grid-column-results">
     <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
     <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-      <% @patient_locations.each do |patient_location| %>
+      <% @patients.each do |patient| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
-              patient: patient_location.patient,
+              patient:,
               session: @session,
               context: :patients,
               programmes: @form.programmes,
diff --git a/app/views/sessions/record/show.html.erb b/app/views/sessions/record/show.html.erb
index 3899d686c7..d82a377be7 100644
--- a/app/views/sessions/record/show.html.erb
+++ b/app/views/sessions/record/show.html.erb
@@ -24,9 +24,9 @@
       <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
       <%= render AppVaccinationsSummaryTableComponent.new(current_user:, session: @session, request_session: session) %>
       <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-        <% @patient_locations.each do |patient_location| %>
+        <% @patients.each do |patient| %>
           <%= render AppPatientSessionSearchResultCardComponent.new(
-                patient: patient_location.patient,
+                patient:,
                 session: @session,
                 context: :record,
                 programmes: @form.programmes,
diff --git a/app/views/sessions/register/show.html.erb b/app/views/sessions/register/show.html.erb
index 9e8a087409..4df9a18f34 100644
--- a/app/views/sessions/register/show.html.erb
+++ b/app/views/sessions/register/show.html.erb
@@ -24,9 +24,9 @@
     <div class="app-grid-column-results">
       <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
       <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-        <% @patient_locations.each do |patient_location| %>
+        <% @patients.each do |patient| %>
           <%= render AppPatientSessionSearchResultCardComponent.new(
-                patient: patient_location.patient,
+                patient:,
                 session: @session,
                 context: :register,
                 programmes: @form.programmes,
diff --git a/app/views/sessions/triage/show.html.erb b/app/views/sessions/triage/show.html.erb
index 3e56b5514a..d4e49a14cf 100644
--- a/app/views/sessions/triage/show.html.erb
+++ b/app/views/sessions/triage/show.html.erb
@@ -22,9 +22,9 @@
   <div class="app-grid-column-results">
     <%= render AppSessionNeedsReviewWarningComponent.new(session: @session) %>
     <%= render AppSearchResultsComponent.new(@pagy, label: "children") do %>
-      <% @patient_locations.each do |patient_location| %>
+      <% @patients.each do |patient| %>
         <%= render AppPatientSessionSearchResultCardComponent.new(
-              patient: patient_location.patient,
+              patient:,
               session: @session,
               context: :triage,
               programmes: @form.programmes,
diff --git a/spec/components/app_programme_session_table_component_spec.rb b/spec/components/app_programme_session_table_component_spec.rb
index fc96c1a13a..e96ea17172 100644
--- a/spec/components/app_programme_session_table_component_spec.rb
+++ b/spec/components/app_programme_session_table_component_spec.rb
@@ -3,9 +3,10 @@
 describe AppProgrammeSessionTableComponent do
   subject(:rendered) { render_inline(component) }
 
-  let(:component) { described_class.new(sessions, programme:) }
+  let(:component) { described_class.new(sessions, programme:, academic_year:) }
 
   let(:programme) { create(:programme) }
+  let(:academic_year) { AcademicYear.current }
   let(:location) do
     create(:school, name: "Waterloo Road", programmes: [programme])
   end
diff --git a/spec/features/parental_consent_flu_spec.rb b/spec/features/parental_consent_flu_spec.rb
index 332cd0c0c2..ae2bd375aa 100644
--- a/spec/features/parental_consent_flu_spec.rb
+++ b/spec/features/parental_consent_flu_spec.rb
@@ -39,7 +39,7 @@
   def given_a_flu_programme_is_underway
     @programme = create(:programme, :flu)
     @team = create(:team, :with_one_nurse, programmes: [@programme])
-    location = create(:school, name: "Pilot School")
+    location = create(:school, name: "Pilot School", programmes: [@programme])
     @session = create(:session, :scheduled, programmes: [@programme], location:)
     @child = create(:patient, session: @session)
   end
diff --git a/spec/forms/patient_search_form_spec.rb b/spec/forms/patient_search_form_spec.rb
index c8485df99e..ff4be12440 100644
--- a/spec/forms/patient_search_form_spec.rb
+++ b/spec/forms/patient_search_form_spec.rb
@@ -59,7 +59,7 @@
 
   let(:empty_params) { {} }
 
-  context "for patients" do
+  describe "#apply" do
     let(:scope) { Patient.all }
 
     let(:session_for_patients) { create(:session, team:, programmes:) }
@@ -217,8 +217,8 @@
       end
     end
 
-    context "filtering on programmes" do
-      let(:consent_status) { nil }
+    context "filtering on consent status" do
+      let(:consent_statuses) { %w[given refused] }
       let(:date_of_birth_day) { nil }
       let(:date_of_birth_month) { nil }
       let(:date_of_birth_year) { nil }
@@ -230,133 +230,41 @@
       let(:triage_status) { nil }
       let(:year_groups) { nil }
 
-      let(:programme) { create(:programme, :menacwy) }
-      let(:programmes) { [programme] }
-
-      context "with a patient eligible for the programme" do
-        let(:patient) { create(:patient, session: session_for_patients) }
+      let(:session) { session_for_patients }
 
-        it "is included" do
-          expect(form.apply(scope)).to include(patient)
-        end
-      end
+      it "filters on consent status" do
+        patient_given =
+          create(:patient, :consent_given_triage_not_needed, session:)
 
-      context "with a patient not eligible for the programme" do
-        let(:patient) { create(:patient, year_group: 8) }
+        patient_refused = create(:patient, :consent_refused, session:)
 
-        it "is not included" do
-          expect(form.apply(scope)).not_to include(patient)
-        end
+        expect(form.apply(scope)).to contain_exactly(
+          patient_given,
+          patient_refused
+        )
       end
-    end
 
-    context "filtering on programme status" do
-      let(:consent_statuses) { nil }
-      let(:date_of_birth_day) { nil }
-      let(:date_of_birth_month) { nil }
-      let(:date_of_birth_year) { nil }
-      let(:missing_nhs_number) { nil }
-      let(:vaccination_status) { "vaccinated" }
-      let(:programme_types) { programmes.map(&:type) }
-      let(:q) { nil }
-      let(:register_status) { nil }
-      let(:triage_status) { nil }
-      let(:year_groups) { nil }
+      context "with combined consent status and vaccine method" do
+        let(:consent_statuses) { %w[given_nasal] }
+
+        it "filters on consent status" do
+          patient_given_nasal =
+            create(
+              :patient,
+              :consent_given_nasal_only_triage_not_needed,
+              session:
+            )
 
-      it "filters on programme status" do
-        patient =
           create(
             :patient,
-            :vaccinated,
-            programmes:,
-            session: session_for_patients
-          )
-
-        expect(form.apply(scope)).to include(patient)
-      end
-    end
-
-    context "searching on name" do
-      let(:consent_statuses) { nil }
-      let(:date_of_birth_day) { nil }
-      let(:date_of_birth_month) { nil }
-      let(:date_of_birth_year) { nil }
-      let(:missing_nhs_number) { nil }
-      let(:vaccination_status) { nil }
-      let(:q) { nil }
-      let(:register_status) { nil }
-      let(:triage_status) { nil }
-      let(:year_groups) { nil }
-
-      let(:patient_a) do
-        create(
-          :patient,
-          given_name: "Harry",
-          family_name: "Potter",
-          session: session_for_patients
-        )
-      end
-      let(:patient_b) do
-        create(
-          :patient,
-          given_name: "Hari",
-          family_name: "Potter",
-          session: session_for_patients
-        )
-      end
-      let(:patient_c) do
-        create(
-          :patient,
-          given_name: "Arry",
-          family_name: "Pott",
-          session: session_for_patients
-        )
-      end
-      let(:patient_d) do
-        create(
-          :patient,
-          given_name: "Ron",
-          family_name: "Weasley",
-          session: session_for_patients
-        )
-      end
-      let(:patient_e) do
-        create(
-          :patient,
-          given_name: "Ginny",
-          family_name: "Weasley",
-          session: session_for_patients
-        )
-      end
-
-      context "with no search query" do
-        let(:q) { nil }
-
-        it "sorts alphabetically by name" do
-          expect(form.apply(scope)).to eq(
-            [patient_c, patient_b, patient_a, patient_e, patient_d]
+            :consent_given_injection_only_triage_not_needed,
+            session:
           )
-        end
-      end
 
-      context "with some search query" do
-        let(:q) { "Harry Potter" }
-
-        it "sorts by similarity" do
-          expect(form.apply(scope)).to eq([patient_a, patient_b, patient_c])
+          expect(form.apply(scope)).to contain_exactly(patient_given_nasal)
         end
       end
     end
-  end
-
-  context "for patient sessions" do
-    let(:scope) { PatientLocation.all }
-
-    let(:session) { create(:session, programmes:, team:) }
-
-    it "doesn't raise an error" do
-      expect { form.apply(scope) }.not_to raise_error
-    end
 
     context "filtering on programmes" do
       let(:consent_status) { nil }
@@ -371,75 +279,49 @@
       let(:triage_status) { nil }
       let(:year_groups) { nil }
 
-      let(:programmes) { [create(:programme, :menacwy)] }
-
-      context "with a patient session eligible for the programme" do
-        let(:patient) { create(:patient, year_group: 9) }
+      let(:programme) { create(:programme, :menacwy) }
+      let(:programmes) { [programme] }
 
-        let(:patient_location) { create(:patient_location, patient:, session:) }
+      context "with a patient eligible for the programme" do
+        let(:patient) { create(:patient, session: session_for_patients) }
 
         it "is included" do
-          expect(form.apply(scope)).to include(patient_location)
+          expect(form.apply(scope)).to include(patient)
         end
       end
 
-      context "with a patient session not eligible for the programme" do
+      context "with a patient not eligible for the programme" do
         let(:patient) { create(:patient, year_group: 8) }
 
-        let(:patient_location) { create(:patient_location, patient:, session:) }
-
         it "is not included" do
-          expect(form.apply(scope)).not_to include(patient_location)
+          expect(form.apply(scope)).not_to include(patient)
         end
       end
     end
 
-    context "filtering on consent status" do
-      let(:consent_statuses) { %w[given refused] }
+    context "filtering on programme status" do
+      let(:consent_statuses) { nil }
       let(:date_of_birth_day) { nil }
       let(:date_of_birth_month) { nil }
       let(:date_of_birth_year) { nil }
       let(:missing_nhs_number) { nil }
-      let(:vaccination_status) { nil }
+      let(:vaccination_status) { "vaccinated" }
       let(:programme_types) { programmes.map(&:type) }
       let(:q) { nil }
       let(:register_status) { nil }
       let(:triage_status) { nil }
       let(:year_groups) { nil }
 
-      it "filters on consent status" do
-        patient_given =
-          create(:patient, :consent_given_triage_not_needed, session:)
-
-        patient_refused = create(:patient, :consent_refused, session:)
-
-        expect(form.apply(scope)).to contain_exactly(
-          patient_given.patient_locations.first,
-          patient_refused.patient_locations.first
-        )
-      end
-
-      context "with combined consent status and vaccine method" do
-        let(:consent_statuses) { %w[given_nasal] }
-
-        it "filters on consent status" do
-          patient_location_given_nasal =
-            create(
-              :patient,
-              :consent_given_nasal_only_triage_not_needed,
-              session:
-            ).patient_locations.first
-
+      it "filters on programme status" do
+        patient =
           create(
             :patient,
-            :consent_given_injection_only_triage_not_needed,
-            session:
+            :vaccinated,
+            programmes:,
+            session: session_for_patients
           )
 
-          expect(form.apply(scope)).to contain_exactly(
-            patient_location_given_nasal
-          )
-        end
+        expect(form.apply(scope)).to include(patient)
       end
     end
 
@@ -455,10 +337,11 @@
       let(:triage_status) { nil }
       let(:year_groups) { nil }
 
+      let(:session) { session_for_patients }
+
       it "filters on register status" do
         patient = create(:patient, :in_attendance, session:)
-        patient_location = patient.patient_locations.first
-        expect(form.apply(scope)).to include(patient_location)
+        expect(form.apply(scope)).to include(patient)
       end
     end
 
@@ -475,11 +358,12 @@
       let(:triage_status) { "required" }
       let(:year_groups) { nil }
 
+      let(:session) { session_for_patients }
+
       it "filters on triage status" do
         patient = create(:patient, :consent_given_triage_needed, session:)
-        patient_location = patient.patient_locations.first
 
-        expect(form.apply(scope)).to include(patient_location)
+        expect(form.apply(scope)).to include(patient)
       end
     end
 
@@ -496,28 +380,25 @@
       let(:triage_status) { nil }
       let(:year_groups) { nil }
 
-      let!(:patient_location_with_psd) do
-        create(:patient_location, session:).tap do |patient_location|
-          create(
-            :patient_specific_direction,
-            patient: patient_location.patient,
-            programme: programmes.first,
-            team:
-          )
-        end
-      end
+      let(:session) { session_for_patients }
+
+      let!(:patient_with_psd) { create(:patient, session:) }
+      let!(:patient_without_psd) { create(:patient, session:) }
 
-      let!(:patient_location_without_psd) do
-        create(:patient_location, session:)
+      before do
+        create(
+          :patient_specific_direction,
+          patient: patient_with_psd,
+          programme: programmes.first,
+          team:
+        )
       end
 
       context "when status is 'added'" do
         let(:patient_specific_direction_status) { "added" }
 
         it "finds the patient with the PSD" do
-          expect(form.apply(scope)).to contain_exactly(
-            patient_location_with_psd
-          )
+          expect(form.apply(scope)).to contain_exactly(patient_with_psd)
         end
       end
 
@@ -525,9 +406,7 @@
         let(:patient_specific_direction_status) { "not_added" }
 
         it "finds the patient that has no PSD" do
-          expect(form.apply(scope)).to contain_exactly(
-            patient_location_without_psd
-          )
+          expect(form.apply(scope)).to contain_exactly(patient_without_psd)
         end
       end
     end
@@ -546,7 +425,7 @@
       let(:vaccine_method) { "nasal" }
       let(:year_groups) { nil }
 
-      let(:programme) { create(:programme, :flu) }
+      let(:session) { session_for_patients }
 
       it "filters on vaccine method" do
         nasal_patient =
@@ -573,10 +452,80 @@
           vaccine_methods: %w[injection nasal]
         )
 
-        expect(form.apply(scope)).to contain_exactly(
-          nasal_patient.patient_locations.first
+        expect(form.apply(scope)).to contain_exactly(nasal_patient)
+      end
+    end
+
+    context "searching on name" do
+      let(:consent_statuses) { nil }
+      let(:date_of_birth_day) { nil }
+      let(:date_of_birth_month) { nil }
+      let(:date_of_birth_year) { nil }
+      let(:missing_nhs_number) { nil }
+      let(:vaccination_status) { nil }
+      let(:q) { nil }
+      let(:register_status) { nil }
+      let(:triage_status) { nil }
+      let(:year_groups) { nil }
+
+      let(:patient_a) do
+        create(
+          :patient,
+          given_name: "Harry",
+          family_name: "Potter",
+          session: session_for_patients
         )
       end
+      let(:patient_b) do
+        create(
+          :patient,
+          given_name: "Hari",
+          family_name: "Potter",
+          session: session_for_patients
+        )
+      end
+      let(:patient_c) do
+        create(
+          :patient,
+          given_name: "Arry",
+          family_name: "Pott",
+          session: session_for_patients
+        )
+      end
+      let(:patient_d) do
+        create(
+          :patient,
+          given_name: "Ron",
+          family_name: "Weasley",
+          session: session_for_patients
+        )
+      end
+      let(:patient_e) do
+        create(
+          :patient,
+          given_name: "Ginny",
+          family_name: "Weasley",
+          session: session_for_patients
+        )
+      end
+
+      context "with no search query" do
+        let(:q) { nil }
+
+        it "sorts alphabetically by name" do
+          expect(form.apply(scope)).to eq(
+            [patient_c, patient_b, patient_a, patient_e, patient_d]
+          )
+        end
+      end
+
+      context "with some search query" do
+        let(:q) { "Harry Potter" }
+
+        it "sorts by similarity" do
+          expect(form.apply(scope)).to eq([patient_a, patient_b, patient_c])
+        end
+      end
     end
   end
 
diff --git a/spec/jobs/enqueue_vaccinations_search_in_nhs_job_spec.rb b/spec/jobs/enqueue_vaccinations_search_in_nhs_job_spec.rb
index ac2116ae8f..a8b832bd26 100644
--- a/spec/jobs/enqueue_vaccinations_search_in_nhs_job_spec.rb
+++ b/spec/jobs/enqueue_vaccinations_search_in_nhs_job_spec.rb
@@ -43,13 +43,6 @@
 
       it { should have_received(:perform_bulk).once.with([[patient.id]]) }
 
-      context "community clinic session" do
-        let(:location) { create(:community_clinic, team:, programmes: [flu]) }
-        let(:school) { create(:school, team:, programmes: [flu]) }
-
-        it { should have_received(:perform_bulk).exactly(:once) }
-      end
-
       context "generic clinic session" do
         let(:location) { create(:generic_clinic, team:, programmes: [flu]) }
         let(:school) { create(:school, team:, programmes: [flu]) }
diff --git a/spec/jobs/patients_aged_out_of_school_job_spec.rb b/spec/jobs/patients_aged_out_of_school_job_spec.rb
index 465daf8ad3..6b7f40c3e9 100644
--- a/spec/jobs/patients_aged_out_of_school_job_spec.rb
+++ b/spec/jobs/patients_aged_out_of_school_job_spec.rb
@@ -13,9 +13,6 @@
   let(:date_of_birth) { Date.new(2008, 1, 1) }
 
   let!(:patient) { create(:patient, school:, date_of_birth:) }
-  let!(:clinic_session) do
-    team.generic_clinic_session(academic_year: AcademicYear.pending)
-  end
 
   context "on the last day of July" do
     let(:today) { Date.new(2024, 7, 31) }
@@ -58,8 +55,8 @@
     end
 
     it "adds the patient to the clinic session" do
-      expect { perform }.to change { patient.sessions.count }.by(1)
-      expect(patient.sessions).to include(clinic_session)
+      expect { perform }.to change { patient.locations.count }.by(1)
+      expect(patient.locations).to include(team.generic_clinic)
     end
   end
 end
diff --git a/spec/lib/patient_archiver_spec.rb b/spec/lib/patient_archiver_spec.rb
index 965f0466a0..a227967519 100644
--- a/spec/lib/patient_archiver_spec.rb
+++ b/spec/lib/patient_archiver_spec.rb
@@ -21,8 +21,7 @@
 
   context "when in upcoming sessions" do
     let(:session) { create(:session, :tomorrow, team:) }
-
-    before { create(:patient_location, patient:, session:) }
+    let(:patient) { create(:patient, session:) }
 
     it "removes the patient from the sessions" do
       expect(patient.sessions).to include(session)
diff --git a/spec/models/patient_location_spec.rb b/spec/models/patient_location_spec.rb
index 6b18071ad8..22f3cc5fc8 100644
--- a/spec/models/patient_location_spec.rb
+++ b/spec/models/patient_location_spec.rb
@@ -39,7 +39,10 @@
   describe "scopes" do
     describe "#appear_in_programmes" do
       subject(:scope) do
-        described_class.joins(:patient).appear_in_programmes(programmes)
+        described_class
+          .joins_sessions
+          .joins(:patient)
+          .appear_in_programmes(programmes)
       end
 
       let(:programmes) { create_list(:programme, 1, :td_ipv) }
@@ -80,65 +83,6 @@
         it { should_not include(patient_location) }
       end
     end
-
-    describe "#consent_given_and_ready_to_vaccinate" do
-      subject(:scope) do
-        described_class.consent_given_and_ready_to_vaccinate(
-          programmes:,
-          academic_year:,
-          vaccine_method:
-        )
-      end
-
-      let(:programmes) { [create(:programme, :flu), create(:programme, :hpv)] }
-      let(:session) { create(:session, programmes:) }
-      let(:academic_year) { Date.current.academic_year }
-      let(:vaccine_method) { nil }
-      let(:patient_location) { patient.patient_locations.first }
-
-      it { should be_empty }
-
-      context "with a patient eligible for vaccination" do
-        let(:patient) do
-          create(:patient, :consent_given_triage_not_needed, session:)
-        end
-
-        it { should include(patient_location) }
-      end
-
-      context "when filtering on nasal spray" do
-        let(:vaccine_method) { "nasal" }
-
-        context "with a patient eligible for vaccination" do
-          let(:patient) do
-            create(:patient, :consent_given_triage_not_needed, session:)
-          end
-
-          before do
-            patient.consent_status(
-              programme: programmes.first,
-              academic_year:
-            ).update!(vaccine_methods: %w[nasal injection])
-          end
-
-          it { should include(patient_location) }
-
-          context "when the patient has been vaccinated for flu" do
-            before do
-              create(
-                :vaccination_record,
-                programme: programmes.first,
-                session:,
-                patient:
-              )
-              StatusUpdater.call(session:, patient:)
-            end
-
-            it { should_not include(patient_location) }
-          end
-        end
-      end
-    end
   end
 
   describe "#safe_to_destroy?" do
diff --git a/spec/models/patient_spec.rb b/spec/models/patient_spec.rb
index 8e06e7f1ec..590b82ea0b 100644
--- a/spec/models/patient_spec.rb
+++ b/spec/models/patient_spec.rb
@@ -360,6 +360,64 @@
 
       it { should eq([patient_a, patient_b, patient_c]) }
     end
+
+    describe "#consent_given_and_ready_to_vaccinate" do
+      subject(:scope) do
+        described_class.consent_given_and_ready_to_vaccinate(
+          programmes:,
+          academic_year:,
+          vaccine_method:
+        )
+      end
+
+      let(:programmes) { [create(:programme, :flu), create(:programme, :hpv)] }
+      let(:session) { create(:session, programmes:) }
+      let(:academic_year) { Date.current.academic_year }
+      let(:vaccine_method) { nil }
+
+      it { should be_empty }
+
+      context "with a patient eligible for vaccination" do
+        let(:patient) do
+          create(:patient, :consent_given_triage_not_needed, session:)
+        end
+
+        it { should include(patient) }
+      end
+
+      context "when filtering on nasal spray" do
+        let(:vaccine_method) { "nasal" }
+
+        context "with a patient eligible for vaccination" do
+          let(:patient) do
+            create(:patient, :consent_given_triage_not_needed, session:)
+          end
+
+          before do
+            patient.consent_status(
+              programme: programmes.first,
+              academic_year:
+            ).update!(vaccine_methods: %w[nasal injection])
+          end
+
+          it { should include(patient) }
+
+          context "when the patient has been vaccinated for flu" do
+            before do
+              create(
+                :vaccination_record,
+                programme: programmes.first,
+                session:,
+                patient:
+              )
+              StatusUpdater.call(session:, patient:)
+            end
+
+            it { should_not include(patient) }
+          end
+        end
+      end
+    end
   end
 
   describe "validations" do
@@ -878,12 +936,14 @@
           )
         end
 
-        before { create(:patient_location, patient:, session:) }
+        let!(:patient_location) do
+          create(:patient_location, patient:, session:)
+        end
 
         it "removes the patient from the session" do
-          expect(session.patients).to include(patient)
+          expect(patient.patient_locations).to include(patient_location)
           update_from_pds!
-          expect(session.patients).not_to include(patient)
+          expect(patient.patient_locations).not_to include(patient_location)
         end
 
         it "archives the patient" do
diff --git a/spec/models/school_move_spec.rb b/spec/models/school_move_spec.rb
index 6c9a929228..ab93680a7f 100644
--- a/spec/models/school_move_spec.rb
+++ b/spec/models/school_move_spec.rb
@@ -167,7 +167,7 @@
       let(:academic_year) { AcademicYear.pending }
 
       context "with a patient in no sessions" do
-        let(:patient) { create(:patient, team: nil) }
+        let(:patient) { create(:patient, team: nil, programmes:) }
 
         context "to a school with a scheduled session" do
           let(:school_move) do
@@ -228,7 +228,7 @@
       end
 
       context "with an archived patient" do
-        let(:patient) { create(:patient, team: nil) }
+        let(:patient) { create(:patient, team: nil, programmes:) }
 
         before { create(:archive_reason, :imported_in_error, patient:, team:) }