Removing Patients from Practice Lists
Most removals from the GP list are for administrative reasons e.g. the patient has left the practice area or has died. You can, however, also remove patients from your list if there is an irrevocable breakdown in the doctor-patient relationship or violence.
Please click here to download an example of an agreement/covering letter which a practice may wish to adapt for patients whose behaviour is inappropriate but not violent.
Breakdown in the Relationship
- This may justify removal of a patient from your list
- It should be a very rare event
- Try to resolve complaints so as to maintain the doctor-patient relationship
- Persistent or vexatious complaints or litigation may destroy doctor-patient relationship
- A written warning needs to be issued advising the patient that their behaviour is unacceptable and that any further incidents occur they may be removed from the list. Click here to access our zero tolerance pack which includes example template letters
GPs have the right to request that any patient should be removed from their lists where a written warning has been issued in the preceding 12 month period. Where a practice has reasonable grounds to remove the patient from its list of patients, it must inform the primary care organisation in writing, and must notify the patient in writing of the reasons for removal. However, where the practice believes that it is not appropriate to give specific reasons, it is sufficient to state that there has been an irrevocable breakdown in the relationship between the practice and the patient. Care should be taken to ensure that the reasons given are factual, and that the tone of the letter is polite and suitably informative. There has been increasing publicity surrounding this (see below) and we would always suggest practices contact us for advice if they are considering removing a patient from their list.
Violence or threatening behaviour by the patient........implies a total abrogation by the patient of any responsibility towards the doctor and will normally result in removal from the list. As well as having a right to protect themselves, GPs have a duty as employers to protect their staff. (BMA)
It is now possible to request the immediate removal of any patient who has committed an act of violence or caused the doctor to fear for his or her safety. The police (or in Scotland, either the police or the procurator fiscal) must have been informed of the patient's behaviour and the doctor must notify both the PCO and the patient of the removal in writing. GPs will use their clinical judgement to determine those rare cases where a patient's violent behaviour results from their medical condition.
The Health Service Ombudsman has reported that some GP practices are removing patients from practice lists without warning. It said "there were cases where whole families had been told to find a new doctor after one person was abusive". The ombudsman also said the NHS as a whole was failing to adequately deal with complaints, and many minor disputes were escalating. The ombudsman, which looks at serious complaints that cannot be resolved locally, investigated 10 cases where GPs had struck off patients from their lists - a fifth of the total GP-related cases they took on. All of them were upheld.
Please note that NHS contracts require practices to give a warning before patients are removed from their lists, unless the circumstances are exceptional i.e. involving violence, and the Ombudsman has made it clear that whole families should not be removed due to the behaviour of one.