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.
When considering an irrevocable breakdown you may wish to read the GMC guidance on "Ending your professional relationship with a patient".
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 if any further incidents occur they may be removed from the list. Click here to access our zero tolerance pack which includes example template letters
- 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.
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. This process is manged by PCSE (on behalf of NHSE).
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.
If the patient has committed an act of violence or behaved in such a way that staff fear for their safety, then the practice can ask for an immediate removal.
- The practice should call their local police or 999 as appropriate
- The police will need to act as necessary at the time of the incident and likely give the practice a crime/incident number. However, practices do not need a police crime/incident number in order for an immediate removal of a patient that fits the criteria.
- Contact PCSE for an immediate removal (See PCSE webpage)
- Notify NHS England at 0333 014 2884 or firstname.lastname@example.org.
- The removal takes effect at the time at which the practice contacts PCSE.
Inform the patient of the removal, as long as it would not be harmful to the patient’s mental or physical health or put anyone else, including practice staff, at risk.
Notify the CQC ‘without delay’, either while a registered activity is provided or as a consequence of it being provided, including incidents involving the police. (This is part of CQC Regulation 18. You may also wish to look at CQC Mythbuster 21 on this topic)
Once you have notified PCSE, then responsibility passes to them. The patient can continue to receive primary medical services via the Special Allocation Scheme (SAS). PCSE will write to the patient about this and they should also ensure their record is flagged to stop the patient registering at another practice.
- The BMA also has some helpful guidance on this issue.
- NHSE Violent Patient Removal Form
- Primary Care Support England Request for Removal of Patient From Practice List Form