The removal of a patient from a GP practice list should be a rare event. Reasons include:
- disagreement between the practice and patient, and an irretrievable breakdown of the relationship
- the patient has died
- the patient has moved outside the practice area
- patients have a right to change their practice.
Read our guidance on the special allocation scheme for the removal of violent patients.
Removing a patient from the practice list
Practices have the right to ask for a patient to be removed from their list.
In cases other than violence and abuse, the decision to remove a patient should only be made after careful consideration.
Many patients who are misusing services can change their behaviour if it is brought to their attention. If all else fails, however, it is not in the best interests of either the patient or doctor for an unsatisfactory relationship to continue.
- Where practices intend to remove a patient because of the breakdown of the doctor-patient relationship, you should first consider discussing the problem with an independent party, eg LMC secretary.
- Issue a warning to the patient, preferably in writing, giving the reasons for the possibility of removal. Warnings are valid for 12 months and a written record must be retained.
- Send a written notice to the PCO or NHS England, giving the patient’s name, address, date of birth and NHS number.
- The removal will take effect on the eighth day after the request is received.
- If the practice is treating the patient at intervals of less than seven days, the removal will be eight days after treatment ceases, or until the patient is accepted at another practice.
- The only exception is on the grounds of violence, eg when police are involved, in which case the patient will be removed immediately.
- If the removal is on the grounds of violence or threatened violence, the police must have been informed.
Complaints and removals
The BMA neither supports nor condones the removal of patients because they have made a complaint.
The current NHS complaints policy requires all practices to have an in-house complaints procedure. Patients should normally raise a complaint with their practice in the first instance. There is public concern that patients may be removed from the list simply for making a complaint, but complaints made in a reasonable and constructive manner can help practices to improve their services.
The practice-based complaints procedure is a chance to discuss instances where a patient is felt to be behaving inappropriately. This shows patients a possible problem in their relationship with their doctor, along with an opportunity to discuss ways of preventing further difficulties.
However, complaints that are a personal attack on members of the practice or that contain clearly unfounded allegations usually show a serious breakdown in the patient-doctor relationship.
It is a breakdown of the relationship rather than a complaint per se that must form the basis of any decision to remove a patient from the list.
Warning a patient
A warning is not necessary when:
- the removal is due to a change of address
- the practice believes that the warning would harm the patient’s physical or mental health
- the practice believes that issuing the warning would put the safety of members of the practice or those on the premises at risk
- it is, in the GP’s opinion, not otherwise reasonable or practical for a warning to be given.
If no reason is given, an explanation in writing should be made and retained for potential future inspection by the PCO or NHS England.
Removing their family members
If the behaviour of one patient has led to their removal, this does not mean the removal of other family or household members should automatically follow.
An explicit discussion with other family members, while protecting the patient’s confidentiality, should take place.
Visiting their home
In rare cases, because of the possible need to visit patients at home, you might need to remove their family members from the list. This is particularly likely if the patient was removed for violence or threatening behaviour.
Again, reasons should be given. The practice should consider how it looks to observers if a family were to be removed from the list without explanation for a single disagreement with one family member.
Removing patients due to costly care
There has been public perception that patients are being removed from practice lists because their care is too costly, their clinical condition or their age.
The BMA supports actions that make it clear that any such discrimination is unacceptable. The regulations specifically require that a removal is not on the grounds of ‘race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition’.