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Can we remove a family who never turn up from our list?

Several members of the same family keep missing appointments - and seemingly couldn't care less.

Several members of the same family keep missing appointments - and seemingly couldn't care less.

The case

During a recent practice meeting some of the partners complained about different members of a family who persistently failed to keep appointments with the GPs and practice nurses. The family had joined the practice a year ago, and this non-attendance had been a problem right from the start.

The offending patients never apologised or explained why they failed to turn up and we feel enough is enough. We wonder if it is time to remove the whole family from the practice list.

The advice

Removing a patient from your list is generally a last resort for a GP, not least because it can be fraught with difficulty.

In particular, beware of removing patients who are considered "difficult" - because, for example, they have missed an appointment or made a complaint.

"Being difficult" can be difficult to justify. Indeed it may prompt a further complaint from the patient.

The GMC's Good Medical Practice (2006) advises: "Before you end a professional relationship with a patient you must be satisfied that your decision is fair" and is not influenced by your personal views.

It adds that "You must be prepared to justify your decision." (Paragraph 39.)

Unless the patients had been violent, practices would generally be expected to warn the patients that they were at risk of removal in the preceding 12 months as this is a contractual requirement.

Meeting the patient

It may also be worth meeting with the patients concerned to find out whether there are any problems that need to be addressed.

At this meeting you could explain the practice's policy and to try and see if you can do anything to meet the patients` expectations.

The Royal College of General Practitioners has published advice1 on steps, short of removal from the list, which may help to restore the doctor-patient relationship.

If this approach does not work and you feel that the relationship has irretrievably broken down, then it may be that you have no alternative but to set in train the formal procedure for removing a patient from the list.

However, it is a good idea to document all the steps you have taken to resolve the situation up to this point.

Even if you decide to remove the patients concerned, this does not mean that non offending members of the family should be removed too.

It may be hard to justify the removal of patients whose behaviour has not directly lead to problems.

Continuing care

If you decide to remove a patient, the GMC says that "you should inform [them] of your decision and your reasons for ending the professional relationship, wherever practical in writing.

You must take steps to ensure that arrangements are made promptly for the continuing care of the patient, an you must pass on the patient's records without delay." (Paragraph 39, Good Medical Practice.)

You will also need to consider your contractual arrangements.

The practice should notify the PCT in writing that it wishes to have a patient removed.

The patient should also be written to and notified of the reasons for removal, in line with the requirements of the GP contract (General Medical Services Contract Regulations 2004, or the equivalent Primary Medical Services requirements).

It should be made clear that the patient will not be left without a GP and the patient should be given information on how to begin the process of registering with another practice.

Dr David Morgan is a medico-legal adviser with the MDU

The case mentioned is based on cases from the MDU's files. Doctors with specific concerns are advised to contact their medical defence organisation for advice.© The MDU 2008

Can we remove an entire family, none of whom turn up for appointments, from our list?

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