A patient has been behaving in a troublesome manner, being persistently rude and abusive to staff and critical of the practice, and you want to remove him from your list. However, your partner has raised concerns and is worried you might get referred to the Parliamentary and Health Service Ombudsman. How should you proceed?
Recent NHS figures show that out of the 15,000 investigated complaints made against GPs in England in 2010, a fifth were about patient removal from surgery lists.
If you are considering removing a patient you must think carefully before doing so and follow guidance set by the GMC, RCGP and the BMA, as well as considering the requirements of your GMS contract.
Deviating from these guidelines – which apply to all doctors across the UK – could lead to the patient complaining and even attract the attention of the GMC.
In November 2011, for example, a GP in the West Midlands was ordered to pay £500 in damages and reported to the GMC by the Parliamentary and Health Service Ombudsman after a patient removal row.
You should be aware that your contract requires you to give a warning and a reason before removing a patient, except in exceptional circumstances where this could increase the likelihood of unacceptable behaviour, such as violence or harassment towards a doctor or other member of staff.
If a relationship breaks down between you and a patient, your practice would be encouraged to consider continuing treatment for that patient via another doctor within the practice. However, you retain the right to remove a patient from the practice list if their continued registration with the practice might be detrimental to your primary healthcare team as a whole.
Patient removal should be dealt with sensitively and sympathetically. Situations that may justify removal of a patient include unacceptable behaviour such as physical violence, verbal or physical abuse, sexual and racial harassment, stalking and inappropriate emotional attachment to a doctor.
Another reason is crime and deception such as cases of patients fraudulently obtaining drugs, deliberately lying to a doctor or other member of the healthcare team or stealing from your practice premises or staff. A patient can also be removed legitimately if they move out of the designated practice area.
Except in extreme cases (such as those involving violence), removal should only be considered where the patient has persistently displayed unacceptable behaviour. It is important that you avoid a knee-jerk response to a single incident. Patients should not be removed from a practice list simply because they have made a complaint against your practice, for failing to comply with your health advice or because they have a highly dependent condition or disability.
If you feel your relationship with a patient has irretrievably broken down, you must discuss it carefully with your colleagues, inform the patient of the problem and consider meeting the patient to discuss the situation further.
If all steps fail, you need to inform the patient and your PCT/health board in writing of the decision and reason for removal and explain to the patient how to register with another practice. You shouldn't automatically remove the patient's family, nor should any patient be removed due to the actions of their relatives.
It is important that you thoroughly document the incident or incidents that have led to a removal as well as any discussions with your colleagues and communication with the patient. This will provide valuable evidence if the patients complains. The documentation should be kept in a separate file as it does not form part of the clinical records, and should not be passed to the new practice.
Dr Mary Peddie is a medical adviser with the UK-wide medical and dental defence organisation MDDUS.
