No evidence GPs remove patients to hit MMR targets
By Craig Kenny
GPs liken removing patients from their lists to 'divorce' and find it hard to tell patients why they have ended their relationship, research finds.
The qualitative study of 25 Leicestershire GPs also found no evidence to back media claims that doctors are striking off patients for 'unprofessional' reasons, such as helping the practice hit vaccination or screening targets.
GPs said they only removed patients as a 'last resort'.
Most removals were in
cases where patients behaved badly or were 'difficult' rather than for threats or incidents of violence.
The study by the department of general practice and primary care at the University of Leicester found GPs had 'informal' rules defining the doctor-patient relationship and expected standards of behaviour.
GPs removed patients when they broke these rules on more than one occasion, such as through aggression, rudeness, attacking the GPs' competence or making complaints.
But GPs also removed
difficult or heartsink patients who made inappropriate or
repeated demands for house calls, appointments or sicknotes or tried to 'manipulate' them.
'GPs feel their ability to care for the patients had been so badly compromised that the only option is to end their relationship,' the study in Family Practice concluded.
Some GPs said they feared that in their haste to end the consultation with a 'difficult' patient whom they did not like they might miss an important diagnosis.
'One of these days they would have something significantly wrong, and we might miss it, and he would be the first to have you for breakfast,' said one GP.
However, the study found patients were often left confused about their removal because they didn't understand the practice's informal rules and the decision was not explained.
Only one practice had a written policy for removing patients.
Eight GPs said they would not tell the patient why they had been removed because 'usually patients already knew'.
Study author Dr Tim Stokes, a GP in Leicester, said: 'GPs should try to keep patients aware of the difficulties they are having and try to resolve them.'