A patient is found to have forged a sick note to his employer and claims it was from a doctor at your practice. How should you handle this deception and are you entitled to remove the patient from the practice list?
You should consult the RCGP's guidance, Removal of Patients from GPs Lists. The RCGP states that 'unacceptable behaviour such as… crime and deception' are grounds for removal.
Patients must always be given a reason for their removal from a practice, except in ‘very exceptional circumstances.' The practice's contract also requires patients are sent a written warning if they are about to be removed or if they face the risk of removal, should the inappropriate behaviour be repeated.
You should use your judgement as to whether to remove the patient in this instance or simply warn him of the consequences of any repeat behaviour.
The GMC's Good Medical Practice also advises doctors to make a ‘fair' and justifiable decision. If a patient is removed, the doctor must make prompt arrangements for the patient's continuing care.
Dr Anthea Martin is senior medical adviser for the Medical and Dental Defence Union of Scotland
Sick note MDDUS
