This site is intended for health professionals only


Updated advice says GPs can deregister patients for ‘unrealistic service demands’

GP practices should review policies on patient behaviour, NHS England says

GP practices can now consider deregistering patients who have ‘unnecessarily persistent or unrealistic service demands that cause disruption’.

Stating that protecting GP teams’ mental health is ‘as important’ as protecting their physical health’, NHS England has updated guidance on managing unacceptable patient behaviours to also include non-violent abuse.

These include patients:

  • Using bad language or swearing at practice staff or other service users;
  • Unnecessarily persistent or unrealistic service demands that cause disruption;
  • Verbal, non-verbal and environmental slights, snubs and insults which communicate hostile, derogatory or negative messages;
  • Behaviours that target a person based on their protected characteristic or belonging to a marginalised group. These can be intentional and unintentional and are based on biases (either conscious and unconscious).

The guidance goes on to say that ‘where a patient has acted inappropriately or unacceptably, the provider will need to carefully consider’ if the incident ‘meets the relevant criteria for removal from the practice patient list’.

In doing so, the practices should take into account ‘the nature and severity of the incident/behaviour, the impact on practice services, staff or other service users and the patient’s own circumstances’, and:

  • If the incident does meet the relevant criteria for removal from the practice patient list a practice will need to decide whether it is ‘nevertheless willing to continue to manage its relationship with the patient or proceed with the removal’.
  • If the incident does not meet the relevant criteria for removal from the practice patient list, the practice will need to decide ‘how it will manage its continuing relationship with the patient’.

NHS England’s guidance added that removing a patient from the practice list is ‘expected to be an exceptional event’.

Urging GP practices to update their policies on unacceptable behaviours, NHS England said it ‘supports and requests that providers practice policies addressing inappropriate and unacceptable patient behaviours also explicitly include positions on not tolerating any form of discrimination, harassment or victimisation’.

MDU medico-legal adviser Dr Ellie Mein said NHS England’s new guidance will ‘go some way to reassuring practice teams, who have worked so hard at a time of immense pressure, of the situations when action should be taken’.

‘There is increasing evidence that abuse and violence against primary care staff has worsened over the last two years and we support many practices to take action following an incident,’ she added.

GPs can also approach their indemnity provider for ‘advice on whether to issue a patient with a warning, instigate an acceptable behaviour agreement or remove a patient from the practice list,’ Dr Mein said.

Earlier this month, a GP practice stopped offering a face-to-face reception to protect staff after they suffered ‘excessive verbal abuse and physical intimidation’ from patients.

And almost one in three GPs and practice staff have been physically abused at work by patients, according to the shocking results of a recent survey.

How to deregister abusive patients

If a practice wishes to remove a patient it ‘must normally provide the reason for removal in writing to the patient’. It should also have ‘warned the patient in writing that they are at risk of removal’ within the past 12 months.

However, if an incident was bad enough for practice staff or patients to have ‘feared for their safety’, the patient can be immediately deregistered. These incidents must also be reported to the police.

All patient removals ‘must be recorded by the practice, including the reasons and circumstances of the removal’.

Patients ‘may experience difficulties in registering where they have been removed from a practice list’, however, ‘this should not ordinarily be a factor considered by practices when approached by new patients’ – except on the grounds of ‘violence or threatening behaviour’.

Source: NHS England

READERS' COMMENTS [10]

David Church 23 May, 2022 10:42 am

Does that mean that the PM, the Health Secretary, and the head of NHSE can be removed from registered patient lists, as they have made repeated unreasonable demands on primary care?
And perhaps also the editors of most newspapers for a torrent of abusive language and smear campaigns?
And Mr Covid, for causing too much illness and destroying the economy, but mainly for racist tendencies in the severity stakes?

Jeremy Carter 23 May, 2022 11:32 am

“NHS England’s guidance added that removing a patient from the practice list is ‘expected to be an exceptional event’.”
“almost one in three GPs and practice staff have been physically abused at work by patients”

From Gov website : The new, zero-tolerance approach aims to protect the NHS workforce against deliberate violence and aggression from patients,

Policy and soundbites about zero tolerance seem disconnected from reality on the ground? Zero tolerance they say, yet 1/3rd GP Practice staff being victims, and still NHSE saying removal should be exceptional, and patients should have been warned before (so perhaps not really zero tolerance after all …..)

Slobber Dog 23 May, 2022 1:28 pm

I wonder if they realise how many patients would be affected by this.

The Prime Minister 23 May, 2022 5:58 pm

I enjoyed the episode of This is going to hurt where the patient said to the junior dr “i pay your taxes ! ” and the junior dr said “any chance of a pay rise then ?”……………

The Prime Minister 23 May, 2022 5:58 pm

oops….wages….

The Prime Minister 23 May, 2022 7:24 pm

PS THE DAILY NUTTER….A CRIMINAL OUTFIT THAT ACTS AS THE GOVERNMENT’S PET ENFORCER AND MORE LOYAL THAN PUTIN’S MEDIA THUGS WILL PRINT AN ARTICLE “NOW GPs WANT TO STRIKE OFF COMPLAINERS (THE LAZY B’STARDS..ALSO SUBTLY INCITING VIOLENCE AGAINST GPs…THEY MIGHT GET THEIR FIRST SCALP…A GP KILLED BECAUSE OF INCITEMENT BY THE DAILY B’STARD)……THE PATIENT COMMENTS SECTION WILL READ….ALL GPs (I DO LOVE STEROTYPING) ARE B’STARDS, LAZY, EVIL, BENTLEY DRIVING KILLERS AND SHOULD BE LOCKED UP, MADE TO WORK 24/7 UNTIL 80 YEARS OLD AND BEFORE BEING GIVEN A LETHAL INJECTION TO STOP THEM CLAIMING THEIR GOLD PLATED PENSIONS……AND WHAT’S WRONG WITH THAT ??????? BLAH BLAH MORE INSANE RAMBLINGS ON THE WAY…….

The Prime Minister 23 May, 2022 7:28 pm

THE SECRET PHONE CALLS FROM “THE TOP” GIVING THE GREEN LIGHT FOR THESE ATTACKS WILL START WITH MORE PROMISES OF NO PRESS REGULATION……HANG ON THERE IS ALREADY NO PRESS REGULATION…….I FORGOT THERE IS PRESS REGULATION….THEY REGULATE EACH OTHER……YES OF COURSE…..ABOUT AS EFFECTIVE AS ASKING PUTIN TO REGULATE HIMSELF…..

paul cundy 23 May, 2022 10:20 pm

Dear All,
If you read the regulations you will rapidly realise that they are a “fire and forget” process. Once initiated by the practice the CCG, ICS, PCSE, CSU or any other grouping has no option other then to de-register the patient within 8 days. All the practice has to do is start the process, once started there is no mechanism for halting, stopping or reversing it.
Well worth a read and having every practice manager store the regs in their useful for the future files.

Regards
Paul C

David Jarvis 25 May, 2022 8:59 am

The idea that this is only rare and exceptional shows how clueless those at the top really are. I could remove 2-3 patients a week under those criteria. Perhaps we should record every racist comment made in patients clinical record.
I have often thought that if there were more like shipman who managed a list of 3500 singlehandedly. Perhaps by “removing” these patients. It is impressive resilience that it doesn’t happen. Ultimately what happens to these patients? Perhaps they should be the first to have to co-pay and return to normal service after a period of good behaviour. I am not defending or inciting murder.

Truth Finder 1 June, 2022 5:07 pm

I strongly recommend Dr Monk’s book Life Line. It shows how untouchable the managers are and how powerless the government is against them as well as a lot of incompetence. The MDU says only 1/5 of practices tackle this behaviour so we are to blame too.