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GMC figures undermine claims GPs are ‘unfairly’ removing patients from lists



Exclusive: The GMC has reviewed nearly 100 cases where GPs were accused of ‘unfairly’ removing patients from their practice list over the past four years, but only two resulted in any further regulatory action.

The figures undermine claims that GPs are removing ‘unfairly’ removing patients from their lists, with the GMC declining to investigate the vast majority of referrals for GPs ‘unfairly ending relationships’.

Figures obtained by Pulse show that from the beginning of 2009 to November 2012, the GMC investigated ‘stream 1’ cases for 27 GPs – potentially serious complaints identified as requiring formal investigation.

Nine of the cases investigated by the GMC were concluded with no action taken against the family doctor, and sixteen were concluded with the GP offered advice. In 11 of the 16 cases the advice was to follow GMC good medical practice on ending relationships with patients, and in the other five the advice related to other allegations.

In 2011 one GP was received undertakings on their registration as a result of removing a patient from a list, though the GMC cannot provide more details due to confidentiality issues.

In the same year another GP was referred to a fitness to practise hearing after removing a married couple from a list following an affair with the wife, and refusing to refer the husband to an orthopaedic specialist despite a request for this.

The GMC declined to investigate a further 71 cases referred to them, as they were deemed unlikely to require the council to take formal action against the doctor and could be dealt with under local complaints procedures. In all these cases it was found there was a valid reason for the patient’s removal from a list.

These modest figures come despite a damning report by the Health Ombudsman that said complaints about patients being ‘unfairly’ removed from GP lists were on the rise for the second year running, and suggested this may mean the profession may not be fit to take on thier commissioning responsibilities.

GMC guidance says GPs must not end a relationship with a patient solely because they have made a complaint, or because of the resource implications of their care.

The decision to remove a patient from a list- which the GP should be prepared to justify- also cannot be made on the grounds of age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status or on the perception that a patient’s actions have contributed to their condition.

GPs should inform the patient in writing, wherever practical, and make prompt arrangements for their care to be continued elsewhere and their notes passed on without delay.

Dr Satya Sharma, a former member of the GPC and chair of Wolverhampton LMC, said it was a ‘shame’ that the extent of patients being removed from a practice list unfairly had been overblown.

He said: ‘The figures give a powerful message that this is not a widespread phenomenon. If it was the number of GPs taken to task by the GMC would be higher. It’s not getting out of hand and I don’t see this as a major problem.

‘The Ombudsman is in a very powerful position and patients are more aware of what’s going on- which is a good thing. But it is a shame there is an element of exaggeration – that does not help.’

A spokesperson for the Health Ombudsman said: ‘We’ve seen an increase in this type of complaint, as laid out in our report. Just as with any case, we might decide to refer such a complaint to the GMC if the GP did not accept our recommendations, but it would be on a case-by-case basis. Because we don’t automatically refer every case to the GMC, our figures and theirs will never be directly comparable.’

The GMC did not wish to comment on the figures.

The new comes as the BMA recently launched an investigation into the psychological affect of rising complaints on doctors, to assess the repercussions they have on the profession.

Closed cases by case streams and case closed year

Case closed year Stream 1* Stream 2* Total closed cases
2009 5 15 20
2010 3 16 19
2011 10 19 29
2012 9 21 30
Total 27 71 98

*Stream 1: Complaints the GMC identify that they need to investigate  because the issues are potentially serious.

* Stream 2:  Complaints that can best be dealt with under local procedures for considering complaints. This is because the concerns raised are, on their own, unlikely to require the GMC to take formal action against the doctor.

Closed cases by investigation outcomes

Case closed year # cases with investigation outcomes
Conclude Conclude with advice Undertakings Refer to hearing Grand total
2009 2 3 5 -5 5
2010 2 1 0 0 3
2011 3 5 1 1 10
2012 2 7 0 0 9
Total 9 16 1 1 27