Removal from Practice List

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BMA and GMC

Both GMC and BMA have written documents supporting decision making when it is perceived there is a breakdown in relationship between Practice and Patient

The sole arbiter of that breakdown is the Doctor / Practice

There are a number of options available including request to seek another Practice to provide care, warning letter or enforced removal at the request of the Practice.

The latter is deemed last resort and should normally be initiated following a Warning letter usually within the last 12 months.

There are exceptions to this and there is provision to allow a practice to immediately remove a patient following act or severe threat of violence to a member of staff.

The police should normally be informed in such a case.

Threatening or Violent Behaviour

Violence or threatening behaviour by the patient is a special case. It usually implies a total abrogation by the patient of any responsibility towards the doctor or other members of the practice and will normally result in removal from the list.

It has been possible to request the immediate removal of any patient who has committed an act of violence or caused a doctor to fear for his or her safety. In April 2004, these provisions were extended to make it clear that the provisions extend to anyone else on the premises.

The police (or in Scotland, either the police or the procurator fiscal) must have been informed of the patient’s behaviour and the doctor must notify the LHB and,other than in exceptional circumstances, the patient of the removal in writing.

The removal will take effect from the time the practice phones, sends or delivers notification to the LHB but must be followed up in writing within seven days.

Patient / Practice Relationship Broken down

In cases other than violence and abuse, the GPC recommends that the decision to remove a patient from the list should only be made after careful consideration

The GPC believes that many patients who are misusing services can alter their behaviour if this is brought to their attention and the regulations normally require a warning to be given within the 12 months prior to removal.

Warnings

A patient must be warned that they are at risk of removal, together with an explanation of the reasons for this, within the period of 12 months before the date of the request to the LHB Whilst warnings do not have to be in writing it is good practice for them to be so as this allows for carefully considered reasons to be given.

However, no warning is required if:

The removal is on the grounds of change of address


The practice has reasonable grounds for believing that the issue of such a warning would be harmful to the physical or mental health of the patient


The practice has reasonable grounds for believing that the issue of such a warning would put at risk the safety of members of the practice or those entitled to be on the practice premises


It is, in the opinion of the contractor, not otherwise reasonable or practical for a warning to be given.

If no reason is given an explanation in writing should be made and retained for potential future inspection by the PCO or NHS England.

How to remove a patient from the list if necessary

Where practices intend to remove a patient because of the irretrievable breakdown of the doctor- patient relationship, they should first consider discussing the problem confidentially with the LHB.The decision should be a considered one

Practices should issue a warning, preferably in writing, giving the reasons for the possibility of removal. Warnings are valid for 12 months and a written record must be retained

Practices should send a written notice to the LHB, giving the patient’s name, address, date of birth, and NHS number. They should state that they wish to have the patient removed from their list under the terms of their agreement or contract

If the removal is on grounds of violence or threatened violence the police, or Procurator Fiscal, must have been informed; there is no obligation to ask them to pursue the matter.

The practice must notify the patient of the removal with an explanation for the removal. The GPC recommends that this should be in the form of a letter to the patient briefly outlining the reasons. A copy of the letter should be retained.