BMA Advice

Removing patients from the practice list is an emotive issue and should only be used as a last resort.

Process

1. Practices have the right to ask for a patient to be removed from their list.

2. A reason should be given to the patient by the practice and that normally a warning (that they are at risk of removal, together with an explanation of the reasons for this) should have been given by the practice within the past year.

3. The PCO or NHS England must be informed in writing of the request and the removal will not take effect until the eighth day after the receipt of the request is received by the PCO or NHS England. There is an exception to this: immediate removal on the grounds of violence e.g. when the police are involved.

Reasons for removal

1. Patient has died

2. Patient has moved to an address which is outside their practice area.

3. An irretrievable breakdown of all or part of the patient-practice relationship (usually the doctor-patient relationship)

4. Violence or threatening behaviour by the patient.

   If patients have been violent to any members of the practice staff or have been threatening to the point where there have been fears for personal safety, the incident must be reported to the police straightaway. In these circumstances, the practice can remove the patient from the practice list quickly.

Invalid reasons for removal

1. Patient has made a complaint

   The GMC states: “You should not end a professional relationship with a patient solely because of a complaint the patient has made about you or your team, or because of the resource implications of the patient’s care or treatment.”

   However, complaints that take the form of a scurrilous personal attack on members of the practice or contain allegations which are clearly unfounded usually indicate a serious breakdown in the patient-doctor relationship.

2. Unfair discrimination

   BMA GP states that removal is not indicated on the grounds of “race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition”.

3. Patient treatment is too costly

Circumstances where no warning is required

• 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.