The act of removing a patient from a practice’s list is risky and can often be emotionally-charged. There is a likelihood of criticism from bodies such as the Ombudsman and the GMC, and whilst there are a wide range of reasons for initiating the process, removing a patient from a practice list should never be as retaliation for a complaint, or failure to comply. A patient being generally ‘difficult’ is not a valid reason, either.
The Practice Leaflet
Each practice should have a leaflet outlining the policy for removing patients from the list, as well as guidance on dealing with patients who are a more immediate problem due to threatening behaviour or violence. If a patient is not violent or threatening but still exhibits behaviour that a doctor believes to be grounds for removal, practice staff must ensure that the reason for their dismissal is not due to
- medical condition,
- sexual orientation,
- appearance, and
- relationships with other patients on the list.
Medical professionals intending to remove a patient from their practice list are required to notify their NHS Area Team, and the patient in question. If it would be inappropriate to share the specifics of the dismissal, then irrevocable differences may suffice as a justification – provided there is a genuine specific problem. Removal must also be preceded by a written warning within the previous year. The warning must also explain the reasons behind the move.
Patients may be removed from the list without warning if
- the patient has moved outside the practice catchment area, and has been given 30 days’ notice; or
- the patient is likely to put practice staff at risk or have their physical or mental health damaged if warning is given.
If warning is given, a written record of the date is required – highlighting the reasons, and available to the NHS Area Team. Removal will occur eight days after the team receives the request. Any care due in the eight-day period must still be administered, and if the patient requires treatment in intervals of less than seven days, the practice must continue to deliver care until the patient’s condition has improved, and the interval become greater.
The NHS will inform both parties when the paperwork has been completed, and the patient no longer on the list.
If a patient has used or threatened violence against a member of staff, the incident should be immediately reported to the police. They will be removed from the list as quickly as possible – coming into effect as soon as the practice notifies the Area Team. Written confirmation of the rapid removal must be sent within seven days. The notice must be hard copy, sent by post, not fax.
Despite the threatening or violent circumstances leading to removal, the practice still has an obligation to inform the patient of the reasons behind the decision, unless
- it would be impractical,
- it would put staff in harm’s way, or
- it would harm the patient’s wellbeing.
Everything should be recorded in the patient’s medical record.