Introduction Removing patients from a GP practice list

Be sure your decision is fair and justifiable.
Meet your contractual obligations.
Only remove the patient, not their family.
Follow the GMC's guidance on ending your professional relationship with a patient.

Ending a professional relationship vs deregistration from a GP practice list

The ending of a professional relationship between one or more healthcare professionals and a patient does not always mean the patient will need to be removed from the practice list.

If you are considering ending your relationship, follow the GMC's guidance. You should only end your professional relationship with a patient when there has been an irrevocable breakdown of trust. You must be satisfied your reason is fair and does not discriminate against the patient.

The trust between you and your patient might have broken down to the extent that you cannot continue to provide them with good care, for example because they have threatened you or made a sexual advance. You should not end a professional relationship with a patient solely because they have complained.

The need to be fair

Removing a patient is usually the last resort for doctors following a series of incidents, but it's not always the end of the story. Aggrieved ex-patients can make a complaint, contact the press or post their feelings on social media.

Removing a patient could also lead to criticism by the GMC and the ombudsman. It's therefore important that you're able to justify your decision.

Justifiable grounds for removing a patient might include:

violence or threatening behaviour
discriminatory abuse
sexual advances
theft from the practice, staff or other patients
persistent unreasonable behaviour.

Removing a patient from the list

Follow these steps to meet your ethical and contractual obligations.

Do what you can to restore the professional relationship. For example, find out what might be behind their actions and whether this could be addressed with extra support. You could also consider an acceptable behaviour agreement.
Warn the patient explicitly what aspects of their behaviour are unacceptable and that you will end your professional relationship if they don't change. The patient needs to know exactly what they need to stop doing and what will happen if they don't. GPs are usually contractually obliged to have issued a warning during the 12 months before removal. Keep a record of your discussion and follow up your warning in writing.
Tell the patient of your decision and explain the reasons, in writing if possible, and be clear they will not be left without medical care.
Make a record of your decision, which should be factual and objective. The GMC says you "should not include anything that could unfairly prejudice the patient's future treatment."
Consult and follow relevant local guidance and regulations.

Violent patients

In its guidance, the GMC says: "It may be reasonable to end a relationship immediately in certain circumstances. For example, primary care regulations and contracts allow for the immediate removal of patients from practice lists if a patient has been violent or behaved a way that has caused other people to fear for their safety. You must follow local or national guidance and regulations."

In this situation, you should follow the steps below:

Report the incident to the police and get an incident number. Only give the minimum information needed to allow for proper investigation. The patient's medical details will not usually be required.
Notify the PCO and confirm in writing, either immediately or within seven days. The removal will take effect when the notification has been received.
Tell the patient, unless it would be unsafe or impracticable to have further contact. Speak to your PCO if this is the case.
The PCO will notify the patient in writing and arrange for their ongoing care, in a secure setting if necessary.
Keep relevant witness statements and records of the decision for removal in a file separate from the clinical records.
Ensure that the patient's clinical records are provided to their new doctor without delay.

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