Removing Patients from the Practice List

Practice Leads

  • Doctors: The whole doctor team
  • Admin: Chris Rushton

Date Reviewed

6th July 2016

Date of Next Review

September 2017

Occasionally it will be necessary to remove patients from the practice list for a number of reasons. i.e. moved out of area or unacceptable behaviour. THIS WILL ONLY BE DONE BY THE MANAGER OR ASSISTANT MANAGER – WYCSA MUST ALSO BE ADVISED.  There are 3 key scenarios in which it may be deemed necessary to terminate a patient’s registration: The Practice decision must be made by a minimum of 2 GPs and the Assistant/Practice Manager, preferably at a doctor meeting.  It is totally at the practice discretion who is registered with the practice.

The 3 Scenarios Where a Patient Can Be Removed

Patient misconduct:

The practice has a duty of care to protect staff and other patients, and adheres to the NHS zero tolerance policy.  Displays of the following behaviour are examples of indications for removal:

  • Physical abuse
  • Threatening behaviour
  • Verbal abuse
  • Racial/gender discrimination
  • Damage to practice or staff property
  • Other unreasonable behaviour

To deal with patients who show violent or threatening behaviour:

  1. Following a physically violent abuse incident, or a seriously threatening  incident, the practice is within its rights to immediately remove the patient from the list. The Police should normally have been called to the scene at the time of the incident, or reported to if the person has then already left.
  2. For other patient misconduct unacceptable behaviour, a practice may still choose to:
    • Provide the individual with a written warning to improve behaviour or then leave then practice.
    • Immediate removal if after consideration it is deamed likely for re-occurance, if racial/gender discrimation, impact on the Dr-Pt relationship, ability for practice to continue care. I.e. Dr involved then now willing to treat which could occur if that Dr is emergency practice Dr so put that Dr in difficult situation.

Please also consult the practice unacceptable behaviour policy.   

Irreconcilable differences:

  • Occasionally, the relationship between doctor and patient may break down to the point whereby the practice no longer feels capable of providing a quality level of patient care and feel that the patient’s needs would be better served elsewhere
  • The decision to remove a patient under these circumstances would normally only be taken once every effort has been made by the practice to reconcile those differences
    • In this event, the practice will inform the patient by letter, giving clear reasons for termination of registration
    • A request will also be sent to West Yorkshire Central Services Agency to de-register the patient from the practice list .

Regular failure to attend appointments

Patients who do not attend (DNA) three or more times will usually be advised that any further DNAs could result in removal from the practice list.  We have a separate policy for this.

Please see additional policies in the Downloads & Links section above.

Removal Requirements

  • To remove a patient from the list the practice must inform both the patient and WYCSA, detailing why the patient has been removed.
  • WYCSA will offer the patient registration at a nominated practice, possibly one which is designated to take on violent patients via an enhanced service agreement with the PCT.
  • For patient removals (except out of area), inform the Risk Manager at the PCT of the practice action.