Not to be tolerated

A practice manager contacted the MDU for advice regarding a patient who had made racially abusive comments about one of the doctors while in the surgery waiting room. The local Primary Care Trust had informed the practice that, before removing the patient from the practice list, they should give him a written warning regarding his behaviour. The MDU was asked for advice.

MDU Advice

Ending a relationship with a patient can often trigger a complaint from the patient concerned. Such complaints are often pursued vigorously and the GMC and the Parliamentary and Health Service Ombudsman have not always accepted a doctor's justification for taking action.
The MDU advised the practice manager that it would be appropriate to warn the patient that such behaviour will not be tolerated and that any repetition could result in their removal from the practice list. The MDU also indicated that it was important for the practice to keep a log of any incidents of physical or verbal abuse that occur, specifying the date and time at which the incident took place. This information could be required if the practice is subsequently called upon to justify their issuing of a warning to a patient or the removal of a patient from the practice list.
The MDU discussed with the member the GMC's guidance on ending professional relationships with patients in paragraphs 38-40 of Good Medical Practice (2006). Doctors must be able to show that their decision was fair and justifiable and should inform the patient, if practical in writing, of their decision and the reasons for it. When ending a professional relationship, proper arrangements must also be made for the patient's continuing care.
The General Medical Services (GMS) contract also sets out the procedures to be followed in removing a patient from a practice list (clauses 192-208). There must be reasonable grounds for wishing the patient to be removed which do not relate to the person's race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition. The practice must warn the patient in writing that they are at risk of removal and explain the specific reasons for this, unless:

  • the doctor either has reasonable grounds for believing that the issue of such a warning would be harmful to the physical or mental health of the patient or would put members of the practice staff at risk; or
  • where it is, in the opinion of the doctor, not otherwise reasonable or practicable for a warning to be given.

This page was correct at publication on 01/05/2009. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.