Removal from a GP list

The patient, who had recently registered with the practice, came in to request a prescription for his asthma medication, but became upset when the receptionist asked him to book an appointment for an asthma review. The receptionist sought the advice of the duty doctor who came out to reception to explain why an asthma review was necessary but the patient was not satisfied with this explanation and became verbally abusive.

As a result of this, the practice decided to remove the patient from the practice list with immediate effect. The patient was informed of this and asked to register elsewhere and the practice informed the PCT of the removal.

The patient complained in writing to the practice as he considered that this removal from the list was unreasonable.

The GP responded to the patient's complaint, explaining that in light of the fact that the receptionist and the doctor concerned had felt threatened by his behaviour, the practice felt that the doctor/patient relationship had irretrievably broken down. The GP explained that he considered that it would be in the interest of both the patient and the surgery for him to register elsewhere.

The patient was not satisfied with this response and requested that the Ombudsman review his complaint about the removal from the practice list, and the practice's response to the complaint, as he considered that they had provided insufficient explanation for their actions. During the course of her investigation, the Ombudsman asked the practice to provide a more detailed explanation to the complainant about why he was removed from their list.

At this point, the practice contacted the MDU for advice on what they should do next, as they believed they had already provided a sufficiently thorough explanation to the complainant. The MDU adviser suggested that the practice review the NHS (GMS) Regulations, to determine whether their actions in requesting an immediate removal from the list had been in line with these.

Having studied the regulations, the practice realised that in order to justify immediate removal from the list the patient must have been violent or behaved in a way that caused staff or patients to fear for their safety and the police must have been called: therefore an immediate removal had not been justified. However, they still considered that the doctor patient relationship had broken down sufficiently to justify removal from the list, although in such situations the patient should usually have received a written warning within one year of the removal.

They wrote to the complainant again, acknowledging their mistake and apologising for requesting his immediate removal, rather than issuing a warning.

At the conclusion of her investigation, the Ombudsman partially upheld the complaint, finding that the practice had failed to act fairly and proportionately in that they had not acted in line with the relevant regulations. However, the practice was commended for acknowledging and apologising for their mistake, and the aspect of the complaint about the practice's handling of the complaint was not upheld.

This case is anonymous but based on those from the MDU's files.

This page was correct at publication on 24/11/2010. 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.