- Be sure your decision is fair and justifiable.
- Meet your contractual obligations.
- Only remove the patient, not their family.
- Follow the GMC’s guidance.
The need to be fair
Removing a patient is usually the last resort for doctors following a series of incidents, but it is not always the end of the story. Aggrieved ex-patients have been known to 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.
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.
Justifiable grounds for removing a patient might include:
- violence or aggressive behaviour
- discriminatory abuse
- sexual advances
- theft from the practice, staff or other patients
- repeated unreasonable or inconsiderate actions.
It would be difficult to justify removing a patient based on the following:
- they have complained
- their disruptive behaviour is caused by their condition
- they are related to another patient who is being removed
- you are concerned about the resource implications of their care or treatment
- their medical condition puts you at risk.
Seek advice from the MDU if you are unsure.
Removing a patient
Follow these steps to meet your ethical and contractual obligations.
- Do what you can to restore the professional relationship. For example, find out what's behind their actions and whether this could be addressed with extra support. You could also consider an acceptable behaviour agreement.
- Warn the patient their behaviour is unacceptable and that you will end your professional relationship if they don't change. 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'.
- Notify your local Primary Care Organisation (PCO) (the NHS England Area Team or Health Board) in writing of your decision and the reasons, in line with your NHS contract.
- The PCO will notify you and the patient in writing. The removal will usually take effect when the patient is registered with another provider or the eighth day after the notice has been received, whichever is sooner.
- Transfer the patient’s records to their new practice as soon as possible.
If a patient has been violent or abusive, or has behaved in a threatening way that leaves you or your staff in fear, they can be removed immediately. In this situation, you should follow these steps:
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 should 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.
This guidance was correct at publication 20/11/2017. It 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.