Zero Tolerance Guidelines for Removal of patients from Practice List
Aim:
All patients removed from Stockwell Group Practices NHS List will be in line with both Local and National Guidelines. Further details available here https://www.bma.org.uk/advice/employment/gp-practices/service-provision/removal-of-patients-from-gp-lists
SITUATIONS WHICH JUSTIFY REMOVAL:
Violence:
When a patient:-
· Is physically violent or threatening towards a doctor, practice staff or other patients on the Practices premises
· Causes physical damage to Practice premises or other patient’s property
· Gives verbal abuse or makes threat towards the doctor, Practice staff or other patients
· Gives racist abuse, orally or physically
· Is violent or uses or condones threatening behaviour to doctors (or some other members of the primary health care team) whilst visiting the patient’s home. Such behaviour may involve the patient, a relative, a household member, or pets (such as unchained dogs).
The Police will be informed and SE London will be telephoned and asked to remove the patient immediately. This will be followed up by the request in writing.
In such circumstances patients who live at the same address as the offending patient may be removed because of the possible need to visit the house in the future. The decision is taken after discussion between a senior receptionist, practice manager and at least two partners. The patient will be written to with a clear explanation of the reason for removal.
Unacceptable Behaviour:
If a patient behaves in a manner that causes distress or discomfort to other patients, staff or clinicians, the senior receptionist and/or the practice manager will discuss the incident with the managing partner or deputy. The practice manager will write to the patient giving a formal warning that the described is unacceptable and the patient will be removed from the list if there is a recurrence. Occasionally there may be medical problems (eg acute psychotic illness) which may mitigate against further action. Drug and alcohol misuse would not normally be considered as mitigating circumstances.
Crime & Deception:
Where a patient:-
· Fraudulently obtain drugs for non-medical reasons
· Deliberately lies to the doctor or other members of the primary health care team (e.g. by giving a false name or false medical history) in order to obtain a service or benefit by deception
· Attempts to use the doctor to conceal or aid any criminal activity
· Steals from the Practice premises
Change of Address:
When the practice is made aware that a patient has moved to an address that lies outside of the outer practice boundary Primary Care Support Services (PCSS) will be informed and the patient will be removed 30
days after the patient is written to by the Authority. This allows patients time to register locally. Exceptions to this rule may occasionally be made on clinical grounds with the agreement of the partners.
Removal for Breakdown of the Doctor patient relationship:
Removal of a patient from the list will be discussed and considered by the senior receptionist, practice manager and the partners. A patient will have been prior warned that they are at risk of removal either in writing, or verbally with a written record in the notes. Alternatives to removal, e.g. transferring care to a different doctor at the practice will be considered.
However if after a written warning, within the past 12 months, a patient behaves unacceptably they will be written to and informed that the surgery has asked NHS SE London to remove the patient, and the reasons stated. Under these circumstances, the practice patient relationship has broken down.
Embarkation:
· Where a patient has moved abroad for a period of 3 months or more
Immediate Removal:
If a patient is violent or threatening to a clinician or any member of the practice staff the police will be informed. Primary Care Support Service (PCSS) will be telephoned and asked to remove the patient immediately. This will be followed up by the request in writing.
In such circumstances patients who live at the same address as the offending patient may be removed because of the possible need to visit the house in the future. This decision is taken after discussion between a senior receptionist, practice manager and at least two partners. The patient will be written to with a clear explanation of the reason for removal.
DNAs:
If a patient fails to attend an appointment on three occasions a letter will be sent advising them that this not acceptable. If the patient then fails an appointment they will receive a second letter warning that further failures will result in removal. If a 3rd appointment is failed the patient will be written to and removed from the list. Under these circumstances family members will not be removed unless they also fail appointments.
Complaints:
The practice complaints policy aims to resolve difficulties between the practice and a patient. A patient will not be removed from the list for making a complaint. However if the complaint takes the form of a personal attack on a member of the practice or contains allegations that are clearly unfounded the practice will usually consider that there is a serious breakdown of the practice patient relationship.
Informing Health Authority
If a patient is removed please complete the form and contact PCSE here https://pcse.england.nhs.uk/help/registrations/general-registrations-enquiries/
Updated June 2024
