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The GPC believes that many patients who are misusing services can alter their behaviour if this is brought to their attention and the regulations normally require a warning to be given within the 12 months prior to removal.

An explicit discussions, whilst protecting the confidentiality of the removed patient, with other family members about the problem and the doctor’s concerns will often obviate the need for any further action.

The patient is always notified by the PCO or NHS England.

There is an exception to this: immediate removal on the grounds of violence e.g. Whilst some removals might occur because of disagreement between the practice or individual health professionals, and patients, there are also cases where the practice requests removal because they have become aware that the patient has moved to an address which is outside their practice area.

The GPC believes, however, that complaints that take the form of a scurrilous personal attack on members of the practice or contain allegations which are clearly unfounded usually indicate a serious breakdown in the patient-doctor relationship.

It is a breakdown of the relationship rather than a complaint per se which must form the basis of any decision to remove a patient from the list; it may then be in the patient’s best interest to seek care at another practice.

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