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Patient Warnings & Removals

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The removal of a patient from our practice list is a rare occurrence and is not a decision that’s taken lightly. However, there are circumstances where the decision must be taken for the good of the patient and/or the surgery to do so.

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Contents:

When we might remove a patient
Warnings
How we decide to remove a patient
Removals process

When we might remove a patient

Reasons include:

disagreement between the practice and patient;
an irretrievable breakdown of relationship and trust;
where there have been episodes of unacceptable behaviour;
the patient has moved outside the practice area.

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Any interactions with patients that were difficult or a patient behaved inappropriately, please complete the Difficult Patient Interactions form

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If this is something urgent or pressing e.g. threat of physical violence, please call your Lead, Julie or Karan immediately.

Warnings

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Under normal circumstances, a patient will be advised of the potential relationship breakdown, and the consequences of such a breakdown, at least once in writing before removal is actioned.

A warning is not necessary when:

the removal is due to a change of address;
the practice believes that the warning would harm the patient’s physical or mental health;
the practice believes that issuing the warning would put the safety of members of the practice or those on the premises at risk;
it is, in the GP’s opinion, not otherwise reasonable or practical for a warning to be given.

Removing a patient without warning is only done when it is considered to be in the best interests of both the practice and the patient.

How we decide to remove a patient

Before any patient is removed from the practice list, this will always be discussed by our Patient Experience Manager, Regional Reception Leads, Senior Management Team and site GPs (if applicable).

The removal of a patient is a rare occurrence and serious consideration will be given to each case.

There are three outcomes when deciding to remove a patient:

30 day removal – The patient is given 30 days from the date of notification until they are removed from the practice list. If there is a breakdown in relationship or trust, or repeated episodes of unacceptable behaviour towards team.
8 day removal – The patient is given eight days from the date of notification until they are removed from the practice list. Where there is a severe breakdown in relationship, threats of violence, racism or homophobia, or behaviour that causes our team to feel unable to continue providing medical services.

For 30 and 8 day removals, a list of other local GP practices will be provided to help the patient find another practice to register with, to continue receiving NHS GP services.

Immediate removal – If there are acts of violence or behaviour that requires police intervention.

The patient is automatically registered with the Special Allocations Service for violent/potentially violent patients.

Removals process

Immediate removals or 8-day removals: Processed by our Patient Experience Manager. Deductions will be received in the usual way, so appointments and tasks should be checked.
30-day removals: Reception managers will be be requested to process the removal on a given date, through a deduction (See also 👋Patients Leaving & Deductions).

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To deduct a patient

Go to: Registrations → Ensure the correct patient is selected → Request Deductions (Top Ribbon) → Deduction Reason: Other Reason & Notes: 30-day removal

Reception mangers should then ensure future appointments are cancelled, and check for any outstanding tasks to be closed.

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Resources:

⏰Late Arrivals, DNAs & WNB