Parliamentary and Health Service Ombudsman

Listening and Learning
the Ombudsman’s review of complaint handling by the NHS in England 2010-11

Unfair removal from GP patient lists

Often a patient’s experience of the NHS begins with their GP. It is common for the relationship between a patient and their GP to be long established and to extend across an entire family. In the last year, we received an increased number of complaints about GPs, some of which suggest that GPs are failing to manage relationships with patients properly, resulting in a breakdown in communication and patients being removed from GP patient lists without fair warning or proper explanation.

Last year, the number of complaints about people being removed from their GP’s list of registered patients accounted for 21 per cent of all complaints about GPs investigated, a rise of 6 per cent over 2009-10. We accepted 13 complaints for investigation about removal from GP patient lists and completed 10, all of which were upheld.

There is clear guidance for GPs about removing patients from their lists. NHS contracts require GPs to give patients a warning before they remove them, except where this would pose a risk to health or safety or where it would be unreasonable or impractical to do so. The British Medical Association’s guidance stipulates that patients should not be removed solely because they have made a complaint. It also says that, if the behaviour of one family member has led to his or her removal, other family members should not automatically be removed as well.

Our casework shows that some GPs are not following this guidance. In the cases we have seen, GPs have applied zero tolerance policies without listening to and understanding their patients or considering individual circumstances. Decisions to remove a patient from their GP’s list can be unfair and disproportionate and can leave entire families without access to primary healthcare services following an incident with one individual.

It is not easy for frontline staff to deal with challenging behaviour, and aggression or abuse is never acceptable. However, patients must normally be given a prior warning before being removed from a GP’s list. The relationship between a GP practice and their patient is an important one which may have built up over many years. Despite this, we have seen cases where practices have removed entire families after a few angry words from one individual, without giving them a warning or taking the time to understand the cause of the anger and frustration.

The case studies that follow tell the stories of patients and their families who were removed from GP patient lists during periods of great anxiety about the terminal illness of a loved one or the health of a young child. In one case, the decision to remove the patient was made by the member of staff involved in the altercation. As GPs prepare for the increased commissioning responsibilities outlined in the Government’s health reforms, it is essential that they get the basics of communication right.

For more information about the total number of complaints about GPs received, accepted for formal investigation and reported on please see the information in the statistics section.