Northgate Medical Practice aims to provide the best possible health care for its patients. However, there may be circumstances when it would be considered reasonable, or in the best interests of the Practice or the patient, to remove patient from the list. The purpose of this policy is therefore to define the practice guidelines for patientremoval ensuring that all cases are dealt with fairly.
This is outlined below under several categories, and extends beyond the various forms of abuse of staff:
It also covers situations where our services are repeatedly abused, and the more complex areas of “breakdown of the doctor patient relationship”. We look after over sixteen thousand patients and the frequency of unacceptable behaviour by patients is extremely rare.
Below are examples that will trigger the removal process and the resulting action by the practice.
1.Physical abuse or Violence (Zero Tolerance Policy), or threats of the same, including any damage to practice premises: Will be
immediately reported to the Police and the person will be immediately removed from the list and referred to
the scheme for Violent Patients. Once ratified by the Health Authority the person will forfeit the right to be
registered with a local GP and will need to travel to a distant secure locality for future GP care for a minimum
of one year.
2.Crime and deception. Where a patient fraudulently obtains drugs for non-medical reasons, deliberately lies
in order to obtain a service or benefit by deception, steals from the practice or attempts to use the doctor to
conceal or aid any criminal activity, they will be immediately removed from the list
3.Verbal Abuse of a doctor or other member of staff: (Zero Tolerance Policy) Normally one written warning will be issued with any further incident resulting in removal from the list but the practice reserves the right to remove someone instantly depending on the severity and nature of the incident.
4.Persistent Failure to Attend: Once an appointment is made, patients are expected to keep it, or inform us
that they need to change it. Failure to do so will trigger the Practice Protocol for dealing with patients that “DO
NOT ATTEND. If a patient continues to DNA appointments, then it may result in the patient being removed
from the list.
5.Persistent abuse of services: If the practice is aware that a patient, or relative, persistently ignores requeststo follow procedures set down to ensure safe clinical care for them and other patients, two warnings in writing will be given. On a third occasion, the removal of that patient will be made.
6.Persistent non-compliance with treatment plans: We understand that patients sometimes disagree with a
plan or treatment. We acknowledge this and allow for second opinions both within and beyond the practice.
However, there sometimes comes a point where a patient is unwilling to accept advice and treatment, yet
continues to put the clinicians in a position of responsibility for their care. This represents an impossible
situation and one where the patient risks serious detriment to their health. The GP will discuss the issue with
the patient and following this discussion two warnings will be made in writing before removal is instigated. We
hope that this will almost never be necessary.
7.Irretrievable breakdown of the doctor-patient relationship: Occasionally a patient’s behaviour falls outsidethat which is normally considered reasonable and leads to an irretrievable breakdown of the essential doctorpatient relationship. In some cases this can be overcome by changing GP’s within the practice but in others this will not be appropriate and following written explanation the patient will be removed from the practice list.
8.Distance: If a patient moves outside of the practice boundary, which includes going abroad for a period in
excess of 3 months, they are automatically deemed to have left the practice and will be removed from the list
by the Health Authority.When the extremely rare situation detailed in items 1 & 2 requires instant removal of a patient the Health Authority will be informed in writing, as will the registered patient, and their carer if appropriate and the practice will cease caring forthe individual immediately. In cases covered by items 3 to 7 the practice will continue to treat patients for 7 days from the date of the removal letter to allow them time to register elsewhere.
Under new government rules a patient can request to register or remain registered if moving or living outside the natural Practcie Boundary. Please contact the Practice if you require further information.
In some instances where removal is considered necessary it may be deemed appropriate to extend this to other members of the family or household. In such cases the practice will write to the individuals concerned explaining thesituation and they will be given 4 weeks to re-register with another GP rather than being removed from the practice immediately. Except in the circumstances detailed in 1 and 2 no removal of a patient or their family/household will take place without discussion and agreement amongst the GP partners.
Review Date July 2016
Northgate Medical Practice