Removing patients from the practice list is an emotive issue and should only be used as a last resort. The reasons for removing a patient from the list can be varied, but it should not be in response to patients lodging a complaint or failing to comply with treatment. 

Patients who are not violent or threatening

You must have reasonable grounds to remove a patient from the practice list. Your reasons cannot be based on the patient’s:

• Race
• Gender
• Social class
• Age
• Religion
• Sexual orientation
• Appearance
• Disability
• Medical condition
• Need for specific treatments
• Relationship to a patient already removed from the list.

Removing a patient from the practice list is not an appropriate response to a complaint. The GMC states: “You should not end a professional relationship with a patient solely because of a complaint the patient has made about you or your team, or because of the resource implications of the patient’s care or treatment.”

Removal should only be requested if, during the previous 12 months, the patient has been provided with a written warning that he or she is at risk of removal and has been given reasons explaining why this is so. Removal without warning can only occur if:

• The patient has moved outside the doctor’s practice area (although he/she should be given 30 days in which to make alternative arrangements, the practice is not responsible for visiting or treating the patient during this period).
• The doctor has reasonable grounds to believe that issuing a warning would be harmful to the patient’s mental or physical health, or put practice staff at risk. 
• It is, in the opinion of the contractor, not otherwise reasonable or practical for a warning to be given (GMS contract).

If a warning is given, the practice is required to produce a written record of the date on which it was issued, including the reason(s) for the warning as explained to the patient, or the reason why no warning was given. 

Violent or threatening patients

If patients have been violent to any members of the practice staff or have been threatening to the point where there have been fears for personal safety, the incident must be reported to the police straightaway. In these circumstances, the practice can remove the patient from the practice list quickly.

Even in these circumstances, the practice should inform the patient of the reasons leading to removal from the practice list unless one or more of the following apply:

• It would be harmful to the mental or physical health of the patient
• It would put practice staff or patients at risk
• It would not be reasonably practicable to do so.

Following removal of a patient from a practice list for violent or threatening behaviour, the practice is required to record the fact in the patient’s records and set out the circumstances leading to removal.

Practice boundaries

The National Health Service (Primary Medical Services) (Miscellaneous Amendments) Regulations 2012 makes provision for the establishment of an outer practice boundary area, in addition to the current practice boundary. It is a statutory requirement for practices to publicise the fact that they have an outer boundary and they may have to justify why patients have been removed from their list whilst remaining in the outer boundary.