Removal of patients from your practice list (including immediate removal for reasons of violence and abusive behaviour)

There are currently 2 routes that practices can take to remove patients from their lists depending on the situation:

• Immediate removals
  In situations where a patient has been violent, or caused staff to fear for their safety, practices can request the immediate removal of the patient, although the incident should have been reported to the police.
   
• Standard eight days removals
  Patients can also be removed from practice lists for non-violent reasons, such as an irretrievable breakdown of the practice-patient relationship. In these cases the patient must be warned that they are at risk of removal, together with an explanation of the reasons for this, within the 12 months prior to the request for removal. The warning does not have to have been made in writing (although it is good practice to do so). If this patient has previously received a warning from the practice about rude/abusive behaviour, the practice can proceed with a standard eight day removal if that is what is decided. If the patient has not previously received a warning, or the practice decides not to remove them from the list on this occasion, it is advisable that the practice writes to the patient about this incident and warns them that should they be rude/abusive at the practice again, they may be removed from the practice list and have to register elsewhere.

The relevant Regulation references with regard to the above are:

• GMS Schedule 3 Part 2 Patients: General Para 24 and 25
• PMS Schedule 2 Part 2 Patients: General Para 23 and 24

Further information on how to request removal of a patient can be found here: https://pcse.england.nhs.uk/services/registrations/

Please be aware that for immediate removals, the incident must have been reported to the police and a police incident number needs to be provided to PCSE within seven days. Immediate removal requests will be processed within 24 hours of receipt of the form (available at the above weblink) by PCSE.

As part of the 2018/19 GP contract negotiations there was agreement to clarify the regulations that already allow for patients to be refused registration where there are ‘reasonable grounds’ for doing so – having a violent patient flag on the patient’s record is considered to be a reasonable ground for refusing to register. The Regulations have been strengthened to allow a practice to remove a patient who has joined them from a previous practice who removed them because of a violent incident and placed a violent patient flag on their record. Where a patient is removed under the violent patient regulations, they will be put onto the appropriate ‘Special Allocation Scheme’ unless that patient refuses to be registered at any practice (remembering that they will still have a flag on their record and can be refused registration as outlined above).

In summary therefore, having a violent patient flag on their record, is reasonable grounds for a practice to refuse to register that patient (using paragraph 21 of part 2 of the regulations ‘refusal of applications for inclusion in the list’). If a practice does register someone with a violent patient flag on their record, they may with effect from 01 October 2018 remove them immediately by giving notice to the Board.

The BMA website contains some helpful information on patient removals here: https://www.bma.org.uk/advice/employment/gp-practices/service-provision/removal-of-patients-from-gp-lists

The NHSE policy for managing patient assignments contains information on patient removals from page 9: https://www.england.nhs.uk/wp-content/uploads/2013/10/manag-pat-assig.pdf

October 2018