Removal of Patients from a General Practitioner's List - The Patient Perspective
accounts of being removed from their general practitioner’s list: qualitative
study, British Medical Journal, June 14
General Practitioners (GPs) have the right
to remove patients from their practice list. They are not obliged to explain
their reasons for removing to patients and patients have no right of appeal.
A report by University of Leicester
researchers published in this week’s British Medical Journal offers
insight into the experiences of patients who are removed from a GP’s list.
A research team from the University’s
Departments of General Practice and Primary Care and Epidemiology and Public
Health conducted interviews with 28 patients who had been recently removed from
a GP’s list in Leicestershire.
They identified three themes which help to
explain removal from the perspective of removed patients:
the 'good' patient, the 'bad' GP and removal as a 'threat'.
The patients felt that their removal was
unjustified and were concerned to show that they were 'good' patients who
complied with the rules they understood governed the doctor-patient
relationship: they tried to cope with
their illness and follow medical advice; used general practice services
'appropriately'; were uncomplaining and were polite with doctors. They characterised
the removing general practitioner as breaking the lay rules of the
doctor-patient relationship by being rude, impersonal, uncaring, clinically
incompetent and lying to patients.
was experienced by participants as very threatening: an attack on their right to
be an NHS patient. The method used to inform patients of removal, involving a
letter from a Health Authority advising of the removal and of the means for
registering with a new doctor, appeared to intensify this problem. Patients did
not have access to GP services until they found or were ‘allocated’ to a new
was deeply shocking to participants: all but one presented their removal as a
completely unanticipated event. The dominant emotional reaction to the letter
was shock and disbelief or anger and indignation. These emotions were especially
prominent where entire families were removed. Removal is also felt to be
shameful, stigmatising and participants feared discrimination by their next GP.
is an overwhelmingly negative and distressing
experience for these patients”, first author Tim Stokes said. “However,
it’s important to bear in mind that there are two sides to every story. Our
research on GPs’ experiences suggests that GPs perceive removal as a last
resort. GPs tell us that they only remove patients when they feel the
doctor-patient relationship has broken down. It’s important that any proposals
for improving this area look at solutions that suit both sides.”
The researchers suggest that general
practices should have a clear public policy on removal and consider convening a
practice-based meeting with patients to try and resolve difficulties before
making a decision to remove. If a patient needs to be removed then the practice
should inform patients of the reasons for their removal and ensure that patients
know they are entitled to re-register with another GP and how they should go
about this. Patients should also be informed about local NHS Patient Advice and
TO EDITORS: For further information contact Dr Tim
Stokes, Senior Lecturer in General
Practice, Department of General Practice and Primary Health Care, University of
Leicester, Leicester, UK, 00
44 (0)116 258 4873;
This document has been approved by the head of department or section.