University of Leicester eBulletin

Removal of Patients from a General Practitioner's List - The Patient Perspective

June 2003 

Patients’ 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.

Removal 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 GP   

Removal 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.

“Removal 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 Liaison Services.

NOTE 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; email tns2@leicester.ac.uk.

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Last updated: June 2003
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