Menu Home Search
01622 851197 Contact us

Dealing with difficult patients & Removal of Patients from GP Lists

Kent LMC Advice

Please read the GPC Guidance before deciding how to proceed to remove a patient. The LMC advice builds on the GPC guidance with some suggested standard processes and letters that you can adopt. Also attached is a suggested Practice Charter that should be part of your practice leaflet and on your practice website. Below are suggested processes for advising patients about their behaviour or the way that they use services. The process should not be used to remove patients for trivial reasons even where these are repeated. Practices should seek to use all available services to change patient behaviour.

At the current time mediation services are not funded by NHS England but are still useful and available.  Tony Hamlin Mediation is an independent provider of Mediation Services within Kent and London specialising in the resolution of conflicts in the NHS environment. In addition to mediation services within the NHS complaints process and the workplace, he provides a facilitation service which partnerships have found a useful support particularly during periods of change. An experienced and qualified trainer he delivers a wide range of courses and workshops including communication, leadership development, conflict management and team building.  For further information please visit his website: http://www.tonyhamlinmediation.co.uk

1.  Verbal Warning

  • Useful for low level difficult behaviour/first warning.
  • Format - arrange a meeting with the PM/GP to explain standards expected of patients.
  • Refer to the Practice Leaflet and Practice Charter (Appendix E).
  • Use the meeting to change behaviour. Keep a File note and explain to the patient that it will be kept for one year.      

2.  Letter of Concern              

  • useful where there is a repeat of behaviour where a verbal warning has failed or where there have been repeated DNA’s
  • See Appendix A for draft letter

3.  First Stage Yellow Card

  • It is a requirement of the regulations that before removing a patient a letter be sent warning that the unacceptable behaviour may lead to removal if it is repeated within 1 year
  • Yellow card letter can be used when a letter of concern has not had the desired effect or if a serious incident has occurred
  • See Appendix B for a draft letter
  • If the patient decides to appeal against the decision to send a yellow card then arrange a meeting with the patient. It helps to encourage the patient to seek support from Kent Advocacy –  https://www.theadvocacypeople.org.uk/

4.  Second Stage Red Card Removal

  • If the patients behaviour does not improve or there is a repetition of the type of incidents that caused the yellow card letter then removal may be appropriate
  • Removal still requires that the patient doctor relationship has to have broken down irretrievably.
  • Be aware that removal will often trigger a complaint which can end up being considered by the Ombudsman who will scrutinise both the process and the reason for removal so be clear that removal decision is defensible.
  • See Appendix C for a draft letter
  • Notify Primary Care Support England (PCSE) of the removal

5.  Immediate removal – Violent/Abusive Behaviour

  • Immediate does mean Immediate. Action is required the same day unless there are good reasons why it cannot be actioned immediately
  • If possible take advice from the LMC Office or your CCG
  • Notify the police. This is a requirement. You do not need a crime number. A simple letter outlining the incident and naming the patient is sufficient. If the incident is very serious resulting in physical harm to staff or patients seek urgent support from the police, dial 999 if necessary particularly if the patient needs to be removed from the premises
  • Formal letter to the patient Appendix D
  • Notify PCSE using their form available HERE
  • Keep copies of all letters
Updated on Tuesday, 7 December 2021, 5402 views

Related guidance...

Violence in General Practice - Guidance for General Practitioners

Introduction The Terms of Service have always allowed GPs to remove a violent patient from their list. Patients removed in this way...

Mediation & Counselling Services

We regret to inform you, despite the LMC's best efforts, that contracts for both counselling and mediation lapsed and there are no...

Registering with Kent LMC

Kent Local Medical Committee (LMC) are committed to representing all GPs in Kent and Medway, and nearly half the workforce are sessional...

Nursing and Midwifery Council

Are your nurses registered? Following a recent incident all practices in Kent and Medway have been asked to check that all nurses...

About GPAS

General Practice Alert system (GPAS) - to be launched in September 2022 Hospital trusts use Operating Pressures Escalation Level (OPEL)...

Debt and Mental Health

On October 1st 2019 the BMA announced that patients will no longer have to pay for medical evidence to support a diagnosis of a mental...

Key Worker Letter

It is possible that practice staff will be stopped by police as they check whether people have a reason not to stay at home. The CCG has...

Kent & Medway Interpretation and Translation Services

With effect from 1st April 2022 During the spring of 2018, NHS England delegated the responsibility for Interpreting and Translation...

NHSE Access to GP letter 14.9.20

Dear All Many of you will have seen the disappointing NHSE Access to GP Letter 14th September 2020. We wanted to take this opportunity...

Kent LMC Express Weekly Update

Kent LMC Express: 5th December 2022 Firearms Licensing Update, Success and celebration at GPN conference , National Update from the...