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In cases other than violence and abuse, the GPC recommends that the decision to remove a patient from the list should only be made after careful consideration.
Alternatives, short of removal, should be considered such as transferring the patient’s care to a partner (with the consent of both parties) or persuading the patient that it would be better for all concerned for them to go to another practice.
In rare cases, however, because of the possible need to visit patients at home it may be necessary to terminate responsibility for other members of the family or the entire household.
The prospect of visiting patients where a relative who is no longer a patient of the practice by virtue of their unacceptable behaviour resides, or being regularly confronted by the removed patient, may make it too difficult for the practice to look after the whole family.
A permanent record of the warning, including the date and reason for the warning, must be made and retained as the PCO or NHS England may require sight of them.
Copies of such records must therefore be retained after the patient has left the list.
Patients also have a right to change their practice.
They are not required to give their reasons, nor is there any period of notice or requirement to notify the practice.
Whilst warnings do not have to be in writing it is good practice for them to be so as this allows for carefully considered reasons to be given.These provisions require that a reason should be given to the patient by the practice and that normally a warning should have been given by the practice within the past year.The PCO or NHS England must be informed in writing of the request and the removal will not take effect until the eighth day after the request is received by the PCO or NHS England or, if the practice is treating the patient at intervals of less than seven days, eight days after treatment ceases unless the patient is accepted by, allocated or assigned to another practice sooner than this.Patients should normally raise a complaint with their practice in the first instance.
There is public concern that patients may be removed from the list simply for making a complaint.The regulations specifically require that a removal is not on the grounds of “race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition”.