How to remove a patient from your practice list 

It isn’t uncommon for practices to remove patients from their practice lists – but are they always removed properly, and for the correct reasons?

The removal of a patient from a GP practice list may occur because of one or more of the following reasons:

• Disagreement between the practice and patient, and an irretrievable breakdown of the relationship.
• The patient has died.
• The patient has moved outside the practice area.
• The patient has decided to change practice.

Types of removal

• Immediate removal

An immediate removal can only be requested when an incident involving the patient has been reported to the police by your practice. It will be processed by Primary Care Support England (PCSE) within 24 hours of receipt of notification – which must be sent from the GP practice via email. The removal of a patient in these circumstances results in them being allocated to a provider under the special allocation scheme.

• Eight-day removal 

An eight-day removal can be processed without police intervention but it will require a GP-signed request for removal. This is usually initiated by the GP as a result of a breakdown in the relationship between the GP and patient. The removal will take effect on the eighth day after the request is received by the PCSE from the GP via email.

• 30-day removal

Practices can remove a patient via GP Links as a 30-day removal request. The PCSE will receive the request and contact the patient to place them on a 30-day removal notice; your practice will be notified of the removal through the clinical system. 

The contact details for requesting any removal can be found here. 

Steps for removal

The process of removing a patient starts with the GP. The practice must:

• Issue a warning to the patient, preferably in writing, giving the reasons for the possibility of removal (warnings are valid for 12 months and a written record must be retained).
• Send a written notice (via email) to the PCSE or NHS England, giving the patient’s name, address, date of birth and NHS number.

Although the removal should occur eight or 30 days after the request is received there are a number of factors that could impact this process, such as:

• If the practice is treating the patient at intervals of less than seven days, the removal will be eight days after treatment ceases, or until the patient is accepted at another practice.
• If the police are involved in the removal of a violent patient, the patient will be removed immediately.

Warning a patient 

In order to remove a patient, GPs must give patients a warning that they are at risk of removal due to their behaviour. Practices must keep a record of any discussions and follow the warning up in writing. 

Warnings are not necessary when:

• the removal is due to a change of address;
• the practice believes that the warning would harm the patient’s physical or mental health;
• the practice believes that issuing the warning would put the safety of members of the practice or those on the premises at risk;
• it is, in the GP’s opinion, not otherwise reasonable or practical for a warning to be given,

Unacceptable removals 

Your practice must have reasonable ground for removal and cannot be based on the following:

• Race.
• Gender.
• Social class.
• Age.
• Religion.
• Sexual orientation.
• Appearance.
• Disability.
• Medical condition.
• Need for specific treatments.
• Relationship to a patient already removed from the list.

If you do remove a patient, you must be prepared to explain the reasons for the removal and offer an opportunity to review the removal.