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However no warning is required if: If the behaviour of one member of a household or family has led to their removal, this does not mean that the removal of other family members should automatically follow.

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The GPC believes, however, that complaints that take the form of a scurrilous personal attack on members of the practice or contain allegations which are clearly unfounded usually indicate a serious breakdown in the patient-doctor relationship.

It is a breakdown of the relationship rather than a complaint per se which must form the basis of any decision to remove a patient from the list; it may then be in the patient’s best interest to seek care at another practice.

There has been a public perception, fuelled by reports in the media, that patients are being removed from practice lists because their care is too costly, because of their clinical condition or even their age.

The GPC supports provisions in the contract that make explicit that any such discrimination is unacceptable.

When trust has irretrievably broken down, it is in the patient’s interest, just as much as that of the practice, that they should find a new practice.

Practices have the right to ask for a patient to be removed from their list.

A good patient-doctor relationship, based on mutual respect and trust, is the cornerstone of good patient care.

The removal of patients from practice lists should continue to be an exceptional and rare event, and a last resort in an impaired patient-practice relationship.

Government figures for removals do not differentiate between those removed because of a breakdown in the relationship and those who are removed for administrative reasons, such as moving to an address outside the practice area.

In any case the number of removals must be considered in the context of there being 10,600 practices in the United Kingdom and some 250 million consultations in practices in the course of any one year.

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.

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