Patient Removal Policy

Introduction: The NHS has recently updated its policy, known as the Zero Tolerance Policy, to cover issues around abuse of staff and doctors by patients and other users of the NHS. The partners have a duty under employment law to protect staff from all forms of abuse. We also have a duty to other patients to ensure a fair and even service to all our registered patients. We must ensure safety at all times, and have developed these policies to be secure and even-handed in our treatment of everyone. If a Patient makes a complaint, this is not adequate reason for removal from the list. The Complaints Procedure should be followed under these circumstances Patients will not be discriminated against for race, gender, social class, age ,religion, sexual orientation, appearance, or disability / medical condition.

The Policy: This is outlined below under several categories, and is extended beyond the various forms of abuse of staff: it also covers situations where our services are repeatedly abused, and the more complex areas of “breakdown of the doctor patient relationship”. We look after over nine thousand patients, from cradle to grave in many cases, and the frequency of unacceptable behaviour by patients is extremely rare. Except in cases of physical violence or threats of the same, patients will always be informed in writing that an incident or set of incidents represents unacceptable behaviour towards us. There is a principle of either “two” or “three strikes and you’re out”, depending on the circumstances.  Below are examples which will trigger this process.

1. Physical abuse or Violence, or threats of the same: Immediate reporting to the Police, removal  from the list, and referral to the Cornwall scheme for Violent Patients. Once ratified by the Primary Care Trust (PCT), the person will forfeit the right to be registered with a local GP and will need to travel to a distant secure locality for future GP care for a minimum of one year.
   
   
2. Verbal Abuse of a doctor or other member of staff: One warning in writing, after verifying the facts: a further incident will mean removal from the list.
   
   
3. Persistent Failure to Attend:  Once an appointment is made, patients are expected to keep it, or inform us that they need to change. Failure to do so will be overlooked once: the next occasion will trigger a warning letter. Any further incidents will mean removal from the list.
   
   
4. Persistent abuse of services:  If the practice is aware that a patient or relative persistently ignores requests to follow procedures set down to ensure safe clinical care for them and other patients, two warnings in writing will be given. On a third occasion, the removal of that patient will be made.
   
   
5. Persistent non-compliance with treatment plans: We understand that patients sometimes disagree with a plan or treatment. We acknowledge this and allow for second opinions both within and beyond the practice. However, there sometimes comes a point where a patient is unwilling to accept advice and treatment, yet continues to put the clinicians in a position of responsibility for their care. This represents an impossible situation, and one where the patient risks serious detriment to their health. Two warnings will be made in writing before removal is instigated. We hope that this will almost never be necessary.

When the extremely rare situation does require removal of a patient, the PCT will be informed in writing, as will the registered patient, and their carer if appropriate. The practice will continue to treat for 9 days to allow for the patient to register elsewhere, except as in 1.above.  No removal of a patient will occur without discussion amongst the partners.