Ombudsman slams patient removals

Tuesday 18th October 2011

A critical report condemns "unfair removal from GP patient lists" and says some practices are failing to deal appropriately with the most basic complaints.

Published today (18 October 2011), the Ombudsman's annual review of complaint handling by the NHS in England said 21% of all complaints about GPs it investigated last year were about patient removals.

In one case, a terminally ill woman was removed from her GP's list following a dispute between the practice and her daughter.

In another, a woman was removed from her GP's list after a "simple disagreement" about unanswered telephone calls.

The Ombudsman, Ann Abraham, said such incidents "suggest GPs are failing to manage relationships with patients properly, resulting in a breakdown of communication and patients being removed from GP patient lists without fair warning or proper explanation."

The report says some GPs are not following the "clear guidance" that patients must be given a warning before they are removed from lists, except where this would pose a risk to health or safety or where it would be unreasonable or impractical to do so.

"Zero tolerance policies" of some GPs were criticised, with the report slamming "unfair and disproportionate" decisions that "can leave entire families without access to primary healthcare services following an incident with one individual".

The report acknowledged "it is not easy for frontline staff to deal with challenging behaviour, and aggression or abuse is never acceptable", and described the importance of the GP-patient relationship.

However, it added: "As GPs prepare for the increased commissioning responsibilities outlined in the government's health reforms, it is essential that they get the basics of communication right."

In response, Dr Michael Devlin, the Medical Defence Union's head of advisory services, said: "To put this report in context, the 48 complaints against GPs investigated and reported on by the Health Service Ombudsman represent a tiny proportion of the 300 million GP consultations estimated to place in England each year."

"However, it's important we are all alive to any emerging trends and it is clear from the report that the Ombudsman's office is investigating more complaints about removals from practice lists which it believes are happening without fair warning or proper explanation."

The MDU stressed that removing patients from a practice list "should only be considered in exceptional circumstances after other options to resolve the problem have been explored."

The two most common reasons people gave for being dissatisfied with how the NHS had handled their complaint were poor explanations and no acknowledgement of mistakes.

The Ombudsman report calls for "an increased focus for all NHS staff on understanding and evaluating the totality of a patient's experience, from the minute they pick up the phone to their GP surgery until the time they no longer need NHS care."

Your comments (terms and conditions apply):

"Laughable. Who else would be expected to put up with the rubbish GPs and their staff routinely put up? If I went in to my local Starbucks and started swearing and being abusive expecting to jump the queue for no other reason than I am me would I be given a warning? I doubt it I would be asked toleave and escorted off the premises by the police if I did not. This typifies the 'briefing aginst GPs' that has characterised govt and similar for years, why was this not put in context? Let's know how many GPs/GP staff have been assaulted never mind those who have been verbally abused. Patients have to take responsibility for their own actions we have a responsibility to our staff under employment law. How could anyone feel safe doing a home visit on a member of the same family once they have been assaulted by by a patient? The Ombudsman needs to grow up and face reality, if people are allowed to behave badly they continue to do so. Complaints should be handled correctly but that is a one sided process, can I complain against the oaf who assaulted one of our GPs no and if I tried I would be a whinging overpaid (I wish) public servant" – Name and address withheld

"The culture that exists in the NHS has created some of the behaviour exhibited by patients. Patients are demanding more and failure to give them what they want is taking its toll on themselves and particularly on staff. It is with regret that a few create a problem for the majority. We are all patients and should consider that the NHS is for the care of all not a one to one privately funded service delivery" – V Henry, London

"Patients are increasingly abusive, difficult and have demands that cannot be reasonably met. In such circumstances, the practice has no alternative but to warn the patient and then remove them when they do not comply. It is unfair to say that patients who have been removed have "entire families without access to primary healthcare services following an incident with one individual". Patients are given 1 month to find another GP. If they cannot find one, the PCT is obliged to find them a GP. Also, the whole family is not necessarily excluded. The practice/patient experience should be a two way relationship, where the practice and patients have an understanding of what is asked of each of them" – Sangeeta Ganvir, Salford

"Spend a day at our practice and see how some people behave face to face and on phone! We are about to install voice recording as a two-way process!" – Name and address withheld