Removal of Patients from the Practice List Policy

• Policy Statement

This Practice aims to maintain a safe, effective, and respectful environment for patients and staff, while ensuring fair access to NHS primary care services. In certain circumstances, it may be necessary to remove a patient from the Practice registration list. This policy outlines the reasons for removal and the processes followed, in line with NHS regulations.

Removal from the Practice list is always decided fairly, consistently, and with appropriate documentation.

• Scope

This policy applies to:

• All registered patients of the Practice
• All forms of interaction with the Practice, including face-to-face, telephone, written, and electronic contact

• Principles

• Patient safety and staff safety are paramount
• Decisions will comply with NHS guidance and contractual requirements
• Patients will usually be given notice of removal unless immediate removal is justified
• Equality and reasonable adjustments will be considered where appropriate

• Grounds for Removal from the Practice List

• Repeated Missed Appointments (DNAs)

A patient may be removed from the Practice list if they:

• Fail to attend or cancel three (3) or more appointments within a rolling 12-month period

Process:

• Missed appointments are recorded in the patient record
• The patient will be given 30 days’ written notice of removal
• The notice period allows the patient time to register with an alternative GP practice

This process is carried out in line with the Practice’s Missed Appointment (DNA) Policy.

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• Moving Outside the Practice Boundary

The Practice covers patients who live within the following areas:

• Central Milton Keynes
• Campbell Park
• Heelands
• Conniburrow
• Bradwell
• Loughton
• Oldbrook

A patient may be removed from the Practice list if they:

• Permanently move to an address outside the Practice boundary

Process:

• The patient will be given 30 days’ written notice of removal
• During this time, the patient should register with a GP practice closer to their new address

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• Breakdown in the GP–Patient Relationship

A patient may be removed where there has been an irretrievable breakdown in the GP–patient relationship, for example:

• Loss of trust or confidence
• Persistent conflict or disagreement
• Repeated failure to engage constructively with care plans or Practice processes

Process:

• Concerns will be documented
• Where appropriate, attempts may be made to resolve issues
• If removal is necessary, the patient will be given 30 days’ written notice

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• Unacceptable Behaviour (Zero Tolerance)

The Practice operates a Zero Tolerance Policy towards violence, aggression, abuse, intimidation, or other unacceptable behaviour.

Removal may occur where a patient:

• Displays aggressive, threatening, abusive, or violent behaviour towards staff, patients, or visitors
• Causes damage to Practice property
• Repeatedly behaves unacceptably despite warnings

Process:

• In serious cases, the patient may be removed with 8 days’ notice, in line with NHS guidance
• In cases involving actual or threatened violence, the patient may be removed immediately without notice
• Police and/or NHS England / Integrated Care Board (ICB) may be notified where appropriate

This process is carried out in line with the Practice’s Zero Tolerance Policy.

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• Immediate Removal Without Notice

Immediate removal may occur where a patient’s behaviour:

• Places staff, patients, or visitors at risk
• Involves violence, threats of violence, or serious intimidation

Immediate removals are carried out in line with NHS regulations. The patient will be informed in writing and advised how to register elsewhere.

• Equality, Safeguarding, and Reasonable Adjustments

The Practice recognises that some patients may have health conditions, disabilities, or social circumstances that affect behaviour or engagement. Where appropriate:

• Reasonable adjustments will be considered
• Safeguarding concerns will be escalated

However, this does not justify violent, threatening, or abusive behaviour.

• Notification and Registration Elsewhere

• Patients removed from the Practice list will be notified in writing
• Patients will be advised to register with an alternative GP practice
• NHS England / Primary Care Support England (PCSE) will be informed as required

• Appeals and Complaints

Patients may raise concerns or complaints about removal decisions through the Practice complaints procedure. Removal decisions themselves cannot usually be appealed once actioned, but concerns will be reviewed.

• Governance and Review

• All removals will be documented and reviewed by Practice Management
• This policy will be reviewed annually or earlier if NHS guidance changes