Removing patients from GP lists is a last resort

According to this report, there is an increase in complaints about patients being unfairly removed from general practice lists. If the daily mail reporting of the story is to be believed, these decisions are left up to heavy handed receptionists and managers who act like overzealous doormen and will boot you “off the list” if you’ve dared to tut that the nurse is running late or are unfortunate enough to suffer from the wrong sort of ailment.

The reality is that for 99% of practices, taking someone off their list is a rare occurrence and a last resort. I myself had been a GP for several years before I even knew that such a drastic measure was even an option. It only crept in to my consciousness when a patient suggested he was going to forcibly remove my testicles from the rest of me and then encourage me to ingest them. His language was more colourful but you get the idea. I had refused to write him a letter that stated he was too unwell to attend his probation appointment that afternoon and it hadn’t been a popular management decision. To be fair to him he hadn’t carried out his threat despite the fact that my room was frighteningly sound proof and exceptionally well equipped with scalpels and tongue depressors. I was regaling the consultation details to an amused colleague when the practice manager overheard and felt it suitable grounds to “off list” him. I was quite surprised as after years of working in A&E and inner city GP practices, I had become well accustomed to receiving threats and abuse at the hands of patients and fully accepted it as just being part of the job.

The only other patient who we have threatened to kick off our list recently is a serial non attendee. She makes appointments and then doesn’t turn up. When this happened ten times in an eight month period we explained how it wasn’t fair on other patients and that wasting her appointments was increasing waiting times for everyone else. When she missed two more appointments in the following month we threatened to take her off our list. It is the only weapon in our armoury, but the dilemma is I don’t really want to kick her out. She and her family have been at our surgery for years and they have a lot of problems both social and medical. The practice and our staff are one of the few constants in her otherwise chaotic existence. I also know that by throwing her off our list, I am basically just passing one of our most difficult patients on to another of the local practices. They could take revenge and “off list” a couple of their problem patients on to us. The tit for tat patient dumping could last for generations. So far we have reluctantly kept her on our books but if anyone has any good ideas for encouraging her to keep her appointments, they would be much appreciated.

Far more common than forcibly eliminating patients from practice lists is patients voluntarily removing themselves. Doctors are just humans and you will get on better with some than others. Often patients shop around until they find a GP or a surgery that suits them and this system seems to work well enough the vast majority of the time. If I ever reach the point where I am regularly removing handfuls of patients from my list due to minor complaints or disagreements, it is probably time I pack it in and find a different job. If you as a patient have just been forcibly ejected from your sixth GP practice in as many months, it is probably time you booked in to those anger management classes everyone keeps telling you about.

Ben Daniels is a pseudonym. The writer is a doctor and author of confessions of a GP

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