Disruptive Patient Policy

Policy for Removal of Patients from the Practice List

1. Purpose

Poplar Grove Practice aims to provide the best possible health care for their patients. However there may be circumstances when it would be considered reasonable, or in the best interests of the patient, to remove patients from the registered practice list. The purpose of this policy, therefore, is to define the practice guidelines for when it is reasonable to remove a patient from the practice list and to ensure that any concerns about removing patients from the list are dealt with fairly.

Inappropriate and unacceptable behaviours may include but are not limited to:

  • Using bad language or swearing at practice staff or other service users
  • Racial abuse
  • Sexual harassment
  • Unnecessarily persistent or unrealistic service demands that cause disruption
  • Causing damage to practice premises or to the property of staff or other service users
  • Stealing from practice premises, staff or other service users
  • Obtaining drugs and/or medical services fraudulently
  • Filming staff without their consent and sharing on social media platforms.


2. Situations which justify an immediate removal from the Practice List

Violence

When a patient:

  • Is physically violent or threatening towards a doctor, practice staff or other patients on the practice premises
  • Causes physical damage to practice premises or other patient’s property
  • Makes threats towards the doctor, practice staff or other patients
  • Gives racist abuse, orally or physically
  • Is violent or uses or condones threatening behaviour to doctors (or some other members of the primary health care team) while visiting the patient’s home. Such behaviour may involve the patient, a relative, a household member, or pets (such as unchained dogs)

Crime & Deception

Where a patient:

  • Fraudulently obtains Drugs for non-medical reasons
  • Deliberately lies to the doctor or other member of the primary health care team (e.g. by giving a false name or false medical history) in order to obtain a service or benefit by deception
  • Attempts to use the doctor to conceal or aid any criminal activity
  • Steals from practice premises

Any incident involving violence, crime or deception will be reported to the Police and a crime reference number obtained.

Irretrievable Breakdown of the Doctor-Patient Relationship

  • Where a patient’s behaviour falls outside of that which is normally considered reasonable and leads to an irretrievable breakdown of the doctor-patient relationship.

Where a patient has acted inappropriately or unacceptably, the practice will carefully consider the severity of the incident (taking account of the nature of the incident / behaviour, the impact on practice services, staff or other service users and the patient’s own circumstances). Removing a patient immediately from the practice patient, list without prior written notice under reasonable grounds or grounds of irrevocable breakdown in the relationship, is expected to be an exceptional event. However the practice has the right to instruct an immediate removal with no prior warning letter if any of the above acts of violence, crime and deception occur.

3. Procedure for non-violent disruptive behaviour

Inappropriate behaviour may not always be violent but is always considered unacceptable.

Inappropriate and unacceptable behaviours may include but are not limited to:

  • Using bad language or swearing at practice staff or other service users.
  • Micro aggression: verbal, non-verbal and environmental slights, snubs and insults which communicate hostile, derogatory or negative messages and behaviours
  • Racial abuse
  • Sexual harassment
  • Unnecessarily persistent or unrealistic service demands that cause disruption

Each non- violent case will be discussed at a Managing Partners Meeting and a majority
agreement will be reached.

If this is a first warning, the practice will warn the patient, in writing, that they are at risk of removal and reasons for this will be stated in the letter. A warning letter provides an opportunity to reflect on the incident and will indicate registration will cease if the inappropriate or unacceptable behaviour continues or reoccurs, and therefore formally documents and evidences reasonable grounds for future removal should it do so.

In some circumstances the practice may encourage the patient to sign a contract of behaviour which clearly sets out the expectations of the patient if they wish to remain registered at Poplar Grove.

If the patient’s behaviour does not improve the practice will issue a second warning letter. This letter will then inform the patient that they will be removed from the practice list in 8 days from the date on the letter.


4. Other factors which may result in a patient’s removal from the practice list

Distance

On notification that the patient is no longer living within the practice boundary, a letter will be sent to the patient advising of the need to re-register within the next 30 days. If the patient has not re-registered, or contacted the surgery with a reasonable explanation, within the 30-day period, they will be removed from the practice list.

Embarkation

On notification that the patient has moved abroad the patient will be removed from the practice list within 3 months of that notification. 

Failure to attend pre-booked appointments

If a patient fails to attend a pre-booked appointment on more than one occasion in the last year, a warning letter will be sent to the patient, advising them that a further occurrence could risk removal from the practice.

If the patient fails to attend another appointment, the matter will be discussed at a Practice Meeting and a majority agreement will be reached as to whether the patient will be removed from the practice list. Following agreement, the practice will write to the patient and explain the reasons for removal.

5. Guidance on removing patients due to irretrievable breakdown of the doctor patient relationship

Occasionally patients persistently act inconsiderately and their behaviour falls outside that which is normally considered to be reasonable. In such circumstances there may be a complete breakdown in the doctor-patient relationship.

Steps to be taken within the practice

  • Inform all appropriate members of the practice about the problem.
  • The practice will take into account that service user’s mental health, clinical presentation, neurodiversity and any other health which may influence their behaviour and ensure that patient’s own protected characteristics take no bearing in the consideration process


Steps to be taken with the patient

  • Inform the patient, either personally or in writing, that there is a problem.
  • Explain the nature of the problem to the patient.
  • Obtain the patient’s perspective and interpretation of the situation.
  • Signpost the patient to support organisations like PALS
  • Obtain advice of a Medical Defence Society

Steps to be taken if discussion fails to resolve the problem

  • Suggest that another GP within the practice might better fit with the patient’s needs and expectations.

Steps to be taken in actually removing the patient

  • Inform the appropriate Health Authority in writing of your decision.
  • Inform the patient in writing of the decision and the reason for removal from the list.
  • Explain to the patient that he or she will not be left without a GP.
  • Give the patient information on how to begin the process of registering with another GP.

Responsibility

Responsibility for implementing and monitoring the policy rests with the practice partners / practice manager. The Partners of Poplar Grove Practice re-affirm their commitment to do everything possible to protect staff, patients and visitors from unacceptable behaviour and their zero tolerance of any incident that causes hurt, alarm damage or distress.