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Violent patients most likely to be removed from GPs' lists

General practitioners' reasons for removing patients from their lists: postal survey in England and Wales

Violent, threatening or abusive behaviour by patients is the most common reason for removing a patient from their lists, report general practitioners in this week's BMJ.

In April 2000, researchers at the University of Sheffield surveyed 1,000 general practitioners in England and Wales about the current scale of, and reasons for, removal of patients from their lists (other than the patient living outside the practice area). A total of 748 questionnaires were returned.

They found that 40% of practices had removed one or more patients in the previous six months. Violent, threatening, or abusive behaviour was given as a primary reason in 176 (59%) of these cases and as a contributory reason in a further 24 (8%). Other primary reasons given were complaint by a patient (5 cases), non-compliance with childhood immunisation (4 cases), and non-compliance with cervical smear testing (2 cases). In 83% of most recent removals, the practice had given the patient a reason for the removal, either in writing or in person.

A substantial proportion of general practitioners believed that the target payment systems for childhood immunisation and cervical smear testing and financial arrangements for drug budgets and out-of-hours care created financial incentives for removing patients. However, non-compliance with childhood immunisation or cervical smear testing was rarely reported as a reason, and never as the sole reason for removal.

The validity of these findings depends on doctors being able and willing to identify and report the number of removals and their reasons for them, say the authors. Moreover, patients may have different views of the events leading to the removal, which future research should seek to understand, they conclude.

Contact:

James Munro, Clinical Senior Lecturer, Medical Care Research Unit, University of Sheffield, Sheffield, UK Email: j.f.munro@shef.ac.uk

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