Practice removed patient from list without warning

What happened

Mr U had a number of appointments at the Practice between summer and winter 2013 about his heel pain. He also complained to the Practice in late summer 2012 about the attitude of a GP. This complaint went unanswered.

The Practice recommended a number of treatment options for Mr U and made a referral to podiatry services for some specialist input. Unfortunately, the treatments recommended did not help Mr U's heel pain. Mr U kept the Practice updated on his work situation at this time and asked the Practice to provide letters for his employer explaining how the heel pain affected his work.

Mr U became more frustrated by his work situation and asked the Practice to do more to support him in his dispute with his employer. In winter 2013 the Practice removed Mr U from the Practice list after a discussion he had with one of the GPs during which the GP felt that Mr U was verbally aggressive towards her. The Practice cited relationship breakdown as the reason for removing Mr U from its list.

What we found

The Practice acted appropriately in the care and treatment it gave. Our adviser said that Mr U's condition was hard to treat and that different patients needed different treatments because there was no standard approach. Although the Practice was unsuccessful in resolving Mr U's heel pain by the time he was removed from the list, this was not through any failing by the Practice.

We considered the notes of Mr U's consultations and phone calls with the Practice and agreed that there was a breakdown in the doctor patient relationship, and it was reasonable for the Practice to remove Mr U from its list because of this. We saw no evidence that the Practice had removed Mr U from the list because he had made a complaint. However, we decided that the Practice should have spoken to Mr U about the relationship breakdown and given him a warning before it removed him from its list. In failing to give Mr U a warning, the Practice denied him the opportunity to attempt to resolve the situation and discuss the issues that were causing the breakdown.

Putting it right

The Practice has apologised to Mr U for failing to give him an appropriate warning before it removed him from its list. It has also reviewed its guidance about GP removals and has confirmed that it will issue appropriate warnings before it removes a patient from its patient list in future.