LLANFAIR SURGERY

POLICY DOCUMENT

REMOVAL OF PATIENT FROM PRACTICE LIST

 

Policy Statement

Our staff come to work to care for others, and it is important for all members of the public and our staff to be treated with respect.

In line with the rest of the NHS, and to ensure this is fully observed we have instigated a Dignity at Work and Zero Tolerance policy, whereby aggressive or violent behaviour towards our staff will not be tolerated under any circumstances.

Anyone giving verbal abuse of members of staff will be sent a letter from the Practice Manager that this behaviour will not be tolerated. Any future violation of this policy may result in removal from the Practice patient list. There will be no appeal process.

The Practice feels sure you will understand that proper behaviour is absolutely necessary for our staff and patients and that non observance will not be accepted.

Llanfair Surgery aims to provide the best possible health care for its patients.  However there may be circumstances when it would be considered reasonable, or in the best interest of the patients, to remove patients from the 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.

  1. Situations which justify removal

       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
  •          Gives verbal abuse or 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 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 premisis

         Distance

  •          Where a patient has moved out of the designated practice area and has failed to register with another GP

      Embarkation

  • Where a patient has moved abroad for a period of 3 months of more
  • Failure to attend pre-booked appointments
  • Where a patient fails to attend pre-booked appointments on a number of occasions during a given period
  • 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
  1.     Procedure for Removal

Violence / Crime and Deception

Any incident involving violence, crime or deception will be reported to the practice manager, who will complete an incident report and

bring to the attention of the practice partners.

Each individual case will be discussed at a Practice Meeting and a majority agreement will be reached.

Following agreement, the practice manager will write to the patient and explain the reasons for removal.

The exception to this is if a patient has to be reported to the police for violent behaviour towards any member of the practice staff when he/she may be immediately removed.

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 manager will write to the patient and explain the reasons for removal.

Guidance for 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 patient and possible reasons for the patient’s behaviour (e.g. disagreeableness, cultural differences, mental illness, personality disorder) will be discussed at a Practice Meeting

        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
  • 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 HDUHB 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 by contacting their local Health Authority or Local Health Board.  Contact address details are:

Shared Services Partnership NHS Business Services Centre

Mid and West Region

NWSSP

Primary Care Services

Floor 3, Matrix House

Northern Boulevard

Matrix Park

Swansea Enterprise Park

Swansea  SA6 8BX

TeL no: 01792 458 066

Hywel Dda University Health Board

Corporate Offices,

Ystwyth Building,

St Davids Park

Hafan Derwen,

Jobswell Road,

Carmarthen

SA31 3BB

        Family Members

  • When a decision is made to remove a patient from the practice list, the removal may well be extended to other members of the family or household.
  • The practice manager will write to the family / household offering an explanation for the removal. They will be allowed 4 weeks to re-register rather than being removed from the practice list immediately.

       Responsibility

       Responsibility for implementing and monitoring the policy rests with the practice partners / practice manager.

       The Partners at Llanfair Surgery 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.