Zero Tolerance

Zero Tolerance (PDF, 210KB)

The NHS operates a zero tolerance policy with regard to violence and abuse. The practice therefore has the right to remove violent patients from the list with immediate effect in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.

If the incident is serious enough to involve the police, either to assist whilst the patient is present, or to inform the police after the event, the practice will secure an incident / crime number and inform the CCG/NHS England and FHSA that the practice would like the patient removed immediately from its list. It is anticipated that, in instances such as this, the severity of the incident would warrant referral to the “difficult patient service”

Patient Removal Policy

Introduction

Queslett Medical Centre 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 interests of the Practice or the patient, to remove patients from the list. The purpose of this policy is therefore to define the practice guidelines for patient removal ensuring that all cases are dealt with fairly.

The Policy

This is outlined below under several categories, and extends beyond the various forms of abuse of staff: It also covers situations where our services are repeatedly abused, and the more complex areas of “breakdown of the doctor patient relationship”. We look after over 1200 patients and the frequency of unacceptable behaviour by patients is extremely rare.

Below are examples that will trigger the removal process and the resulting action by the practice.

1. Physical abuse or Violence, or threats of the same, including any damage to practice premises: Will be immediately reported to the Police and the person will be immediately removed from the list and referred to the scheme for Violent Patients. Once ratified by the Health Authority the person will forfeit the right to be registered with a local GP and will need to travel to a distant secure locality for future GP care for a minimum of one year.
2. Crime and deception. Where a patient fraudulently obtains drugs for non-medical reasons, deliberately lies in order to obtain a service or benefit by deception, steals from the practice or attempts to use the doctor to conceal or aid any criminal activity, they will be immediately removed from the list
3. Verbal Abuse of a doctor or other member of staff: Normally one written warning will be issued with any further incident resulting in removal from the list but the practice reserves the right to remove someone instantly depending on the severity and nature of the incident.
4. Persistent Failure to Attend: Once an appointment is made, patients are expected to keep it, or inform us that they need to change it. Failure to do so will be overlooked once: the next occasion will trigger a warning letter. Any further incidents will result in removal from the list.
5. Persistent abuse of services: If the practice is aware that a patient, or relative, persistently ignores requests to follow procedures set down to ensure safe clinical care for them and other patients, two warnings in writing will be given. On a third occasion, the removal of that patient will be made.
6. Persistent non-compliance with treatment plans: We understand that patients sometimes disagree with a plan or treatment. We acknowledge this and allow for second opinions both within and beyond the practice. However, there sometimes comes a point where a patient is unwilling to accept advice and treatment, yet continues to put the clinicians in a position of responsibility for their care. This represents an impossible situation and one where the patient risks serious detriment to their health. The GP will discuss the issue with the patient and following this discussion two warnings will be made in writing before removal is instigated. We hope that this will almost never be necessary.
7. Irretrievable breakdown of the doctor-patient relationship: Occasionally a patient’s behaviour falls outside that which is normally considered reasonable and leads to an irretrievable breakdown of the essential doctor-patient relationship. In some cases this can be overcome by changing GP’s within the practice but in others this will not be appropriate and following written explanation the patient will be removed from the practice list.
8. Distance: If a patient moves outside of the practice boundary, which includes going abroad for a period in excess of 3 months, they are automatically deemed to have left the practice and will be removed from the list by the Health Authority.

When the extremely rare situation detailed in items 1 & 2 requires instant removal of a patient the Health Authority will be informed in writing, as will the registered patient, and their carer if appropriate and the practice will cease caring for the individual immediately.

In cases covered by items 3 to 7 the practice will continue to treat patients for 9 days from the date of the removal letter to allow them time to register elsewhere.

In some instances where removal is considered necessary it may be deemed appropriate to extend this to other members of the family or household. In such cases the practice will write to the individuals concerned explaining the situation and they will be given 4 weeks to re-register with another GP rather than being removed from the practice immediately.

Except in the circumstances detailed in 1 and 2 no removal of a patient or their family/household will take place without discussion and agreement amongst the GP partners.