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A patient must be warned that they are at risk of removal, together with an explanation of the reasons for this, within the period of 12 months before the date of the request to the Primary Care Organisation.
Whilst warnings do not have to be in writing it is good practice for them to be so as this allows for carefully considered reasons to be given.
A permanent record of the warning, including the date and reason for the warning, must be made and retained as the PCO or NHS England may require sight of them.
Copies of such records must therefore be retained after the patient has left the list.
This is necessary because otherwise the practice may still be under an obligation to visit the patient when medically necessary at a location outside their practice area.
In such cases, the usual rule will apply that the patient will be removed from the practice list as soon as the PCO is notified that the patient is registered with another practice, or will be removed from the practice list on the eighth day after the PCO is notified of the request for removal.
The PCO or NHS England must be informed in writing of the request and the removal will not take effect until the eighth day after the request is received by the PCO or NHS England or, if the practice is treating the patient at intervals of less than seven days, eight days after treatment ceases unless the patient is accepted by, allocated or assigned to another practice sooner than this.There has been a public perception, fuelled by reports in the media, that patients are being removed from practice lists because their care is too costly, because of their clinical condition or even their age.The GPC supports provisions in the contract that make explicit that any such discrimination is unacceptable.In cases other than violence and abuse, the GPC recommends that the decision to remove a patient from the list should only be made after careful consideration.Alternatives, short of removal, should be considered such as transferring the patient’s care to a partner (with the consent of both parties) or persuading the patient that it would be better for all concerned for them to go to another practice.