Background: GPs in the UK may remove a patient from their list without supplying a reason to the patient or the local health authority. Little is known of the events that lead to such removal decisions, nor of patients' views of their removal.
Objective: Our aim was to describe the events that lead to a removal from both the doctor and patient perspectives.
Methods: An anonymized postal survey of 204 GPs and 319 patients with recent experience of removal was carried out.
Results: Violent, threatening or abusive behaviour was the most common reason for removal given by GPs (64%, 57 out of 89), with almost half of instances involving verbal abuse towards receptionists (42 out of 89). However, fewer than a fifth of patients admitted to threatening or abusive behaviour towards practice staff (15 out of 76). Although GPs reported giving patients a reason for the removal in 59% (44 out of 75) of cases, only 36% (26 out of 72) of patients reported receiving a reason. Patients often appeared not to understand why they had been removed.
Conclusions: While doctors and patients frequently give differing accounts of the events which lead to removal, both emphasize relationship breakdown and loss of trust. Financial issues appear negligible. Since few removals seem preventable by policy measures, the distress of removal might best be reduced by trying to improve the removal process-probably through improved communication-rather than prevent removals.