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Ending your professional relationship with a patient

Ending your professional relationship with a patient

1

In Good medical practice1 we say:

1

General Medical Council (2013) Good medical practice London, GMC.

62. You should end a professional relationship with a patient only when the breakdown of trust between you and the patient means you cannot provide good clinical care to the patient.

2

In this guidance, we explain how doctors can put this principle into practice. Serious or persistent failure to follow this guidance will put your registration at risk.

Things to consider

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In rare circumstances, the trust between you and a patient may break down, for example, if the patient has:

  • been violent, threatening or abusive to you or a colleague2 
  • stolen from you or the premises3 
  • persistently acted inconsiderately or unreasonably
  • made a sexual advance4 to you.
3

If you decide to inform the police about a patient you must follow our guidance on confidentiality. General Medical Council (2017) Confidentiality: good practice in handling patient information London, GMC.

4

You must also follow our guidance on maintaining a professional boundary between you and your patient (see paragraph 7). General Medical Council (2013) Maintaining a professional boundary between you and your patient London, GMC.

4

You should not end a professional relationship with a patient solely because of a complaint the patient has made about you or your team, or because of the resource implications of the patient’s care or treatment.

Before you end the relationship

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Before you end a professional relationship with a patient you should:

  1. warn the patient that you are considering ending the relationship
  2. do what you can to restore the professional relationship
  3. explore alternatives to ending the professional relationship
  4. discuss the situation with an experienced colleague or your employer or contracting body5 

and you must be satisfied that your reason for wanting to end the relationship is fair and does not discriminate against the patient (see paragraph 59  of Good medical practice). 

59

You must not unfairly discriminate against patients or colleagues by allowing your personal views24 to affect your professional relationships or the treatment you provide or arrange. You should challenge colleagues if their behaviour does not comply with this guidance, and follow the guidance in paragraph 25c if the behaviour amounts to abuse or denial of a patient’s or colleague’s rights.

5
If you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect you must follow our guidance Protecting children and young people: the responsibilities of all doctors.

When you've made a decision to end the relationship

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If you decide to end your professional relationship with a patient you must:

  1. make sure the patient is told of your decision to end the professional relationship, and your reasons for doing so; where practical, the patient should be told in writing
  2. follow relevant guidance6 and regulations
  3. record your decision to end the professional relationship – information recorded in the patient’s records must be factual and objective, and should not include anything that could unfairly prejudice the patient’s future treatment
  4. make sure arrangements are made promptly for the continuing care of the patient, and you must pass on the patient’s records without delay7  
  5. be prepared to justify your decision. 
7

General Medical Council (2013) Good medical practice London, GMC, paragraph 44.

Closing or relocating your practice

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If you are closing or relocating your practice, you should:

  1. give advance notice
  2. make sure that arrangements are made for the continuing care of all your current patients, including the transfer (or appropriate management) of all patient records.

Further sources of information and advice

England

Department of Health

Health service circular 2000/2001 Tackling violence towards GPs and their staff

British Medical Association – General Practitioners Committee (GPC)

Removal of patients from GP lists

Medical Protection Society

Removing patients from the practice list (see also factsheets for all four UK countries)

Medical Defence Union

Medical Defence Union website

Parliamentary and Health Service Ombudsman

Listening and Learning: the Ombudsman’s review of complaint handling by the NHS in England 2011–12

Case studies on removal from lists

Case studies from the Ombudsman’s review of complaint handling in England

Medical and Dental Defence Union of Scotland (MDDUS)

Risk alert – think before removing patients (30 November 2011)

Northern Ireland

The Health and Personal Social Services (General Medical Services Contracts) Regulations (Northern Ireland) 2004 – part two covers removal from GP lists in a range of scenarios

Scotland

Medical and Dental Defence Union of Scotland (MDDUS)

Risk alert – think before removing patients (30 November 2011)

Scottish Online Appraisal Resource (SOAR) for GPs in Scotland

Section on relationships with patients including removal of patients from GP lists