Ending your professional relationship with a patient
In Good medical practice1 we say:
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.
In this guidance, we explain how doctors can put this principle into practice. You must be prepared to explain and justify your decisions and actions. Only serious or persistent failure to follow our guidance that poses a risk to patient safety or public trust in doctors will put your registration at risk.
Things to consider
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.
See Health Service Circular 2001/18 Withholding treatment from violent and abusive patients in NHS Trusts.
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.
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.
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
Before you end a professional relationship with a patient you should:
- warn the patient that you are considering ending the relationship
- do what you can to restore the professional relationship
- explore alternatives to ending the professional relationship
- 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).
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.
When you've made a decision to end the relationship
If you decide to end your professional relationship with a patient you must:
- 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
- follow relevant guidance6 and regulations
- 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
- make sure arrangements are made promptly for the continuing care of the patient, and you must pass on the patient’s records without delay7
- be prepared to justify your decision.
Closing or relocating your practice
If you are closing or relocating your practice, you should:
- give advance notice
- 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
Department of Health
British Medical Association – General Practitioners Committee (GPC)
Medical Protection Society
Removing patients from the practice list (see also factsheets for all four UK countries)
Medical Defence Union
Parliamentary and Health Service Ombudsman