Right of Reply: The chairman of the British Medical Association's General Practitioners Committee responds to a report that patients are being struck off GP lists for financial reasons

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The Independent Culture
PATIENTS NOW face a new type of health horror story, with media reports suggesting that GPs are striking off huge numbers of them for financial gain (The Independent: "GPs drop patients to boost profits", 13 September). Despite the headlines, no evidence has been produced to substantiate any such wholesale removal of patients from GPs' lists. And if it were true, no one would deplore it more than the BMA.

It's true that data on the numbers of GP list removals is unreliable, but the BMA totally rejects the statement from the Royal Society of Medicine that "millions" of patients are being removed. We suspect that, on average, there are one or two forced removals a GP a year. This is way below extravagant claims in the media. We are working with the Department of Health to look at how we can collect anonymised data on list removals to get a better picture.

Most removals occur for administrative reasons; the patient has moved, or died. Violence or threatening behaviour by the patient is a special case where removal is justified. Otherwise, the sole criterion for removal should be irrevocable breakdown of the doctor-patient relationship. Refusing immunisation or smear tests after advice would not in itself constitute such a breakdown.

GPs shouldn't strike patients off their list because they have made a complaint, or because their treatment is costly or they are suffering from a particular clinical condition. Nor do we believe they should remove patients to meet target payments. Such payments for immunisation and cervical screening were imposed on GPs in 1990. We should like to see a change in the system.

We suggest that patients who have been given advice, but choose to disregard it, should be excluded from the calculations of GP target payments. This would prevent GPs being penalised when they have done their job. We shall continue to press the Government on this.