Thousands of patients struck off by their GPs

Family doctors are adopting a zero-tolerance approach to patients who displease them by striking them off practice lists, in breach of NHS regulations.

The tough "one strike and you're out" approach led to a 6 per cent rise in complaints to the Health Service Ombudsman about patient removals last year, which accounted for more than one in five of all complaints about GPs.

In one particularly stark case, a terminally ill woman was struck off a GP practice's list after her daughter changed the battery on a device delivering an anti-sickness drug instead of waiting for the district nurse to change it for her. The revelations come in a highly critical report which lambasts the NHS for its failure to deal adequately with patient complaints.

Overall, the NHS paid out £500,000 in compensation to patients for poor complaint handling by staff, following investigations by the Ombudsman, Ann Abraham. "The NHS is still not dealing adequately with the most straightforward matters. Minor disputes over unanswered telephones or mix-ups over appointments can end up with the Ombudsman because of knee-jerk responses by NHS staff and poor complaint handling," Ms Abraham said.

GPs have always had the right to strike patients off their lists, which reciprocates the right of patients to switch GPs. But the rules require doctors to issue a warning and discuss matters with the patient before the axe falls, except in cases of aggression or abuse.

The finding that some doctors are acting precipitately highlights the vulnerability of patients at a time when GPs are set to acquire major new powers under the Health and Social Care Bill currently going through the Lords. Ms Abraham warned: "As GPs prepare to take on greater responsibility for commissioning patient services, some are failing to handle even the most basic complaints appropriately."

In the case of the terminally ill woman, a district nurse reported the incident to the practice who discussed it with her daughter. The practice decided "the doctor-patient relationship with the family had broken down" and removed not only the daughter, but also her sister and their mother from the practice list. The family was given no warning of the practice's intention, nor an opportunity to respond to it, as required by NHS regulations. The practice removed the women's terminally ill mother even though she had played no part in the disagreement.

Following the Ombudsman's inquiries, the practice apologised and drew up plans to avoid a repeat. Ms Abraham said: "In the cases we have seen, GPs have applied zero-tolerance policies without listening to and understanding their patients or considering individual circumstances. Decisions to remove a patient from their GP's list can be unfair and disproportionate, and can leave entire families without access to primary healthcare."

It is the second time Ms Abraham has criticised the poor handling of complaints in the NHS. Last year she said it needed to "listen harder and learn more". Progress in the last 12 months has been "patchy and slow", she said; complaints received about GPs stood at 2,581 last year, or 17 per cent of a total of 15,066 health service complaints to the Ombudsman.

Health minister Simon Burns said: "We published information on hospital complaints for the first time in August and will continue to do so."

A Department of Health spokesman said that GPs should tell patients if they intend to remove them from their list, adding: "If any patient feels that they have been removed unreasonably or without warning then they can raise this with their local Primary Care Trust."

A spokesperson for the British Medical Association said GPs could remove patients who were violent or abusive, or moved away. "Beyond that patients should only be removed in exceptional circumstances and as a last resort."

Unanswered telephone calls

Mr and Mrs L were removed from the list at their practice after 15 years when they refused to apologise for being "abusive" in a row over unanswered calls.