This page is intended to offer advice when you are considering warning a patient of poor behaviour or removing a patient from your list. Please note that you should refer to the BMA guidance before taking any action Removing patients from your GP practice list ( or get in touch with us. 

It is vital that you set out in your Zero Tolerance Policy what is unacceptable behaviour and what type of behaviour requires a written warning, for example, repeated DNAs. It is good practice to attach a copy of your Zero Tolerance policy to your registration forms, so that patients have the opportunity to note your standards and actions regarding behaviour.

Verbal Warning

  • Useful for low level difficult behaviour such repeated DNAs or issues with prescription requests.
  • Practice Manager to telephone the patient to explain expected standards and /or policies as relevant. A face to face meeting may be necessary.
  • Refer patient to Practice Leaflet/Zero Tolerance Policy.
  • Ensure patient understands this is a verbal warning.
  • Make a note of the conversation in the patient’s medical records.

Written Warning

  • It is a requirement of the regulations that before removing a patient a letter be sent warning that the unacceptable behaviour may lead to removal if it is repeated within 1 year.
  • This letter can used where there has been inappropriate behaviour such as repeated DNAs following a verbal warning, verbal abuse, aggression, or intimidation but not as to require immediate removal.
  • If the patient decides to appeal against this letter arrange a meeting and explain fully the why the behaviour displayed was unacceptable and refer to the medical records to highlight dates and times of incidents.

Removal Letter

  • If the patient’s behaviour does not improve or there is a repetition of the type of incidents that caused the written warning letter, then removal may be appropriate.
  • Removal still requires that the patient doctor relationship has to have broken down irretrievably.
  • Be aware that removal will often trigger a complaint which can end up being considered by the Ombudsman who will scrutinise both the process and the reason for removal so be clear that removal decision is defensible.
  • Notify Primary Care Support England (PCSE) of the removal via the Portal and complete the Patient Removal Form available here
  • Removal will take place on the eighth day following the request being received by PCSE. However, the practice is still responsible for the patient’s medical services until the eighth day or the date the patient registers with another Practice, should this be within eight days.
  • Keep copies of all letters.

Immediate removal – Violent/Abusive Behaviour

  • Immediate does mean Immediate. Action is required the same day unless there are good reasons why it cannot be actioned immediately
  • If necessary, take advice from the LMC Office or your CCG. It is often difficult to decide whether immediate removal is necessary. Your LMC with guide you.
  • Notify the police. If the incident is serious resulting in a threat of, or actual physical violent call 999. The patient may need to be removed from the premises.
  • It is a requirement to notify the police as a crime reference number is required by PCSE to action the immediate removal request.
  • Notify Primary Care Support England (PCSE) of the removal via the Portal and complete the Patient Removal Form available here
  • Keep copies of all letters

The PCSE must be contacted via the portal for you to make a removal request. Removal Request Form can be found here. However, please note the PCSE will not offer you advice regarding removal.