Patients' accounts of being removed from their general practitioner's list: qualitative study

Objective: To explore patients’ accounts of being removed from a general practitioner’s list. Design: Qualitative analysis of semistructured interviews. Setting: Patients’ homes in Leicestershire. Participants: 28 patients who had recently been removed from a general practitioner’s list. Results: The removed patients gave an account of themselves as having genuine illnesses needing medical care. In putting their case that their removal was unjustified, patients were concerned to show that they were “good” patients who complied with the rules that they understood to govern the doctor-patient relationship: they tried to cope with their illness and follow medical advice, used general practice services “appropriately,” were uncomplaining, and were polite with doctors. Removed patients also used their accounts to characterise the removing general practitioner as one who broke the lay rules of the doctor-patient relationship. These “bad” general practitioners were rude, impersonal, uncaring, and clinically incompetent and lied to patients. Patients felt very threatened by being removed from their general practitioner’s list; they experienced removal as an attack on their right to be an NHS patient, as deeply distressing, and as stigmatising. Conclusions: Removal is an overwhelmingly negative and distressing experience for patients. Many of the problems encountered by removed patients may be remediable through general practices having an explicit policy on removal and procedures in place to help with “difficult” patients.