Give patients a second chance before striking them off, says ombudsman

BMJ 2002; 324 doi: (Published 29 June 2002) Cite this as: BMJ 2002;324:1540
  1. Alex Vass
  1. BMJ

    Patients should be given the chance to “rectify their behaviour” before being removed from a GP's list, warned the health service ombudsman for England, Michael Buckley (pictured), in his annual report published this week.

    Nine complaints over unfair removal of patients were investigated during 2001-2—more than about any other aspect of the general practitioner service, said the report. In eight of the nine cases, the complaints were upheld as “justified complaints about the way GPs approached the problem.”

    Failure to give patients adequate warning or opportunity to rectify their behaviour featured in all the cases. This, the report added, goes against guidance given by the Royal College of General Practitioners and the BMA.

    In one case a patient, Mrs B, was removed from her GP's list after telling a receptionist that she was the rudest person she had ever met. The ombudsman commended the GP's view that he should support and protect his staff, but found the GP's action “hasty and ill judged.”

    A total of more than 2500 complaints were received by the health service ombudsman in 2001-2, an increase of 3% on the previous year; 204 of these were accepted for investigation and 73% of grievances were upheld. Of the 225 reports completed during the year, 79% concerned matters of clinical judgment.

    Eighty one cases investigated by the ombudsman related to poor handling of complaints, of which all but three were upheld. The present NHS complaints procedure, currently under review by the government, was criticised in the report as being “unduly complicated and time consuming.”

    Substandard clinical note keeping and juniors' failure to consult senior colleagues also arose in the investigations. Sir Michael, who is leaving his post this year, said that adequate note keeping was an “absolutely crucial part of professionalism.” He estimated that close to half of cases contained evidence of substandard note keeping.

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