Struck off with no explanation

CAN a doctor strike you off his list without warning and without an

explanation? The short answer is: Yes.

A young man in Glasgow who has suffered from M. E. for six years was

flabbergasted the other day to receive a letter from the Department of

Practitioner Services saying that his GP had requested that his name be

removed from his list of NHS patients.

The letter went on to say: ''In accordance with the provisions of the

National Health Service Regulations, removal of your name will take

effect after seven days of the date of this letter, or earlier upon

acceptance by another practitioner.

''If you wish to avail yourself of the facilities of the National

Health Service, it will be necessary for you to register with a new

medical practitioner without delay. In order to do this you should

approach another doctors' practice in your area for an appointment to

have an interview with one of the doctors with a view to being accepted

as a patient.''

The young man in question, a former student who had to drop out of

university because of his illness, is too weak and incapacitated to trek

around GPs' surgeries or even to begin trawling through the telephone

directory to find a doctor. It was left to his family to find him

another doctor, a procedure that took some time.

He was rejected by three practices in the area before his mother, a

well-known personality, decided to step in and write an official letter

on her word-processor using expensive headed notepaper. It did the

trick. Immediately he was offered a place on a doctor's list. But he

still doesn't know why he was crossed off his original practice in the

first place.

And his doctor is not obliged to give an explanation.

Another young man from Drumchapel is not so lucky. He got a similar

letter and he is still without a doctor. But he knows why. He was cheeky

to his GP.

A middle-class Edinburgh woman is absolutely distraught. She received

a similar letter over a month ago. Attempts to find another practice

prepared to take her have so far failed. The reason she was crossed off,

she suspects, is that she took up too much of the doctor's time.

All within the last few weeks. Of course there are some very difficult

and even dangerous patients and GPs may even risk their lives visiting

them.

But the young man from Glasgow is still mystified about his own

removal. Maybe expensive medication? No, he has not been on any drugs

for years.

Surely doctors can't strike you off their lists without explanation?

I'm afraid so. In the same way that you can switch to another doctor

without giving a reason, so a GP can decide that he or she no longer

wants you on their list, says a spokesman for the Greater Glasgow Health

Board.

Am I alone in suspecting that the only ones who are going to get these

letters are the vulnerable and those at risk, the young, the elderly --

in fact those least able to fight back?

And it's all strictly legal.

We all know about Patients' Choice. But how many people are aware of

the existence of Doctors' Choice? They can elect to have only those who

are fit and well, or least likely to cost them time or money.

A spokesman for the Greater Glasgow Health Board pointed out that if a

patient fails to find a GP prepared to take him or her on then the

Department of Practitioner Services, as a final resort, is empowered to

make a GP take a patient on.

But I wonder how many people, panic-stricken by the letter, are able

to read this into the final section of the letter: ''In the event of you

having difficulty in registering with a practice after having tried all

the practices in your area you should contact me at this office giving

details of the practices you have approached.''

The usual reason for doctors removing patients from their lists is

because of physical or verbal abuse, threatened or actual, says a

spokeswoman for the British Medical Association (Scotland). ''However,

since the introduction of the contracts in 1990 some practices are not

replacing a partner when he or she retires and it could lead to some

patients receiving letters asking them to find another doctor. But the

usual reason is a breakdown in communication between doctor and

patient.''

Incidentally, 2000 people in the Greater Glasgow Health Board area

changed their doctor last year: either they received letters from their

GP or they switched doctors.

Perhaps the Health Board ought to find out why.