|Health and Social Care
Dr. Brand: I beg to move, That the clause be read a Second time.
The Bill is wide-ranging, and we were disappointed that the Government did not include provisions on patients' rights to information, which many of us felt were necessary. I am grateful to my hon. Friend the Member for Sutton and Cheam, who has done a lot of work with the citizens advice bureau in drafting the new clause.
I have never struck a patient off my list, but I have occasionally been relieved when patients have gone. The relationship between doctors and patients works better when they get on with each other, or at least are not at open war. It is important for practitioners to analyse why they take people off their list or why they refuse to accept them. It is also important for the reasons why a relationship has broken down to be explained to a patient.
It would be helpful to the contractor and the patient if the Minister considered the substance behind new clause 15. Many people in patient and consumer organisations and in the NHS have felt that the problem is long overdue for attention.
Mr. Swayne: We are generally supportive of the provisions in the new clause. Constituents have come to see me at my advice sessions to complain that they have been removed from their GP's list. I must say that I had some understanding of the GP who removed them. I have often felt that if there were a power for a Member of Parliament to remove a constituent from his list, it might well be worthwhile pursuing such a power.
Dr. Brand: There is always the option to invite them to vote for another candidate, which is something I quite frequently do.
Mr. Swayne: The hon. Gentleman is very kind. However, it is quite proper to remove patients from a GP's list and there are provisions for their immediate removal in cases of violence. That is quite right. Nevertheless, there is a clear case to be made for written reasons to be made available to the patient. That would prevent many abuses. The medical professional bodies regard it as best practice to provide the reason. Therefore, I see no reason, for not requiring it to be provided. Perhaps we could turn the matter on its head and ask the Minister to come up with plausible reasons for saying why and in what circumstances it would not be proper to provide a written reason for removing someone from the list?
Mr. Denham: We have an opportunity for a brief debate on a topic that we should not be trying to resolve through this Bill, although it is certainly a live one that has concerned this House and the Health Select Committee and I shall refer to the work that is under way. GPs have always had the right to remove patients from their lists without giving a reasonjust as patients have had the right to withdraw from a doctor's list without giving reasons. Historically, the view has been that the need for either party to give a reason could be an inhibiting influence on what might be the appropriate course of action. We would expect GPs to exercise their option to de-register patients only where there has been an irretrievable breakdown of the doctor-patient relationship or where the patient has been violent, or has threatened violence towards the GP or the GP's staff. The General Medical Council has advised doctors that they should not end their professional relationship with a patient unless they are satisfied that the decision is fair and does not contravene general guidance that it is unacceptable to discriminate on grounds of lifestyle, culture, belief, race, colour, gender, sexuality, age, social status or perceived economic worth.
The Government are concerned that patients who are removed from GP lists without their consent are treated with consideration and openness. Being removed from a doctor's list can be a distressing experience and patients look for reassurance and explanation. It is worth noting that the profession's representatives advise doctors to give reasons for removal wherever possible.
The current position is that, following the recommendation of the Select Committee on Public Administration after the 1997-98 report of the Health Service Ombudsman, we have agreed to a survey into the scale of and the reasons behind patient removal by GPs. The survey was commissioned from the Medical Care Research Unit at Sheffield university and its report is expected before Easter.
Although I have not seen the results, I am advised that preliminary results give a national picture of de-registrations for reasons other than patients leaving the area, and seem to suggest that the main reason for removing patients is violence or threatening behaviour. However, it may be too early to be certain on the conclusions of that report.
We have commissioned the research and I would not like to pre-judge today what the Government's response might be when we have received this research and considered it properly. Certainly paragraph 10.5 of the NHS plan states that
Dr. Brand: I am grateful for that reply. I hope that the Minister does not rely only on a survey and figures. It would be quite wrong if even a small number of patients were taken off GP's lists without reasonable cause: for example, so that their GPs could meet Government targets on immunisation. Families or extended families are sometimes thrown off a list because the GP does not get on with one family member. I hope that the Minister will also recognise that a code of good practice is an excellent mechanism for good practitioners, but it does not necessarily meet the requirements.
I beg to ask leave to withdraw the motion.
Motion and clause, by leave, withdrawn.
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