This policy details the requirements that this organisation has to consider prior to the removal of a patient from the organisation list in line with extant legislation, including The National Health Service (General Medical Services Contracts) Regulations 2015 (Part 2, Para 23-25) NHS England’s Primary medical services policy and guidance manual and the referenced publications.

In accordance with the Equality Act 2010, we have considered how provisions within this policy might impact on different groups and individuals. This document and any procedures contained within it are non-contractual, which means they may be modified or withdrawn at any time. They apply to all employees and contractors working for the organisation.

2 Death of a patient

2.1 Patients who have died

In the PCSE guidance titled Deductions, amendments and rejections, when a patient dies, their death is recorded by the General Registry Office. This generates a deduction on the organisation’s clinical system.

Further information can be found in the organisation’s Death of a Patient and Bereavement Policy.

3 Patient moving from practice area

3.1 Choice of GP practice

When the patient has made a choice to move to another organisation, a notification of deduction will be received from PCSE. Notifications will be acted on in line with the PCSE guidance titled Deductions, amendments and rejections when the patient will be deducted from the practice list.

Further reading can be found in The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 24.

3.2 Out of area – request to remain registered

When a patient has moved out of the practice’s outer boundary area but wishes to remain registered with this practice, and the organisation remains content to treat them as an out of area patient, in these instances the PCSE guidance titled Deductions, amendments and rejections is to be adhered to.

When continued registration is declined, the patient will be notified. A template letter detailing such notification can be found at Annex A.

3.3 Patients within the secure and detained estate

Patients detained within adult and child and young persons’ secure estates can register at their place of detention as detailed within the PCSE guidance tilted Patient Registrations. This allows records to transfer via the organisation’s GP2GP transfer policy.

It is accepted that this organisation may not be informed of a patient being imprisoned or the length of their sentence but, if this information is provided, the organisation has a duty to act by informing NHS E and moving to deduct the patient from the list.

Further reading can be found in PCSE guidance titled Patient Registrations. Furthermore, refer to The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 19A and Para 29.

3.4 Armed forces personnel

Medical care for serving personnel and mobilised reservists is provided for by the Defence Medical Services (DMS). The patient will still be entitled to treatment as a temporary resident should they find themselves residing too far away from a DMS GP.

When it is known that a patient has joined the armed forces on a full-time basis, the organisation will inform NHS E and deduct the patient from the organisation list as per PCSE guidance. There may be exceptions and guidance should be sought from The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 19.

Armed forces reservists, who usually retain their civilian role for most of the year, are to remain on the organisation list as they only serve for limited periods of time.

NHS E provides additional information for the Healthcare for the armed forces community. Additionally, further reading can also be found in the organisation’s Armed Forces Reserves Policy.

3.5 Patients who are abroad for more than three months

When it is known that a patient has been absent from the UK for a period of more than three months, the organisation must exercise caution when deciding to apply to NHS E to have the patient removed from its list.

The organisation should determine if the patient has retained a sufficient connection to the UK to continue to be habitually resident here, thereby justifying that they remain on the organisation list. For example, it could be considered inappropriate to remove a patient from the organisation list who spends three months abroad but nine months of the year in the UK.

Patients will be referred to the NHS guidance titled Planning your healthcare abroad for further guidance relating to eligibility for healthcare. Further reading can be found in The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 29.

3.6 Movement of at-risk patients

At this organisation, the Safeguarding Lead for both adults and children will be responsible for ensuring that a register of all at-risk children, young people and adults is maintained.

Further reading can be found in The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 24. Furthermore, guidance can be sought from The Safeguarding Handbook.

3.7 Children becoming a resident at school

Should any child be resident at a boarding school outside of the practice area, then it may be a requirement to remove them from the patient list. Further guidance should be sought from The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 31.

4 Patients not contactable – assumed moved

4.1 ‘Ghost’ patients

When, as part of their normal working, PCSE is made aware that the patient might no longer reside at the registered address, a FP69 flag will be raised on the National Health Application and Infrastructure Services (NHAIS) system and the organisation will be notified via the clinical system.

The organisation will attempt to contact the patient to confirm their address directly. When the patient has moved out of area, the patient will be advised to register with an alternative closer organisation and the patient will be deducted as per PCSE guidance. Should PCSE not receive any confirmation from this organisation to confirm residence within six months of the FP69 flag being raised, the patient will be removed from the organisation list.

When a letter is returned to PCSE or the organisation stating that the patient has ‘moved abroad’ or ‘deceased’, the appropriate action would be to confirm this status then deduct the patient.

For further guidance, refer to PCSE guidance titled Patient Removals and The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 28.

5 Patient requesting to leave the practice

5.1 Patient registering with another practice

NHS E is compelled to deduct a patient from the organisation list if the patient registers with another GP practice in the UK. Further guidance should be sought from The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 26.

5.2 End of temporary residence

If a patient has been a temporary resident for three months, they can be deducted from the organisation list without any further reason being given to NHS E.

For full guidance on temporary residence rules, refer to PCSE guidance titled Patient Registrations. For the legislation requirements, refer to The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 20 and Para 21.

6 Irretrievable breakdown in a relationship

6.1 Breakdown of a relationship

When removals due to a breakdown in a relationship are considered, reference should be made to the organisation’s Dealing with Unreasonable, Violent and Abusive Patients Policy for full guidance and example template letters.

The various types of removals and actions required for each are detailed within the PCSE guidance titled Patient removals. These details include:

· 8-day removal process

· Differences between Immediate Removal and High Level Security Deduction

· Immediate removal process

Further guidance can be sought from The National Health Service (General Medical Services Contracts) Regulations 2015 Part 2, Para 25.

7 Non-justified reasons for removal

7.1 Overview

This organisation will never remove a patient for any of the following reasons:

The patient has made a complaint
Medical conditions
Cost of treatment
Any of the protected characteristics

Refer to the BMA guidance titled Removing patients from your practice list.

7.2 Removing family members

The BMA advises in its guidance titled Removing patients from your practice list that, should the behaviour of one patient lead to their removal, this does not mean that the removal of other family or household members should automatically follow. An explicit discussion with other family members, while protecting the patient’s confidentiality, should take place.

Exceptions when it might be in the best interests for all parties if the whole family are removed might be:

· When there are ongoing investigations that could impact upon clinical care

· Safeguarding considerations

· Safety concerns, an example could be when the removed person needs to attend the practice in support of their child

· Home visits

Should other family members be retained, then it would be appropriate to raise a risk assessment to ensure that staff members are supported and any risks are minimised. In all instances, discussions to highlight any concerns should be made to other family members and, where appropriate, the Safeguarding Lead.

Further reading can be sought from the following:

· Health, Safety and Risk Management Handbook

· Home Visit Policy

· The Safeguarding Handbook

Annex A – Out of area refusal or removal

[Address]

[Date]

Dear [insert patient name],

Out of area – request to remain registered

Patients may register with a GP surgery outside their local area to support their personal needs. However, the decision to accept any ‘out of area’ patients will always be at the discretion of the organisation.

There are caveats to these arrangements whereby the patient would often not be close enough to the practice to be able to receive a home visit resulting in immediate necessary treatment for those patients potentially being compromised. Therefore, consideration must be given to any application, and any decision would be based upon whether it is clinically appropriate and practical in any particular case.

To do this we may, at any time:

● Ask questions about how practical it would be for the patient to attend this practice considering the distance, transport arrangements and also availability

● Review all ongoing health needs to ensure it remains clinically appropriate for the patient to be registered with this practice

Decision

Following your application, the partners have reviewed your case and have decided that they would not be able to meet your current healthcare needs under such an arrangement.

The partners feel it would not be in your or their best interests for you to remain registered at this organisation and ask that you seek to register with an organisation more local to your home address.

To find another practice local to you, please visit https://www.nhs.uk/service-search/find-a-GP.

Should you feel that there are additional extenuating circumstances of which we may be unaware which may affect this decision, please advise these in writing to [insert name and role] at the address above.

Yours sincerely,

[Signature]

[Name and role]

Date Published: 4th February, 2026
Date Last Updated: 4th February, 2026