When I received the emails from the practice advising of how [Practice staff member] had portrayed me, and the decision to remove me, I was both horrified and humiliated. I could not believe that the Doctors I had built up a lifelong relationship with, had taken this decision without contacting me to come in for mediation… I have since contacted another practice to hopefully join their books but this has caused a lot of hurt and created major trust issues for me.’
‘I would like to find out why an entire family can be struck off a register because of one individual making a complaint which had absolutely nothing to do with the rest of the family. …my mother-in-law has been left without prescription of controlled medication to relieve pain associated with a chronic back issue, leaving her bed bound and we are having extreme difficulty finding another practice to register with.’
These are just two of the complaints that have resulted in patients being inappropriately removed from GP practice lists.
And patients are sometimes removed without warning or even their knowledge – that’s according to a new report published by the Northern Ireland Public Services Ombudsman (NIPSO).
The overview report, The Removal of Patients from their General Practice Service, highlights repeated failures by GP practices to follow statutory rules when deregistering patients, resulting in unnecessary distress, disruption to care and difficulties re-registering elsewhere.
NIPSO examined complaints received between January 2023 and January 2025, during which 28 complaints were made about patient removals and a further five about warnings of removal – accounting for almost one in five complaints received about GP practices in that period.
One of the most serious findings is that patients are being struck off practice lists without receiving the required warning, despite regulations stating that removal should be an exceptional measure.
In several cases examined, patients were removed after a single non-violent incident, often following disputes with reception staff or expressions of frustration, with practices relying on Zero Tolerance policies.
However, the Ombudsman found that such policies do not override the law, which requires that patients be warned within the previous 12 months and given an opportunity to address concerns, except in cases involving violence or serious threats where police are notified.
NIPSO concluded that some practices either misunderstand or misapply Zero Tolerance policies, leading to unlawful removals.
The report also raises serious concerns that patients have been removed simply for making complaints about their care.
Guidance from the General Medical Council (GMC), British Medical Association (BMA) and the Health and Social Care complaints framework is clear that making a complaint should never, in itself, be grounds for removal.
Despite this, NIPSO identified multiple cases where practices cited a “breakdown in the doctor-patient relationship” directly linked to a complaint, without any attempt at mediation or restoring trust.
The Ombudsman stressed that complaints should be viewed as an opportunity to learn and improve services, warning that removing patients in response to complaints undermines confidence in the health system.
In some of the most troubling examples, entire families were removed from GP lists because of the actions of one individual.
Case studies included partners, children and even elderly relatives being struck off without any evidence of misconduct, contrary to professional guidance which states that removal should apply only to the individual involved.
In one case, a care home resident was removed solely because a family member had complained on their behalf, leaving the vulnerable patient without continuity of care.
The report also highlights failures in notification, with some patients unaware they had been deregistered for years.
In one case, a patient who had lived at the same address since birth was removed on the basis they had “left the area”, without any attempt by the practice to contact them. The patient only discovered the removal three and a half years later.
NIPSO found weaknesses in verification by the Business Services Organisation (BSO), which processes removals, noting that removal requests are often accepted without checks that regulations have been followed.
Currently, there is no independent appeal process for patients removed from GP lists. Patients are instead directed to complain to the same practice that removed them.
NIPSO said this lack of independent review is particularly concerning given the serious consequences of deregistration, including difficulty accessing medication and registering with another GP.
While the Ombudsman decided not to launch a full own-initiative investigation at this stage, the report makes three key recommendations:
– The Department of Health should introduce clearer guidance on patient removals, including warnings, complaints, family members and communication.
– The Department should agree a clear verification process with BSO to ensure removals comply with regulations.
– Consideration should be given to creating an independent review or appeal mechanism for disputed removals.
NIPSO welcomed steps already taken by the Department of Health, including requiring GP practices to submit removal policies, but said further action is urgently needed.
The Ombudsman concluded that without reform, patients will continue to face unfair removals, unnecessary stress and disrupted access to healthcare, while GP practices risk breaching regulations through lack of clarity and oversight.
