Patients Rights (Hansard, 7 November 1995)

§ Mrs. Alice Mahon (Halifax)

I beg to move, That leave be given to bring in a Bill to give patients certain rights in their dealings with general practitioners. My Bill would extend the patients charter to give patients certain rights in their dealings with general practitioners. Those rights would include a requirement for GPs in a practice of four or more, where a doctor-patient relationship has broken down, first, to offer a patient a second chance to stay in that practice by counselling that patient and issuing a warning that that behaviour will not be tolerated in the case of bad behaviour or, secondly, to offer the patient the right to visit another doctor in the same practice. Thirdly, if no other GP in the practice is willing to take the patient, the patients charter should include a requirement that patients be given reasons in writing stating why they are being removed from a GP's list.

This is not a doctor-bashing Bill. I have the greatest respect for our GP service and I recognise the dedication, skill and professionalism of our doctors. However, I believe that there is an injustice against patients and I am sure that, if good will and tolerance were shown by all sides, that injustice might be rectified.

Self-evidently, a good doctor-patient relationship must be based on mutual trust and respect. At present, GPs have the right to request that any patient be removed from their list, and that doctor is under no obligation to say why.

The consequences of such actions can be very far-reaching indeed. For example, if the patient belonged to a large practice, losing his and his family's right to be registered with their nearest GPs might be extremely inconvenient and might involve lengthy travelling, which obviously incurs extra costs.

I have a constituent who was struck off—she believes, for contacting her doctor at 8 o'clock at night to ask him to attend a fairly sick five-year-old. The doctor refused, but the child was admitted to hospital the same evening. The mother and the family were struck off, and now she must travel three miles with her youngest children to the next practice. Her youngest child needs to visit a doctor regularly, and that low-income family has been penalised by a doctor who, I believe, knew that he was wrong not to visit the child and covered his action by striking the whole family off his list.

I know that that is not the usual practice, but that family was never told why it had been struck off. Surely a much better outcome would have been for other doctors in the same practice to take on responsibility for that family.

Another consequence of being struck off a doctor's list without being given a reason is the great hurt that is felt by many people when they are.

Another constituent told me that she rarely visited a doctor, but that when she did on one occasion, the receptionist mistook her for someone else and a few words were exchanged. Realising the mistake, my constituent drew attention to it—fairly calmly, she claims—and made an appointment to visit her doctor, only to receive a letter two days later, telling her that she had been struck off. She told me that at first she felt anger 734 at the injustice and then she experienced a loss of confidence and a feeling of humiliation. She said that she would be very reluctant to visit a doctor again, however ill she felt.

Another constituent, a very brave 86-year-old, Mrs. Marion Greenwood, a pensioner, was struck off her doctor's list when she was ill. Her daughter, who lives with her, called the GP out when her mother became ill. The GP was angry because it was in the evening and was quite cross with the old lady. Mrs. Greenwood was admitted to hospital a couple of days later in a critical condition. While in hospital, she received a letter from her GP, telling her that she was being struck off and that she should find another doctor. I could go on reciting case after case, but time will not allow.

Obviously, there are instances when GPs have a legitimate right to say, "I personally cannot treat this patient any more." The following reasons were outlined in the advice given by the General Medical Services Committee last year as acceptable reasons for striking patients off a register.

A patient may be struck off if there is violent or threatening behaviour towards a doctor and his family, but even then, the GMSC believes that GPs should use their clinical judgment to determine whether a patient's violent behaviour results from his or her medical condition, and that if the patient is mentally ill, consideration should be given to the condition of that patient.

Other reasons for striking off might be a complete breakdown of the doctor-patient relationship, such as might occur if scurrilous, unfounded allegations were made against a doctor, or prescription fraud or the persistent breaking of appointments, which did not improve after a warning. However, the advice from the GMSC is not firm enough and weighs heavily in the doctor's favour.

There is growing support for my view. The Association of Health Councils in England and Wales is concerned that patients may be removed from lists simply for making a complaint. One woman told me that she was suffering from a back injury and took her son along to the doctor's receptionist. She could not sit down because of her injury. She was told that she might have to wait and the receptionist asked her to sit down. The woman said that she could not and would prefer to stand. Three days later she received a letter striking her off the doctor's list. I saw the letter and the only indication of why she had been struck off was the sentence that stated: We hope when you find a new GP there will be comfortable chairs in his waiting room. That is clearly another exceptional case, but it is unacceptable and exposes the inadequacy of the existing legislation. The woman was struck off the list for something trivial.

There is a growing perception that clients are being removed from GPs' lists because their treatment is too costly. The advent of the internal market and GP fundholding has fuelled that perception. Unfortunately, information on the number of patients being removed from lists at the request of doctors has been available from the Department of Health only since 1992–93. In that year, the total for England was more than 78,000. Those figures do not differentiate between GP fundholders and non-fundholders, so there is no hard and fast evidence.

735 However, there is anecdotal evidence that GP fundholders do not want patients whose care is too costly. The Association of Health Councils in England and Wales has expressed concern. Yesterday we learnt that a doctor in Wales intended to strike eight children off his list to increase his practice income by £2,000. Clearly, that has to stop. It is simply not good enough for the Department of Health to talk about unacceptable behaviour. We are entitled to ask what the Department will do about it.

Patients trust doctors less because of the introduction of GP fundholding. They are now, almost daily, made aware of the cost of treatment. Where once a clinical decision was given and accepted, there now lurks a suspicion that a treatment might be advised against owing to the cost. The vital ingredient of trust between patient and doctor is being seriously undermined, which is one reason why it is essential to end GP fundholding.

If implemented, the Bill, which contains moderate measures, could provide the first step towards restoring the trust between patients and their GPs, and I commend it to the House.