Removing patients from the register in Scotland

The DDU receives a great many calls from its members asking how to handle aggrieved patients. Although many of these issues can be resolved swiftly at practice level, sometimes a dentist may feel it necessary to de-register a patient due to unacceptable behaviour. Following the most recent complaints report published by the Scottish Public Services Ombudsman (SPSO), the DDU is issuing fresh advice to dentists to consider mediation before de-registration.

The December SPSO report details a case where a family was removed from a dentist's list, resulting in a complaint to the Ombudsman.

The de-registration of the family arose as a result of a telephone call from the practice receptionist to the patient's daughter to cancel and rearrange her appointment. During the course of the conversation, the patient took over the call as she was unhappy with the practice for rearranging her daughter's appointment. A few days later the patient received a letter from their local NHS Board advising that the practice would no longer be providing the family with NHS treatment and that this would take effect within three months. The dentist did not give an explanation for the family's removal. Upon receipt of the letter, the patient telephoned the practice to complain that she and her family had been unreasonably de-registered and was informed that there was no requirement to provide an explanation for their actions.

Unhappy with the practice's response, the patient referred her complaint to the Ombudsman. The Ombudsman found that the dentist considered the patient to have been 'rude, forceful and unpleasant' to the receptionist during the telephone call regarding her daughter's appointment. The receptionist was said to have been left feeling 'distressed' after the call. The Ombudsman also found that the dentist felt it necessary to de-register the whole family as the patient had behaved this way on their behalf.

The Ombudsman concluded that while the practice had a zero tolerance policy towards the abuse of its staff, the policy was not clear as to what constituted abusive or threatening behaviour, nor did it say how this would be dealt with. It was also found that the dentist had failed to comply with the National Health Service (General Dental Practice) (Scotland) Regulations 2010. The legislation says that a dentist who wants to terminate an arrangement shall give the patient no less than three months' notice of this in writing. Where a dentist does this, they must complete all care and treatment that it was agreed the patient was to receive before termination of the arrangement. The dentist must also provide any further treatment necessary to maintain the patient's oral health.

Although the family was provided with three months' notice of their removal from the register, the practice also cancelled future appointments for the patient's son. The Ombudsman concluded that under the regulations, these appointments should have been honoured.

This case serves as a warning to dentists in Scotland who may believe that de-registering a patient is a straightforward solution. If a patient has been abusive or threatening to a member of staff, it may be necessary to consider removing them from the list but in most cases it should not be the first course of action. Leo Briggs, deputy head of the DDU, advises that "dental practices should look to mediate with patients at practice level where possible. It is also advisable to have a clear policy in place regarding how abusive and threatening behaviour from patients will be treated. If a patient's behaviour gives cause for concern, the dental professional should talk to them and try to determine the reason behind it. If discussions with the patient are unproductive, the dental professional can issue a warning advising them that they risk being removed from the list should their behaviour continue.

"Before taking a decision to remove a patient from the list, the dentist should be satisfied that their decision has not been influenced by any personal grievance. Where the dentist does take the decision to de-register a patient, it is good practice to provide the patient with a reason for their decision but above all, the dentist must ensure that they comply with the National Health Service (General Dental Practice) (Scotland) Regulations 2010. Dentists who are in any doubt as to whether their decision to de-register a patient complies with the regulations should contact their defence organisation for advice."

This guidance was correct at publication 12/01/2012. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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