A practice in the Newcastle upon Tyne area

4. Miss P complains about actions taken by the Practice after she complained about a GP. Specifically, Miss P says the Practice:

• issued her a warning letter on 25 November 2024 and • unfairly removed her from its patient list.

5. Miss P says the Practice’s actions have led to her feeling isolated and unable to speak to any doctor about this as she fears retaliation. Miss P says she considered the warning letter was defamatory. She also says she is experiencing ongoing psychological damage around using GP services.

6. As an outcome of her complaint Miss P would like an apology and for the Practice to withdraw the warning letter it issued her.

7. In November 2023, Miss P raised concerns with the Practice about the actions of one of its GPs. Subsequently, Miss P says the Practice issued her a defamatory warning letter in November 2024. The Practice says it issued Miss P a warning letter in November 2024 as it believed its relationship with Miss P was on the verge of breaking down.

8. The letter explained the Practice’s reasons for believing the relationship was at risk of breaking down. It said Miss P had persistently demonstrated unreasonable behaviour towards one of its GP’s, disregarded professional boundaries and made unrealistic demands on its service such as non-attendance for appointments and refusing to engage with more than one GP in the Practice.

9. In the warning letter, the Practice outlined the behaviour it expected from Miss P to help repair the relationship with the Practice and to ensure it could continue to provide safe care.

10. The Practice sent a response letter to the PHSO explaining the reason for its decision dated 8 December 2025. In its response, the Practice outlined ongoing concerns around Miss P’s behaviour, including her refusal to engage with the requested review while continuing to submit information via e‑consult and continual disagreement between her and the Practice.

11. It also explained staff no longer felt safe attending to her after discovering she had been recording consultations without the doctor’s knowledge or consent.

12. In December 2024 the Practice issued a letter to Miss P informing her it had contacted Primary Care Services England (PCSE) to request it remove her from its Practice list on ‘a 28-day removal’. It explained that the reason for her removal was its conclusion that the patient–doctor relationship had now broken down.

13. PCSE supports front line primary care provision in England by providing key services to GPs, Optometrists, Dentists and Pharmacists.

14. A 28‑day removal is when a GP practice asks PCSE to remove a patient from its list after giving the patient 28 days’ notice to register with another practice. It is usually used when the GP–patient relationship has broken down, but the situation is not urgent enough to require immediate removal.

Warning letter

17. Miss P complains that following her complaining about the actions of one of its GPs in November 2023, the Practice issued her a defamatory warning letter.

18. We refer to the following GMC guidance which states:

‘in rare circumstances, there may be a breakdown in trust between a practice and a patient which prevents it from providing good clinical care. This includes when a patient has been violent, abusive or made threats to a clinician or persistently acted unreasonably.’

19. We note, the GMC guidance also states the following:

‘a Practice should not end a professional relationship with a patient solely because the patient made a complaint about the GP staff.’

20. We also refer to the following BMA guidance which states:

‘in certain circumstances it may be reasonable to immediately end a doctor/patient relationship. However, in other circumstances before a Practice ends the professional relationship with a patient it should:

• tell the patient that it is considering ending the relationship and explain the reasons why • do what it can to restore the relationship which could include setting expectations for the patient’s future behaviour • discuss the situation with an experienced colleague or its employer or contracting body.’

21. The BMA guidance goes on to state:

'if a patient has behaved in a way that had caused others to fear for their safety they could be removed from the Practice list as long as the Practice follows national guidance and regulations in doing so.’

22. We can see Miss P feels strongly that the Practice's warning letter was defamatory. We were sorry to learn about how she has been affected by this. We have carefully considered the letter. In our view, we have seen nothing within the letter which might be considered inappropriate. We acknowledge Miss P's perception of the letter which is subjective. We consider the Practice's warning letter was issued in line with relevant guidelines. We do not consider it contains any information which requires further action by us.

Removal from Practice List

23. Miss P complains that following her complaint about one of the Practice GP’s, the Practice unfairly removed her from its patient list.

24. We refer to the following BMA guidance which states:

‘the removal of a patient from a GP practice list should be a rare event. Reasons include:

• disagreement between the practice and patient, and an irretrievable breakdown of the relationship.’

25. Section 3.2.7 of the PGM guidance states ‘where a practice wishes to remove a patient from its practice list, the practice must normally provide the reason for removal in writing to the patient’

26. Section 2.8 of the PGM guidance says ‘removal may normally only be requested if, within the period of 12 months prior to the date of the request, the practice has warned the patient in writing that they are at risk of removal and stated the reasons for this’.

27. We can see the Practice told Miss P its reason for removing her from its patient list in December 2024. Prior to this the Practice had issued her a warning letter within the previous 12 months as required by the PGM guidance.

28. The Practice followed the relevant guidance on patient removal, acting in accordance with GMC requirements. It also complied with BMA guidance by issuing a warning letter before removing Miss P a few weeks later. The Practice then correctly submitted an application to PCSE, who made the final decision and approved the removal, indicating that the Practice met the necessary criteria.

29. From the evidence available, we have found no indication of maladministration or that anything went wrong in the way the Practice handled Miss P’s removal. We recognise that Miss P has been, and continues to be, under considerable personal strain and that she had understandable concerns about being removed from the patient list. We are pleased she has now been able to register with another GP Practice for her ongoing care.

30. We hope this decision reassures Miss P the Practice acted in line with the relevant guidance throughout this process.

1. We have carefully considered Miss P’s complaint about a Practice in the Newcastle area (the Practice).

2. We have seen no indication of maladministration in the actions the Practice took. This means that from the evidence we have considered, we have not seen any indications that things went wrong in the way the Practice handled Miss P’s concerns.

3. We will explain our reasons for our decision in this decision statement. Complaints give us valuable insight into the organisations we investigate, so we would like to thank Miss P for sharing her experience with us. It is also important to acknowledge that finding no indications of service failure does not detract from Miss P’s experience, or the upset and frustration these events have caused.