Only remove the individual, not their family

It might feel awkward to continue treating the patient's spouse or children but removing them will be very difficult or impossible to justify. Patients must be treated as individuals, and other members of a family should not suffer for the behaviour of a relative.

Abide by GDC standards

The GDC says you must inform the patient in writing, explaining your reasons and, 'take steps to ensure that arrangements are made promptly for their continuing care', e.g. explain how an NHS patient can obtain a list of NHS dental practices.

Meet your contractual obligations

Where there is an 'irrevocable breakdown' in your relationship with an NHS patient, the National Health Service (General Dental Services Contracts) Regulations say you must inform the patient and notify the Local Area Team, usually by forwarding to them a copy of your letter to the patient. If a patient has been violent, you should first report this to the police and then inform the LAT, who will in turn inform the patient.

Seek specific dento-legal advice

The DDU can help you determine whether your reasons for removal can be justified.

'Should we continue to see a patient who is unhappy with their treatment?' It is a question that practices sometimes ask when they seek our assistance. But removing a patient in these circumstances is problematic and it's usually better to focus your time and energy on resolving the original complaint.

The GDC's current standards guidance is more prescriptive on this issue than in the past. It says ending a professional relationship with a patient is only rarely necessary when the trust between you has broken down and specifically warns dental professionals they, 'should not stop providing a service…solely because of a complaint the patient has made about you and your team'.

Given that an unhappy patient is already unlikely to return to the practice, removing them is a gesture that is likely to make matters worse. In the DDU's experience, patients will often make a further complaint, while others might contact the local newspaper, adding another tricky dimension to the practice's predicament.

Some unhappy complainants might even take their case to the ombudsman or the Dental Complaints Service. The ombudsman has highlighted the case of a dental practice (summary 41) that removed a patient after she questioned her treatment. This triggered a further complaint which proved impossible to resolve. The ombudsman concluded the complaint had been mishandled and recommended that the practice offer an apology and compensation.

Is removal ever justified?

A complaint would not usually warrant removing a patient, but there are other situations when your professional relationship has irretrievably broken down and you might feel you have little choice. Examples might include persistently failing to attend appointments and violent or abusive behaviour.

In these cases, we advise you to:

Be sure your decision is fair

Where possible, give patients a chance to change: explain the problem, explore any difficulties they might be experiencing and follow up this conversation in writing. It also helps to consider the patient's behaviour in context, e.g. a sleepless night with toothache might easily lead to uncharacteristic aggression. An apology might be enough for everyone to move on.