Patient removals

As the patient is part of the SAS program, this means they will need to be treated by a SAS practice. The patient will need to be deducted from the practice’s clinical system under high security and any booked appointments cancelled. The patient will receive a letter from PCSE with the details of their current healthcare provider along with confirmation that their registration with your practice has been cancelled.

FP69's are automatically deducted after the 6 months.

The practice should check the address directly with the patient, update the address on the clinical system or send confirmation to PCSE that the current address is correct.

If PCSE doesn’t receive confirmation from the practice (via the link) that the patient is either still at the address or at a new address within 6 months of the FP69 flag being raised, the patient will then be removed from the GP’s patient list.

PCSE will reject a removal request when it does not meet the criteria outlined in the relevant section of NHS England Primary Medical Care Policy and Guidance Manual (PGM).

There are a number of common reasons for removal requests being rejected, please see some examples below:

• They have moved outside of the practice area and you do not wish to treat the patient under the Out of Area Scheme
• Mail has been returned as ‘undelivered’, or
• Whereabouts are unknown

NB: To remove a patient for the above reasons, please submit a request through the GP links.

• Patient no longer wishes to be registered at any GP surgery

It should be emphasised that NHS England and PCSE do not encourage this type of removal due to the potential clinical implications of patients being unregistered. It is encouraged that if patients are unhappy with the services provided by a GP practice that they are advised accordingly on how to register with a different GP practice and not to remove themselves from a GP list. However, if a patient no longer wishes to be registered at any GP surgery, PCSE place the patient on a pending deduction that runs for 14 days. To do so, the patient must send confirmation in the form of a signed letter expressing their desire to be removed. They can send this letter direct to the following address: Primary Care Support England, PO Box 350, Darlington, DL1 9QN.

Alternatively, the patient can direct this letter to their GP and the GP can scan and send the letter via email to pcse.patientremovals@nhs.net for action. Following this, the patient will have no recorded GP after 14 calendar days. PCSE will send out a confirmation letter to the patient providing their removal date. The GP requesting the removal should discuss this removal with the patient to ensure that they are aware of their options.

As PCSE are governed by NHS England policy, we are unable to provide any additional guidance and any complaints or further queries should be raised to your local commissioner. Please note that PCSE do not hold lists of commissioner details.

Eight-day removal requests are initiated by the GP as a result of a breakdown in relationship between the GP and the patient.

Before submitting a request you should ensure that the criteria outlined in the NHS England Primary Medical Care Policy and Guidance Manual (PGM) (Section 3. Managing Patient Lists subsection Removing a Patient from a Practice List) has been met.

GP Practices should provide the patient with a prior warning, before requesting a deduction unless there are extenuating circumstances – please refer to the PGM.  If a request is received that does not meet the criteria it will be rejected by PCSE with any additional information requested. Upon receipt of a valid request, PCSE will process it within 24 hours and the patient is notified. Any prior warning should be within 12 months of the eight-day removal request.

After a request has been validated and the deduction has been initialised within PCSE, the patient is notified immediately via letter, delivered first class. The patient notification informs them of the practice’s decision to remove them, the date the deduction will be finalised and advises them of what action they now need to take, to register elsewhere.

PCSE will notify the GP that the request has been processed. The patient will be deducted after 8 days, unless a registration is received from another practice sooner.

If you require any further guidance in regards to eight-day removals, please contact your local commissioner. Please note that PCSE do not hold lists of commissioner details.

An immediate removal can only be requested via the enquiries form when an incident involving the patient has been reported to the police by your practice. 

A High Level Security Deduction only removes the patient from your clinical system and does not send a deduction request through to the system PCSE use (NHAIS) or the Spine. High Level Security should not be used unless PCSE have instructed.

An immediate removal can only be requested when an incident involving the patient has been reported to the police by your practice.

The removal of a patient in these circumstances results in them being allocated to a provider of the Special Allocation Scheme (SAS).

A request to remove the patient should be made to the Patient Registrations team at PCSE via the Contact Us page.

Please note: the Police Incident number must be supplied to PCSE either immediately or within 7 days of the removal request (if not available when the request is submitted). Please ensure this is clarified on the removal request if not immediately available.

Before submitting a request you should ensure that the circumstances meet the criteria set out by NHS England in the Primary Medical Care Policy and Guidance Manual (PGM) - Section 7. Special Allocation Scheme. PCSE is not responsible for determining if a patient meets the criteria for immediate removal, other than confirming the incident has been reported to the Police, this is the responsibility of the reporting practice.

Where the information provided does not meet the criteria the request will be rejected by PCSE and the GP directed to the PGM for further guidance on how to proceed. If you require any further guidance in regards to immediate removals, please contact your local commissioner. Please note that PCSE do not hold lists of commissioner details.

If a Special Allocation Scheme patient attempts to register with a mainstream GP Practice, no warning or preventative message would be received by the practice's clinical system. However, once the registration is received via the GP link, the flag on the patient's record warns PCSE that the patient is subject to the Special Allocation Scheme.

PCSE will then reject the registration with a rejection note stating the patient is on the scheme, and to remove the registration from their clinical system.

The patient will then be contacted by PCSE via letter to say that as they are still subject to the Special Allocation Scheme, they are unable to register at a practice of their choice and that their registration with your practice has been cancelled.

If you need to contact us about Patient Removals, the quickest and most efficient way is to use our dedicated Patient Removals form. 

If you are a patient on the Special Allocation Scheme (SAS), you can find out more on the NHS England website. 

As part of the services we provide, PCSE regularly writes directly to patients (for example through our new patient registration, ad-hoc patient letters and practice merger and closure programmes).

In line with NHS England procedures, if a letter is returned to PCSE, or PCSE is notified by a screening administration service that a letter has been returned indicating the addressee is no longer at the address, we are required to raise an FP69 flag on the PDS system. This will update the patients record in the GP practice’s clinical system. The practice should then check the address directly with the patient, and update the address on the clinical system or send confirmation to PCSE that the current address is correct.

If PCSE doesn’t receive confirmation from the practice (via GP links) that the patient is either still at the address or at a new address within 6 months of the FP69 flag being raised, the patient will then be removed from the GP’s patient list. Should the letter be returned to us as ‘moved abroad’ or ‘deceased’ the appropriate action would be taken to deduct the patient from PDS.

If you have any further queries about Patient Removals and cannot find the answer to your query here, you can email the PCSE Registrations team at pcse.registrations-preston@nhs.net

To request the immediate or 8-day removal of a patient, please use our dedicated, secure Patient Removals Form.

If you are unable to submit an online form for any reason, please download and complete the Removal Request Paper Form and email this to pcse.patientremovals@nhs.net.

Immediate removal requests can also be made by phone by calling the PCSE Customer Support Centre on 0333 014 2884.