GPs drop patients `to boost profits'

DOCTORS ARE accused of striking from their lists huge numbers of patients, including children, to maximise profits, in a report published today.

An investigation reported in the Journal of the Royal Society of Medicine concludes that GPs have removed from their practices children whose parents refuse to let them have the MMR vaccine, which has controversially been linked to autism and the bowel disorder Crohn's disease.

Family doctors gain financial bonuses for meeting quotas for screening and vaccination programmes. If they immunise all infants on their list from two months to 12 months against measles, mumps and rubella, they receive bonuses.

But, to ensure they have a 100 per cent rate of immunisation, GPs are striking from their lists infants whose parents are "unco-operative", totalling about 10 per cent of babies, the report says.

Dr Neena Buntwal and her colleagues at the Bethlem Royal Hospital and the Royal Free Hospital in London were prompted to investigate why patients were removed after finding that 30 per cent of their patients on acute psychiatric wards had been struck off their GPs' register at some point.

Dr Buntwal said she had heard of some children being taken off their GPs' lists while in the vaccination age range, only to be returned later.

"Patients who require expensive medicine may also face removal and [this is] a factor which is particularly of concern to psychiatric patients needing drugs such as antipsychotics costing pounds 300 to pounds 500 a month," she said.

The investigation by Dr Buntwal and her team found that GPs do not need to give a formal reason, and the health authorities are not obliged to keep a record of the circumstances leading to doctors letting patients go. Reasons found varied from rudeness and threatened violence to unspecified psychiatric behaviour and an unco-operative attitude.

The team reported that attempts to uncover further data had met enormous opposition from the Family Health Authorities and the Local Medicine Committee.

Dr Buntwal said there was a need for compulsory collection of data on the reasons for patients being taken of GPs lists. She said that without a proper review of the situation, there was "a considerable danger of producing a substantial underclass - a population of people excluded from primary health care because of poor resources or personal opposition to screening programmes".

Dr John Chisolm, chairman of the British Medical Association's General Practitioners Committee (GPC), said he rejected the claim that millions of patients were being removed from GPs' lists, but he recognised that the current system of data collection was very poor.

"The GPC is working with the Department of Health to look at how we can collect anonymised data on list removals to get a better picture. We suspect that on average the numbers removed amount to one or two removals per GP per year," he said.

He said that any patients who reject their family doctor's advice on childhood immunisation or cervical smear tests should not, under BMA guidelines, be removed from lists. "The GPC does not support or condone the removal of patients solely because they have made a complaint or because their treatment is too costly or because they are suffering from a particular clinical condition. Nor would it condone removing patients from lists in order to meet target payments," he said.