PATIENT REMOVALS FROM GENERAL-PRACTITIONER LISTS IN NORTHERN-IRELAND - 1987-1996

Background. Being struck off a general practitioner's list is a major event for patients and a subject for much media attention. However, it has not hitherto received much research attention. Aims. To quantify the numbers of patients removed at doctors' request in Northern Irelan d between 1987 and 1996. To describe the characteristics of those remo ved and to determine if the rate of removal has increased. Methods. Th is is a descriptive epidemiological study involving a secondary data a nalysis of records held by the Central Services Agency. Results. Six t housand five hundred and seventy-eight new patients were removed at ge neral practitioner (GP) request between 1987 and 1996 This equated to 3920 removal decisions, a rate of 2.43 per 10 000 person-years. The ve ry young and young adults had the highest rates of removal; most of th e young being removed as part of a family. Ten point six per cent of r emoved patients had a repeat removal, and 16.3% of first removal decis ions required an assignment to another practice. Family removals have decreased and individual removals have increased over the 10 years. Di sadvantaged and densely populated areas with high population Turnover were associated with higher rates of removal, though heterogeneity is evident between general practitioners serving similar areas. Compared to the period 1987 to 1991, removal rates for the years 1992 to 1993 w ere reduced by 20.0% (95% confidence interval (CI) for rate ratio (RR) 0.73-0.87), and Those for the years 1994 to 1996 increased by 8% (95% CI = 1.01-1.16). The greatest increase was in the over-75 years age g roup (standardized RR = 1.60; 95% CI = 1.57-1.62). Conclusions. Remova ls are relatively rare events for both patients and practices, though they have been increasing in recent years. Further research is needed to understand the processes that culminate in a removal.