GMC: Ending Your Professional Relationship with a Patient: Summary

SJT Textbook: Ending Your Professional Relationship with a Patient

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Ending a Professional Relationship with a Patient – GMC Guidance

🎯 THE CORE PRINCIPLE

Sometimes the doctor–patient relationship breaks down to the point where safe and effective care is no longer possible. The GMC allows ending the relationship, but only under strict conditions and with robust safeguards. This includes carefully assessing the reasons, giving appropriate warning, avoiding discrimination, ensuring continuity of care, and documenting everything.

In the MSRA SJT, high-scoring answers emphasise fairness, early escalation, involving colleagues, written communication, and ensuring the patient can access alternative care. Poor answers include sudden removal, discriminatory reasoning, ending the relationship due to complaints, or failing to ensure ongoing care.

🧩 KEY PRINCIPLES (MSRA SJT Interpretation)

1. Ending the relationship is a last resort

Only acceptable when:

* Trust is irreparably damaged
* Risk to staff or other patients
* Repeated violent or threatening behaviour
* Persistent serious boundary breaches
* Theft or harassment Not acceptable reasons:

* Patient made a complaint
* Patient is difficult or demanding
* Complex resource needs

2. Explore solutions before ending the relationship

High-yield actions:

* Discuss concerns with the patient
* Give clear warnings
* Try to rebuild trust
* Offer mediation or senior review
* Document all steps

The SJT rewards showing *effort* before withdrawal.

3. The decision must be fair, justified, and non-discriminatory

You must not end the relationship for reasons related to:

* Age
* Disability
* Ethnicity
* Lifestyle
* Social disadvantage
* Health status
* Complaints made against you

4. Involve colleagues and follow local policies

Before ending the relationship:

* Seek advice from senior colleagues
* Consult GP partners, clinical leads, or employers
* Follow practice/regional regulations
* Make sure decision is consistent with policy

5. Inform the patient formally and explain

Once the decision is made:

* Inform the patient in writing
* Give reasons clearly and professionally
* Avoid judgemental language
* Provide information about next steps

6. Ensure continuity of care

Ending the relationship must not leave the patient without access to care.
You must:

* Arrange transfer of medical records quickly
* Provide bridging prescriptions where appropriate
* Advise how to register elsewhere
* Share urgent information safely

7. Record objectively and thoroughly

Record:

* Behaviour/concerns
* Warnings given
* Discussions held
* Decision rationale
* Outcome and next steps

8. Practice closure or relocation

If a doctor or practice is closing:

* Provide advance notice
* Ensure current patients have options
* Organise record transfer
* Follow regulatory requirements

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Try to repair the relationship first.
2. Seek advice from colleagues or line managers.
3. Give clear warnings before ending the relationship.
4. Ensure the decision is fair and non-discriminatory.
5. Communicate the final decision in writing.
6. Facilitate safe transfer of care and records.
7. Document everything factually.
8. Follow local and national policy.
9. Prioritise staff and patient safety.
10. Remain calm, respectful, and professional throughout.

Pattern: sudden removal, discriminatory reasoning, and inadequate continuity of care.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I need senior advice before making this decision.”
* “I will provide written notice to the patient.”
* “Continuity of care must be ensured.”
* “This decision must not discriminate or be punitive.”
* “I must document this objectively.”

E – Explore solutions first
N – Non-discriminatory reasons only
D – Document concerns and warnings

I – Involve colleagues
T – Transfer care safely

F – Formal written notification
A – Arrange records transfer
I – In the patient’s best interests
R – Reasonable, justified, proportionate

📋 QUICK FAQ

Can I end the relationship because a patient complained?
No — complaints must be handled appropriately, not punished. Do I need to give warnings?
Yes, unless there is immediate danger (e.g., violence). Must I ensure continuity of care?
Always — even after removal. Can demanding or resource-heavy patients be removed?
No — this is discriminatory. Do I need written confirmation?
Yes — written notice is essential.

📚 GMC ANCHOR POINTS

* Maintaining trust
* Fairness and non-discrimination
* Communication and partnership
* Continuity of care
* Documenting decisions
* Professional boundaries
* Safety of staff and patients

💡 MINI PRACTICE SCENARIO

A patient frequently shouts at staff and has made a threatening remark. Despite several discussions, the behaviour continues. Best action: Seek senior advice, provide formal written notice ending the relationship, and arrange safe transfer of care. Why: Staff safety and sustained trust breakdown justify ending the relationship, and continuity of care must still be ensured.

🎯 KEY TAKEAWAYS

✓ Ending a relationship is a *last resort*
✓ Must be fair, justified, and non-discriminatory
✓ Attempt repair first; give clear warnings
✓ Seek senior advice and follow policy
✓ Provide written notice
✓ Ensure continuity of care and transfer records
✓ Document thoroughly and objectively

🔗 RELATED TOPICS

* → Professional boundaries
* → Maintaining trust
* → Complaints and conflict
* → Communication and de-escalation
* → Safety and escalation

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A patient repeatedly shouts at receptionists and has threatened a nurse. Previous warnings have not improved the situation.

Options:
A. Remove the patient from the list immediately with no further action
B. Seek advice from senior colleagues or managers
C. Send written notice formally ending the relationship
D. Document all incidents clearly
E. Ignore the behaviour to avoid escalation
F. Advise staff to refuse further appointments
G. Arrange safe transfer of care and medical records
H. End the relationship because staff feel annoyed

Example SJT — Rank 5 (best → worst)

A patient sends inappropriate messages to a GP over several weeks, despite being asked to stop.

Options:
A. Seek advice and consider ending the relationship
B. Warn the patient formally and document the behaviour
C. Ignore the messages
D. Send a direct message telling them to stop immediately
E. Remove them from the list without warning