"Patient Allocation":
>-----------------------------
Soon after first coming into a large group practice in about 1984 I was
allocated a patient outside our practice area.  The patient didn't want to
be registered with a yellow or black doctor becuase she claimed that she had
once been raped by a coloured man.  Our practice was bursting at the seams,
and we were all anxious at the possibility that boundaries that had been
strictly enforced would suddenly be "rent assunder".  I couldn't find
anything in our terms of service or indeed the Red book at that time that
said the patient couldn't be allocated, but ToS seemed clear that I wouldn't
be obliged to visit.

My recollection is that after various discussions it seemed I had three
options:-

Accept the allocation
Appeal to the FHSA formally (a procedure existed in those days - I have no
idea now)
Remove the patient from my list after an interval (3 months if I felt
charitable, 1 day given the extenuating circumstances if I did not feel
charitable).

I opted for the second, and presented by case to the full FHSA.  ( I hear
some of you saying fools rush in where ...)

I received a largely very polite hearing, probably partly because it was so
obvious that they could have made mincemeat of this new principal rather
easily.  The only hostility was from one of the medical members, who after
discussions with LMC colleagues I had very much expected to be on-side.

Needless to say the verdict went against me, and the patient was indeed
allocated to my list.  She remained there quite happily for a number of
years before moving on.  Our practice boundary was not invalidated, but I
have never forgotten the lesson that HA's have the power to nobble GP's and
find loopholes that allow them to do the unexpected.  (Not that we are
powerless ourselves)

If the patient is significantly outside your area, a word with the LMC would
appear well worthwhile.  Pragmatically the best solution if you have LMC
support will probably be not to challenge the allocation but to remove the
patient yourself ASAP.  All that said someone has to look after difficult
patients under the present system.  Perhaps the real issue is that some
(very few) patients are so dangerous or disruptive that they should have all
their care through some other service.

Whatever the outcome - you're not alone.

Julian Bradley
GP, GP tutor etc.

Julian Bradley
GP etc.



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