Almshouse Surgery & Sandal Castle Medical Centre
Patient Registration &
De- Registration Policy
Version Control
Version
1
Prepared By
Samantha Crone
Lead GP
Dr. Alisha
Date
June 2015
Review Date
June 2017
2
Samantha Crone
Dr. Alisha
January 2016
June 2017
Electronic Version
S:\Admin\HR\Policies, Procedures & Protocols\Patient Registration and De-Reg Policy.docx
Almshouse Surgery & Sandal Castle Medical Centre
Patient Registration & De-Registration Policy
Contents
When a Patient Wishes To Register With the Practice ..................................................................................................... 3
Checking a patient lives within the practice boundary ................................................................................................. 3
New Patient Registration Packs .................................................................................................................................... 3
Completed Registration Forms ..................................................................................................................................... 4
Registration Checklist................................................................................................................................................ 4
Identification ............................................................................................................................................................. 4
Patients without ID or a Permanent Address ........................................................................................................... 5
New Patient Health Check ........................................................................................................................................ 5
Verifying the Registration ......................................................................................................................................... 5
Registering a child with the practice................................................................................................................................. 6
New-born Registration Protocol ................................................................................................................................... 6
Children under 16 ......................................................................................................................................................... 6
Preventing a patient from registering with the practice .................................................................................................. 6
Registering a Patient with the Practice ............................................................................................................................. 7
Registering a Patient on SystmOne............................................................................................................................... 7
Registering an Existing SystmOne Patient ................................................................................................................ 7
Registering a New Patient to SystmOne ................................................................................................................... 7
When a patient has a nominated pharmacy..................................................................................................................... 8
Registering a Patient for SystmOnline Access................................................................................................................... 8
Notifying Patients of their Named GP............................................................................................................................... 8
Scanning the Registration Forms ...................................................................................................................................... 8
Transferring a Patients Records into the Practice ............................................................................................................ 8
Electronic Transfers - SystmOne ................................................................................................................................... 8
Electronic Transfers - GP2GP ........................................................................................................................................ 8
Checking data is ready for GP2GP Transfer .............................................................................................................. 9
Performing a GP2GP Data Transfer........................................................................................................................... 9
Using the GP2GP Transfers Screen ........................................................................................................................... 9
Dealing with Degraded Data ..................................................................................................................................... 9
Transfer of Paper Records........................................................................................................................................... 10
Patients with a previous GP .................................................................................................................................... 10
Patients with no previous GP .................................................................................................................................. 10
Summarising of Paper Records ................................................................................................................................... 10
Scanning paper records into the electronic record ................................................................................................ 11
Registration of Armed Forces Personnel & Veterans ..................................................................................................... 11
Serving Personnel........................................................................................................................................................ 11
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Almshouse Surgery & Sandal Castle Medical Centre
Patient Registration & De-Registration Policy
Veterans ...................................................................................................................................................................... 11
Registration of those without a permanent address ...................................................................................................... 11
Registration of those released from prison/criminal justice system .............................................................................. 11
New Patient Health Checks ............................................................................................................................................. 11
Temporary Resident Registration ................................................................................................................................... 11
Registering a Temporary Resident .............................................................................................................................. 12
Clinical Notes from Temporary Residents .................................................................................................................. 12
Immediately Necessary ........................................................................................................................................... 12
Over 15 Days ........................................................................................................................................................... 12
Removal of a Temporary Resident .............................................................................................................................. 12
Receiving Temporary Registration Documents for our Patients ................................................................................ 13
Amendments to a Patients Registered Details ............................................................................................................... 13
Written Requests ........................................................................................................................................................ 13
Verbal Requests .......................................................................................................................................................... 13
PDS changes ................................................................................................................................................................ 14
Removing a Patient from the Practice List ...................................................................................................................... 14
Removal due to Non Attendance................................................................................................................................ 14
Vulnerable Adults .................................................................................................................................................... 15
Removal due to Violence/Abuse/Aggressive Behaviour ............................................................................................ 15
Removal due to address change ................................................................................................................................. 16
Removal due to Death ................................................................................................................................................ 16
Removal Due to Imprisonment ................................................................................................................................... 17
Removal Due to Joining HM Forces ............................................................................................................................ 17
Deductions ...................................................................................................................................................................... 17
Appendix 1 – Letter to a new patient who is out of practice boundaries ...................................................................... 19
Appendix 2 – Letter to a patient who has moved out of practice boundaries ............................................................... 20
Appendix 3 – Warning letter to a patient about missing appointments ........................................................................ 21
Appendix 4 - Removal from practice list due to missed appointments ......................................................................... 22
Appendix 5 – Warning a patient about violence/aggressive behaviour ......................................................................... 23
Appendix 6 – Notifying patient of removal due to violence/aggressive behaviour ....................................................... 24
Appendix 7 – Letter to NHS England to Request Removal ............................................................................................. 25
Appendix 8 – Record of Removal & Refusals (Template) ............................................................................................... 26
Appendix 9 – Letter informing patients of Named GP.................................................................................................... 27
Appendix 10 – Amendments Request............................................................................................................................. 28
Appendix 11 – New Baby Registration Letter ................................................................................................................. 29
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Patient Registration & De-Registration Policy
When a Patient Wishes To Register With the Practice
Any individual can register with the practice, either fully or temporarily, providing they are residing within the
practice boundaries and can provide sufficient proof of identity. Only in cases where an alert has been received from
a governing body about the status of an individual will a staff member question a registration. Staff will not
discriminate on the grounds of race, religion, age, sex, sexuality or disability.
Checking a patient lives within the practice boundary
When a patient wishes to register with the practice it is important to establish that they are residing within the
practice boundaries. To do this staff can;
1. Navigate to the practice website and find page “registering with the practice”
2. Click on the desktop link on any reception PC entitled Practice Map.
This will open the Google Map of the practice boundary. In the search bar at the top,
enter the potential patients’ postcode and it will plot their address on the map in
relation to our practice boundary.
The red line indicates our extended boundaries. New patients will not be registered if they live in this area.
New Patient Registration Packs
The new patient registration packs will be given out to any patient wishing to register with the practice. This pack
will include a minimum of;
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Registration Form (GMS1)
Practice Booklet
Summary Care Record consent form
SMS Consent Form
New Patient Questionnaire
New Patient Health Check Leaflet (and sticker to encourage an appointment to be made)
Information and application for SystmOnline access
The content for the packs will be stored in the reception area, available to hand out to any individual wishing to
register with the practice.
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Patient Registration & De-Registration Policy
Completed Registration Forms
When a patient has completed the relevant forms they will be advised to bring them back to reception at either
surgery.
Registration Checklist
Staff will ensure that they have the following documents and they are completed fully;
 Registration Form GMS1
 Summary Care Record consent form
 New Patient Questionnaire
 SMS Consent Form (optional)
 SystmOnline Request Form (optional)
The Registration Form (GMS1) must have a minimum amount of information on before the practice can accept it.
This is;
 First Name & Last Name
 Date of Birth
 Address including Postcode
 Town & Country of Birth
 Telephone Number
 Previous Doctor (if applicable)
 Previous Address OR Date of Entry to the UK
 Form must be signed and dated by the patient OR the patients legal guardian
 Initialled by the member of staff handling the registration
Identification
Staff should request to see 2 pieces of original ID. One of these must be photographic ID and one must detail the
patients address. Acceptable forms of ID are;
Level 2 Identity Evidence
Level 3 Identity Evidence
 DBS Enhanced Disclosure Certificate
 Passports that comply with ICAO 9303
(Machine Readable Travel Documents)
 HMG issued convention travel document
 EEA/EU Government issued identity cards
 HMG issued stateless person document
that comply with Council Regulation (EC) No
 HMG issued certificate of travel
2252/2004
 HMG issued certificate of identity
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US passport card
 Birth certificate
 Retail bank/credit union/building society
 Adoption certificate
current account
 UK asylum seekers Application Registration
 Student loan account
 Card (ARC)
 Bank credit account (credit card)
 Residential property rental or purchase
 Non-bank credit account (including credit/store/cards)
agreement
 Bank savings account
 Non-bank savings account
 Buy to let mortgage account
 Mobile telephone contract account
 Armed Forces ID card
 Buildings insurance
 Secured loan account (including hire purchase)
 Contents insurance
 Mortgage account
 Vehicle insurance
 EEA/EU full driving licences that comply with European
Directive 2006/126/EC
Staff should see 2 pieces of Level 3 Evidence OR 1 piece of Level 3 Evidence and 1 piece of Level 2 evidence.
A photocopy of the ID must be taken and kept with the registration forms. If ID is not available refer to the below
guidance.
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Patient Registration & De-Registration Policy
Patients without ID or a Permanent Address
If a patient cannot provide any identification but can give an address where they are residing then the registration
may be accepted by Reception staff and will be reviewed by the administration team. This may apply to;
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People fleeing domestic violence staying with friends of family
People living on a boat, in unstable accommodation or street homeless (see appropriate subsection also)
People staying long term with friends but who aren’t receiving bills
People working in exploitative situations whose’ employer has taken their documents
People who have submitted their documents to the Home Office as part of an application
People trafficked into the country that had their documents taken on arrival.
Children born in the UK to parents without documentation.
Reasonable exceptions need to be considered and staff must use sensitivity to the situation when registering.
In some circumstances a patient may not be able to give a permanent address. If this is the situation then the
registration should be accepted and the patient will be registered with no fixed abode. NHS England may then
register the patient with the practice address.
In any of the above situations staff should ensure that there is a recorded method of contact for the patient,
either a phone number, email address or a correspondence address should be made available in case the practice
needs to contact the patient.
New Patient Health Check
The member of staff handling the registration will book the patient a New Patient Health Check appointment. The
date/time of this will be given to the patient on the New Patient Health Check appointment card as shown below.
The appointment will need to be booked as a Textual appointment within SystmOne. The patients’ name must be
correct and the date of birth should be detailed also. This ensures staff can match the textual appointment with the
patient when the registration is complete.
New Patient Health Check Appointment
…………………………………………………………………
You will be unable to access the services the
Practice has to offer until you have attended your
NEW PATIENT HEALTH CHECK
Verifying the Registration
When a member of staff has accepted the registration form they will be put in the reception folder ready to be
checked by a senior member of staff. These new registration forms will be checked by a Senior or Deputy Senior
Receptionist to ensure all the information required has been completed before sending the forms to the
Administration team. Once the forms have been checked they should be put in the correct folder and sent to the
Administration team.
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Registering a child with the practice
New-born Registration Protocol
When a patient has a child the practice will receive the discharge notes from the hospital. The parent will then be
sent a registration pack in the post from the practice to enable them to register their new baby.
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Reception staff will put any new baby notes into the New Babies folder that is located in each reception
area.
The folder will be checked weekly by each reception staff and a control sheet used to monitor this.
The parents will either be posted or handed a new patient registration pack
The notes of a baby that has had a pack sent will be separated within the folder to monitor also on a weekly
basis.
When the parent brings back to forms to register the baby with the practice, the notes from the folder in
reception should be submitted to the admin team with the new patient pack.
An 8 Week Check should be booked for a new baby when the parent brings in the registration packs.
The admin, reception and nursing staff are all responsible for the checking of baby clinics to ensure all the patients
booked in are fully registered. The senior reception staff are responsible for overseeing the baby folder in reception.
Children under 16
Parents may register a child under 16 with the practice. There should be at least 1 adult with parental responsibility
for the child registered with the practice already. If there is no adult registered then the child should still be
registered and the practice safeguarding lead or deputy should be advised. The adult registering the child is advised
to bring their own ID as well ID for the child however a lack of ID will not prevent registration. The child must attend
the surgery with the parent when they are registering.
In both cases the usual registration process will be followed to register the new patient.
Preventing a patient from registering with the practice
In some cases a patient may be refused registration with the practice. The following may indicate that a patient may
not be able to register with the practice.
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Patients with a known history of violence or threatening behaviour towards the practice and its staff and
who have previously been removed from our practice list due to this.
Patients who display disruptive/violent/threatening behaviour in the practice before or during the
registration process.
Patients who have previously been removed from the practice list under the Removal Due to Non
Attendance section of this policy.
Patient lives outside of the practice boundaries.
In all cases* the registration forms will still be accepted by reception staff who will note their concern for
preventing registration with the forms. The registration will then be reviewed by the practice. If a decision is made
to refuse the patient they will be notified within 14 days by letter. The practice will keep a record of all refusals of
registration.
*Unless staff have checked and confirmed that a patient is residing out of the practice area prior to registration. In
which case staff will suggest a patient registers with another practice before submitting the completed forms.
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Registering a Patient with the Practice
When a registration form has been received by the administration team it will be entered onto SystmOne and the
appropriate steps will be taken to ensure the patients’ whole record is available when they attend an appointment.
Registering a Patient on SystmOne
Select Patient>Patient Maintenance>Patient Registration Wizard from the Main Menu
Do one of the following:
 Enter the patient 's NHS number
 Enter the patient 's first name, surname, gender and date of birth.
Click Search.
1. If no matches are found click Register New Patient to proceed with the registration.
2. If matches are found do one of the following:
 click
at the end of the row that corresponds to the patient to register an existing SystmOne patient
 click Patient Is Not In This List
Registering an Existing SystmOne Patient
If a patient is already fully registered on SystmOne, when the
to be completed:
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button is clicked, the patient registration will need
Select the appropriate registration type from the Patient Registration Type dialog and click OK.
A message is displayed, explaining that this will create a new record on SystmOne using the values from the
record held on the Spine and asking to confirm to proceed.
Click the buttons stacked down the left -hand side of the screen to enter the patient's details.
Ensure that a patient has a named Partner GP in line with GMC requirements.
Click Ok. The patient record is displayed.
Save the patient record.
Complete any subsequent dialogs as appropriate and click Ok.
A reminder will be automatically added to the Patient Home view for patients registered with a GMS status
of 'Applied' to prompt staff to check the record.
Note: Once “Ok” has been clicked on the Registration Details dialog, the patient registration can no longer be
cancelled.
Registering a New Patient to SystmOne
After running the Patient Registration Wizard search, if no existing patients on either SystmOne or Spine match the
criteria entered, click Register new patient to create a new record
Note: A new Spine record can only be created for patients over three months old.
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Click the buttons stacked down the left -hand side of the screen to enter the patient's details. The right-hand
side of the New Patient screen displays the details entered so far.
Ensure the patient has a Named Partner GP in line with GMC requirements.
When the details have been entered, click Ok. The patient record is displayed.
Save the patient record.
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When a patient has a nominated pharmacy
When a new patient has been registered and the electronic record has been received by the practice it will show
whether the patient has a nominated pharmacy for Electronic Prescription Services. If the patient has a pharmacy
nomination they will be called and asked to confirm if they wish to keep this nomination or if they would like to renominate a local pharmacy.
Registering a Patient for SystmOnline Access
If a patient completes an application for SystmOnline they will be issued registration details by admin staff when
their registration is being processed.
For complete information on SystmOnline Access see the relevant policy
Notifying Patients of their Named GP
When a patient is registered they will be allocated a named GP and they will be sent a letter notifying them of this.
This will be coded in the patient’s record using the following codes;
(XacWQ) Patient allocated named accountable general practitioner
(Xab9D) Informing patient of named accountable general practitioner
Scanning the Registration Forms
When a patient has been entered onto SystmOne, the administration team will scan the new patients’ documents
onto their electronic record and filed.
Transferring a Patients Records into the Practice
When a patient is registered the practice must obtain the Electronic Records and the Paper Records. Firstly the
electronic record will be requested within SystmOne. This will be either using a SystmOne automatic transfer or
using a GP2GP transfer from a non SystmOne practice.
Electronic Transfers - SystmOne
If a patient is transferring from a previous practice that uses SystmOne, the electronic record will be available within
24 hours of registering the patient providing they have been matched to the Spine.
Electronic Transfers - GP2GP
If the patient's registration type is Applied and the patient was previously at a GP practice that does not use
SystmOne, a “GP2GP Transfer In Task” request is automatically sent to Spine. This will request the patient data to be
extracted from the patients’ previous practice's clinical system, ready for import into SystmOne.
Most records will be transferable using the GP2GP transfer into SystmOne. There are certain limitations for that
prevent the transfer of records if they;
 exceed 5mb in size, and/or
 include more than 100 attachments (for example, scanned letters)
Users must be logged on with a Smartcard to be able to perform a GP2GP transfer.
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Checking data is ready for GP2GP Transfer
Before starting the data transfer, the data extract that has been received from the patient's previous practice must
be checked via Spine. To do this:
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Select Workflow>GP2GP Transfers from the Main Menu to view the GP2GP Transfers screen.
Select the Transfers In tab.
Locate the patient.
Check whether a date and time is displayed in the Extract Received column for the patient.
Performing a GP2GP Data Transfer
To transfer data from the patient's previous practice:
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Select Workflow>Task List from the Main Menu.
Select the 'GP2GP Transfer In' node from the Tasks tree, under 'Unassigned Tasks'.
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Select the 'GP2GP Transfer In' task that corresponds to the correct patient and click
to action it.
Check the preview of the SystmOne patient record that is displayed, which shows the data that is going to be
imported.
Click Integrate in the SystmOne toolbar to add the data to the patient record
OR click Cancel transfer. The user will be asked to provide a reason, which will be shown as an update on the
'GP2GP Transfer In' task. The cancellation will also be shown on the GP2GP Transfers screen.
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Note: Cancelled transfers cannot be reinstated – if cancelled; the data can no longer be imported electronically. The
data will need to be added manually using the paper record sent by the other practice.
Using the GP2GP Transfers Screen
To view the GP2GP Transfers screen, select Workflow>GP2GP Transfers from the Main Menu.
This screen allows the practice to keep track of the progress of all GP2GP data transfers into and out of the practice.
Select the tab that relates to the type of transfer:
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Transfers In – shows patients whose data needs transferring/has been transferred into SystmOne from
another clinical system.
Transfers Out – shows patients for whom the practice has received requests to transfer data out of
SystmOne for import into another clinical system.
The following colour -coding is used:
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Black – active transfer that has not yet been completed.
Red – transfer was rejected/cancelled by the receiving practice (right-click on the entry and select Show
Details to view information).
Bold red – failed transfer (right-click on the entry and select Show Details to view information)
Grey – completed transfer.
Note: Failed transfers will remain on screen. To view a full list of failed transfers, select 'All active transfers' from the
Show drop-down list and click the Flags column header to group them together.
Dealing with Degraded Data
The practice summariser will check the degraded data when a patients paper records are received by the practice.
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Almshouse Surgery & Sandal Castle Medical Centre
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Some information that is sent via GP2GP transfer may not always be in a format that SystmOne can interpret. When
the Electronic Record is integrated into the SystmOne record, this kind of data is changed from being a coded entry
to free text known as degraded data.
Degraded data items are flagged in the record with the Read code '(XaLGM) Transfer- degraded record entry’ or a
child of this code. When viewing a patient, select the following nodes from the Clinical tree to view any degraded
items:
 'Degraded GP2GP Data'
 'Degraded GP2GP Medication'
Once the Electronic Record has been integrated into the SystmOne record, this data will need to be manually
re-recorded in a suitable format.
To re-record degraded data:
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Retrieve the patient record.
Select 'Degraded GP2GP Data' from the Clinical tree.
Right -click on the degraded item and select the appropriate option from the sub-menu, for example New
Coded Entry. Note: The right-click options available will vary depending on the type of data that has been
degraded.
Save the patient record.
Notes: If data relating to allergies or sensitivities has been degraded to text, the system will prevent clinicians from
prescribing until suitable coded entries have been added to the patient record and the degraded entries have been
marked in error. Any active repeats are ended when data is transferred, so will need re-prescribing.
When a degraded allergy or sensitivity has been re-recorded in the correct SystmOne format, the original degraded
allergy or sensitivity will need to be 'marked in error'; otherwise, SystmOne will continue to prevent prescribing for
the patient. When marking degraded items in error, select Other on the Reason for Marking in Error dialog and type
in some explanatory notes.
Transfer of Paper Records
When a patient is registered at the practice, NHS England will receive an automatic request for the patients’ paper
records.
Patients with a previous GP
If a patient has a previous GP in the UK, NHS England will request these paper records from the practice. These paper
records will be sent to NHS England who will then forward them on to us. These are delivered securely on a daily
basis to the practice.
Patients with no previous GP
If a patient has no previous GP because they have just moved into the UK or it is a new baby, NHS England will create
a new paper record for the patient and will send it to the practice via their secure delivery service.
Summarising of Paper Records
When a patients paper records have been transferred into the practice they will be summarised into a format that
allows the practices’ clinicians to view easily.
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The summariser will receive the records via NHS England’s secure delivery system on a daily basis and will associate
the paper records with the electronic record. The summariser will ensure that any degraded data is re-coded and
replaced and all the necessary information from the paper record is easily viewable by the practice staff.
Scanning paper records into the electronic record
Any paper records that are received will be scanned and entered into the patients’ electronic record.
Registration of Armed Forces Personnel & Veterans
Serving Personnel
Generally, patients who are members of the Armed Forces will register with a GP practice or Medical Centre from
the Defence Medical Services. Occasionally, these personnel may be authorised to register with an NHS GP close to
where they work/live.
These patients will be given written authorisation from DMS to register with a GP practice for a period of up to 2
years. The letter will include details of a military contact and the patient will be given a summary of their medical
record for the practice. This information will be given to the practice upon registration. These patients will then be
registered as a normal GMS registration. The practice will sign in receipt for the summary of the medical record and
return this confirmation to the contact within the letter that the patient presented.
Veterans
If a patient has indicated on their GMS1 form that they have previously served in the forces, this will be coded on the
patient’s record when they are summarised. This information will need to be included in any referrals and GPs will
be aware of the status to appropriately handle any injuries and problems that are a result of serving in the armed
forces.
Registration of those without a permanent address
Where necessary the practice may use the practice address to register a patient if they wish. Staff should ensure
they have means of contacting a patient if they need to.
Registration of those released from prison/criminal justice system
These patients should be registered as any other patient. The patient may have a letter with them following release
that states they have a place to stay. This letter will suffice as documentation to support identification and residence
for registration purposes.
New Patient Health Checks
Patients are advised that before they can access routine services within the practice they must attend a New Patient
Health check carried out by a Health Care Assistant. An appointment for this would usually be booked when the
patient submits their registration form. Non Attendance of this appointment will count towards the total number of
“Did Not Attend” appointments.
Staff must always encourage a re-arranged appointment when a patient cancels their New Patient Health Check.
Temporary Resident Registration
There may be occasions where a patient may need medical attention but does not wish to be fully registered with
the practice. The practice may accept a patient for a temporary registration when they wish to remain registered
with their regular GP but they are temporarily out of their usual practice area. Examples of this may include;
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A student who has returned home for the summer
A visiting relative of a registered patient
Registering a Temporary Resident
When it is necessary to register as a temporary resident, patients will need to complete a GMS3 form giving as much
information as possible. Patients registering as a Temporary Resident will be asked to provide 1 form of
photographic identification.
When a patient registers temporarily with the practice it will be agreed how long their registration will last. This can
be anything from 24 hours to 3 months and upon registration it will be classified as;
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Immediately Necessary
Up to 15 days
Over 15 days
The patient will be registered following the same procedures for a routine patient on the practice clinical system but
when choosing the registration type, one of the above options will be selected.
Clinical Notes from Temporary Residents
Immediately Necessary
If a patient has to be registered as a temporary resident with an immediately necessary registration, they may be
seen by a clinician before the administration team can add the patient onto SystmOne. In this case the process is;
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Clinician sees the patient and records the information on the GMS3 card (Any prescriptions are handwritten)
Patient is added onto SystmOne by our administration team and the patients’ electronic record can be
added to by staff in our practice.
GMS3 form is scanned on and attached to the patients electronic record
GMS3 form is sent to NHS England who will re-direct the form to the patients’ usual practice for them to
deal with accordingly.
Over 15 Days
If a patient registers as a temporary resident and books a routine appointment, the registration form should be
prioritised and sent to the administration team for adding on to SystmOne. The clinicians can then use the electronic
record as they would for any other permanently registered patient.
Removal of a Temporary Resident
A temporary residents’ registration will be automatically deducted from the practice list after a period of time
depending on the registration type;
 Immediately necessary – 15 days after registration date
 Up to 15 days – 15 days after registration date
 Over 15 days – 3 months after registration date
If a patient wishes to remain registered with the practice they should advice the practice of a residing address that is
within the practice boundaries.
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Receiving Temporary Registration Documents for our Patients
When the practice receives information from another practice where its patient has chosen to become a temporary
resident, the information will be scanned onto the patients’ records and kept in line with the practices’ Scanning
policy.
Amendments to a Patients Registered Details
If a patient wishes to make an amendment to their registered details this must be done using the following methods;
Written Requests
The following changes to a patient’s record will only be done upon receipt of a written request from the patient or
their representative.
 Change of address
 Change of name
 Date of birth
The written request will be sent to admin to allow them to make the necessary changes and to ensure the request is
scanned electronically onto the patients’ records.
If a patient is changing their name staff will request to see the original deed poll registration or the original marriage
certificate.
If a patient is changing their address the patient may have moved out of the practice area. In which case the patient
will receive a letter from the practice and will automatically be removed from the practice list after 28days following
the Removal Due To Address Change section of this policy.
If a patient has been registered with the wrong date of birth they must bring in a passport or similar form of
photographic ID to confirm the correct date of birth.
Verbal Requests
The following changes to a patient’s record may be done verbally by the patient or their representative.
 Change of or adding a new phone number
 SMS consent
 Changing or adding an email address
Staff can make the appropriate changes to patients’ records if the patient or their representative gives the above
information verbally. A note must be left in the patients’ records to detail the date/time and method in which the
information was received along with the staff members’ name. This must be done either as a note against the new
phone number or a textual entry into the new journal.
e.g. Mum (Name) rang to change contact number for this child on 1st Jan 15. SJC
Changes to a patient’s record that were received verbally must only be done once staff have confirmed;
1. The patient is who they say they are. Asking a patient to confirm their name/address/D.O.B is the easiest
way to confirm.
2. Amendments are being made to the correct patients’ records. This should be correct if confirmed in step 1.
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PDS changes
If any changes are made to a patient’s registration details on the Spine these will be shown on the practice record
and SystmOne will ask staff to confirm or decline the changes. The changes will be shown either in the unassigned
task list or they will act as a reminder when opening the patients’ records and be shown as below.
Unassigned Tasks – PDS Update Tasks
These tasks will be
dealt with daily by
administration staff.
Admin staff are aware
of which changes to
accept and decline
based on who has
done them and the
information they have.
PDS Pop Up
Reminders
These reminders must be ignored (using the “Do Later” option) by staff unless they can confirm with the patient (in
person) that the change of details is correct.
A PDS update is created every
time a patients registration details
are changed. Generally changes
made by our own practice staff
can be deemed correct however
the administration team will check
that the correct information has
been recorded by our staff.
Changes made by staff outside the
organisation will only be accepted
if they are an ADDITION to the
patients’ record (such as an
additional contact number).
Anything that changes a patients
registration details will be checked
and confirmed with the patient.
Removing a Patient from the Practice List
Removal due to Non Attendance
A Non Attendance (DNA – Did Not Attend) is when the patient does not attend an appointment at the practice.
An appointment is labelled as a DNA either by;
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

a GP who has finished their surgery can mark an appointment as a DNA, OR
SystmOne will automatically label appointments that have not been marked as “Arrived” or “Seen” as a DNA
every night.
It is practice policy to remove a patient from the practice list if they have failed to attend appointments on numerous
occasions. The amount of missed appointments before the warning process will be initiated is;
 3 consecutive missed appointments OR
 3 missed appointments within a 12 month period
When the above criteria has been met, the patient will be sent a warning letter to advise them that a further missed
appointment will result in the patient being considered for removal from the practice list.
After a further missed appointment within a 12 month period, a GP Partner will be made aware that the patient is
being considered for removal. If there are no medical reasons for the missed appointments and the GP sees fit, the
patient will be sent a letter advising them to find a new practice within 7 days.
The practice will write to NHS England and ask them to initiate the removal process and including the letters that the
practice has sent to the patient. NHS England will automatically deduct the patient after 7 days.
Vulnerable Adults
If a patient that falls under the above criteria for 3 missed appointments and is on the Learning Disability Register,
the practice nurses will be made aware and will contact the patient or their support worker/carer in the first
instance. If no contact can be made or after the first warning there is a further DNA then the patient will be referred
to Social Care Direct and a GP partner will be consulted about the individual to determine a course of action.
Removal due to Violence/Abuse/Aggressive Behaviour
The practice has the right to remove any patient who they feel may be a threat to its staff and other patients at the
practice. Instances where removal may be initiated may include, but not be limited to;



Persistent and excessive verbal abuse.
Discrimination against any of the practice staff or other patients
Persistent non-compliance with clinical treatment/advice.
In all instances a significant event form must be completed with the details of the incident. The police must be called
and the incident reported if staff feel necessary at the time of the event or within a short time after the event.
The significant event will then be discussed with a GP Partner and if necessary taken to a practice meeting where a
decision can be made based on the severity of the event. The practice will first send a warning letter to the patient
and warn them that any further incidents in the following 12 months will result in removal from the practice list.
Following any further incidents within a 12 month period and when the decision has been made by a GP or the
Practice to remove a patient, the patient will be notified in writing unless in extreme circumstances when the
practice deems it unsafe to do so. (i.e. doing so may result in a further incident that may endanger practice staff and
patients or may be harmful to the patients’ physical or mental health). The practice must include the details of why
they have decided to remove the patients including dates of any incidents that occurred.
The practice will also write to NHS England at the same time and express an interest in removing a patient including
details of why this decision has been reached. An automatic removal will be done by NHS England when the patient
registers with another practice OR 8 days after the notification is sent to NHS England, whichever comes first. The
practice will still be responsible for the medical services of this patient until either occurs.
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A patient can be removed from the practice list with immediate effect if such an incident has occurred where it has
been necessary to report the incident to the police. In this case the practice must notify NHS England immediately
orally and then confirm with them in writing within 7 days. A significant event form must still be completed and this
must include the details of the report to the police. The practice must notify the patient of the removal unless doing
so would further endanger any of the practice staff/patients or the mental/physical health of the patient)
When a patient is removed due to violence/abuse/aggressive behaviour and they have children registered with the
practice, NHS England will advise the patients to arrange for an alternative parent/carer to take them to the practice.
If this is not possible the patient is asked to contact the practice to discuss the best plan for ensuring children can still
be seen either in practice or in the community. An individual plan will be made by the GP’s at a practice meeting.
If a patient that is removed due to the above has children also registered with the practice, the practice safeguarding
lead and/or deputy will be notified and the practice will carry out a risk assessment to identify any risk to those
children and appropriate referrals made where necessary. THE CHILD WILL NOT BE DEDUCTED UNTIL ALTERNATIVE
GMS REGISTRATION HAS BEEN PROCESSED
Removal due to address change
When a patient notifies the practice that they have moved address and their new address is outside of the practice
boundaries, the practice will;
1. Write to the patient to advise them they are no longer within the practice boundaries and recommend they
find a practice closer to their new address. The practice will allow the patient 30 days to register with a new
practice before the patient will automatically be removed from its practice list, and
2. Notify NHS England who will automatically deduct the patient from the practice list after 30 days of receiving
the notification.
When a patient registers with a new practice, this will initiate the deduction process from the practice list. See
Deductions
If a patient is removed due to an address change but the practice is not notified of an address change of any children
that appear to be residing at that address, the practice safeguarding lead and/or deputy will be made aware of this.
CHILDREN SHOULD NOT BE DEDUCTED AND LEFT WITHOUT ACCESS TO PRIMARY CARE SERVICES.
Removal due to Death
When a patient has died reception staff will follow the “Deaths Protocol” and part of this includes letting the
administration team know when a patient has died.
The Administration team will then request a deduction in SystmOne.
To send an electronic deduction request to NHS England:






Retrieve the patient record.
Select Patient>Patient Maintenance>Deduction Request from the Main Menu. The Patient Deduction
Request dialog is displayed.
Check that the current patient is the one to deduct (if not, select Use another patient and click Search to find
the patient to deduct).
Click Next Step.
Select “death” from the drop -down list.
Click Next Step.
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


Specify the deduction date and select Date is approximate if appropriate.
Click Next Step.
Submit deduction request.
Removal Due to Imprisonment
If the practice is made aware that a patient will be serving a prison sentence of more than 2 years. It will notify NHS
England in writing that the patient needs to be removed from its practice list for this reason.
Removal Due to Joining HM Forces
If a patient joins HM Forces on a full time basis, the forces GP will request the notes and the transfer will be treat like
that of a patient moving to a new surgery. If the practice becomes aware of a patient that has joined HM Forces the
practice will inform NHS England in writing.
If a patient is registered with the HM forces but was given authorisation to register with an NHS GP practice they will
be removed after the authorisation period or 2 years from registration, whichever comes first. The practice will
contact the DMS using the patients original authorisation letter to arrange secure transfer of patient summary
information.
The DMS may authorise an extension of the registration by letter, in which case the patient will not be removed until
the further authorisation period has expired.
Deductions
A patient will be deducted from the practice clinical system when they have either;



Registered with a different practice,
Moved out of the country OR
Died (The practice will request the deduction first before the following procedures are followed)
When any of the above occurs, NHS England will send a deduction request to the practice. Deduction requests can
be viewed in SystmOne under “Links > EDI Administration” and they are shown under the “Deductions” Tab.
These patients should be actioned which will move them into the Medical Records Out tab.
When the patients in the Deductions list have been actioned, their medical records need to be sent back to NHS
England. The list of patients whose records need sending can be seen in “Links>Medical Records In/Out” and under
the “Sending to HA” tab.
The administration team will retrieve the paper records for each of these patients and will also print the medical
records from the system if necessary by right clicking on the patient and choosing “print selected records”
The following box will appear and the options should be as shown.
If the patient is going to another SystmOne practice – a warning will appear saying the records do not need printing
for this reason. This should be accepted and the records do not need to be printed.
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The paper records and any print out (where applicable) will be sent back to NHS England securely via their collection
service. (Also known as the “Yellow Bag”)
When a deduction has been printed/actioned accordingly it will remain in this list until NHS England accept the
message to the EDI administration screen under the “Med. Rec. Flag Removal” tab where it is possible to see when
the records have been received. These messages can be actioned when the admin team are sure the records have
been received by NHS England.
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Appendix 1 – Letter to a new patient who is out of practice boundaries
Dr Power & Partners
Web address: www.almshouseandsandal.com
The Almshouse Surgery, Trinity Medical Centre, Thornhill Street, Wakefield. Tel No: 01924 784103
Sandal Castle Medical Centre, Asdale Road, Sandal, Wakefield, Tel No: 01924 258955
<Title> <Forename> <Surname>
<Patient address>
<Todays date>
Dear <Title> <Surname>
Firstly we would like to thank you for choosing Almshouse Surgery & Sandal Castle Medical Centre as your GP
Practice.
After reviewing your patient application it has become apparent that your address is in an area of Wakefield that our
practice boundaries do not cover. We therefore are unable to accept your registration.
If you are unsure of which surgeries cover your area please visit the NHS choices website where you can find the
most practical GP surgery for you.
We apologise for any inconvenience this may have caused.
Kind Regards,
Almshouse Surgery & Sandal Castle Medical Centre
Please Note: An outline of our practice boundaries can be found on the contact page of our practice website
www.almshouseandsandal.co.uk
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Appendix 2 – Letter to a patient who has moved out of practice boundaries
Dr Power & Partners
Web address: www.almshouseandsandal.com
The Almshouse Surgery, Trinity Medical Centre, Thornhill Street, Wakefield. Tel No: 01924 784103
Sandal Castle Medical Centre, Asdale Road, Sandal, Wakefield, Tel No: 01924 258955
<Title> <Forename> <Surname>
<Patient address>
<Todays date>
Dear <Title> <Surname>
Unfortunately you have now moved to an address that is out of the area that our practice covers.
Please could you make arrangements to register with a doctor in your local area. If you are unsure of the surgeries
that cover that area, please visit the NHS choices website and you can find a local GP surgery.
Please also be aware, we have let NHS England know that you have moved to an area that we do not cover. They will
allow 30 days for you to register with a new Surgery.
When you register with a new practice you will automatically be removed from our practice list and your records will
be transferred to the new surgery.
If, after 30 days, you have not registered with a new GP Surgery you will be removed from our practice list and your
records will be sent to NHS England.
We apologise for any inconvenience this may have caused.
Kind Regards,
Almshouse Surgery & Sandal Castle Medical Centre
Please Note: An outline of our practice boundaries can be found on the contact page of our practice website
www.almshouseandsandal.co.uk
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Appendix 3 – Warning letter to a patient about missing appointments
Dr Power & Partners
Web address: www.almshouseandsandal.com
The Almshouse Surgery, Trinity Medical Centre, Thornhill Street, Wakefield. Tel No: 01924 784103
Sandal Castle Medical Centre, Asdale Road, Sandal, Wakefield, Tel No: 01924 258955
<Title> <Forename> <Surname>
<Patient address>
<Todays date>
Dear <Title> <Surname>
It has been brought to our attention that you did not attend for your appointment on
According to our records this is the 3rd time this has happened.
We now feel that we must advise you that if you do not attend another appointment, you will be considered for
removal from our practice list and will need to find a new surgery.
We do hope that we do not have to take this action.
Missed appointments waste doctor’s time and prevent other patients getting to see the doctor, so we must be
vigilant when patients miss appointments.
Kind Regards,
Almshouse Surgery & Sandal Castle Medical Centre
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Appendix 4 - Removal from practice list due to missed appointments
Dr Power & Partners
Web address: www.almshouseandsandal.com
The Almshouse Surgery, Trinity Medical Centre, Thornhill Street, Wakefield. Tel No: 01924 784103
Sandal Castle Medical Centre, Asdale Road, Sandal, Wakefield, Tel No: 01924 258955
<Title> <Forename> <Surname>
<Patient address>
<Todays date>
Dear <Title> <Surname>
It has been brought to our attention that you did not attend for your appointment on
According to our records this is the 4th time this has happened.
Following our previous warning letter (enclosed) we have made the decision to request your removal from our
practice list in line with our practice policy.
We have informed NHS England of this request and you will be removed from our practice list in 7 days’ time.
If you register with a new surgery within 7 days, your records will be sent to the new surgery. If you fail to register
with a new practice within 7 days, your records will be returned to NHS England who will keep them until you
register with a new surgery.
As a surgery we rarely request the removal of a patient, however, missed appointments waste doctor’s time and
prevent other patients getting to see the doctor, so we must be vigilant when patients abuse the services we
provide.
To find the most appropriate new surgery to register with we suggest you look on the NHS Choices website.
Kind Regards,
Almshouse Surgery & Sandal Castle Medical Centre
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Appendix 5 – Warning a patient about violence/aggressive behaviour
Dr Power & Partners
Web address: www.almshouseandsandal.com
The Almshouse Surgery, Trinity Medical Centre, Thornhill Street, Wakefield. Tel No: 01924 784103
Sandal Castle Medical Centre, Asdale Road, Sandal, Wakefield, Tel No: 01924 258955
<Title> <Forename> <Surname>
<Patient address>
<Todays date>
Dear <Title> <Surname>
It has been brought to our attention that there has been an incident between the surgery and yourself.
(DETAILS OF THE INCIDENT)
We would like to hear your comments on this matter if you could please contact the practice manager ASAP to
discuss this issue.
The surgery maintains a Zero Tolerance policy on violence and abuse. If we encounter another incident within the
next 12 months we will consider removing you from our practice list and you will be required to find another
surgery.
We like to maintain a good relationship with all our patients and hope that we can continue to do so with you.
Kind Regards,
Almshouse Surgery & Sandal Castle Medical Centre
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Appendix 6 – Notifying patient of removal due to violence/aggressive
behaviour
Dr Power & Partners
Web address: www.almshouseandsandal.com
The Almshouse Surgery, Trinity Medical Centre, Thornhill Street, Wakefield. Tel No: 01924 784103
Sandal Castle Medical Centre, Asdale Road, Sandal, Wakefield, Tel No: 01924 258955
<Title> <Forename> <Surname>
<Patient address>
<Todays date>
Dear <Title> <Surname>
It has been brought to our attention that there has been an incident between the surgery and yourself.
(DETAILS OF THE INCIDENT)
{The surgery maintains a Zero Tolerance policy on violence and abuse. Unfortunately this has been the second
occurrence within a 12 month period and we are therefore requesting that you register with another surgery. }
OR
{The surgery maintains a Zero Tolerance policy on violence and abuse and the incident in question caused potential
danger for our staff and our other patients. After practice discussion it has been decided that we must request you
find another surgery. }
We have notified NHS England who will take the appropriate steps to ensure you are removed from our practice list
in 7 days or when you register with another surgery.
We regret that this decision has to be made however we appreciate your cooperation.
Kind Regards,
Almshouse Surgery & Sandal Castle Medical Centre
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Appendix 7 – Letter to NHS England to Request Removal
Dr Power & Partners
Web address: www.almshouseandsandal.com
The Almshouse Surgery, Trinity Medical Centre, Thornhill Street, Wakefield. Tel No: 01924 784103
Sandal Castle Medical Centre, Asdale Road, Sandal, Wakefield, Tel No: 01924 258955
WYCSA
Registration Department
Brunswick Court
Bridge Street
LEEDS
LS2 7RJ
<Todays date>
To Whom it May Concern,
<Forename> <Surname>, <Date of birth>
<Patient address>
Please remove the above patient from our practice list. We are requesting removal because the patient has;
☐
Moved out of the area covered by our practice boundaries (removal within 30days)
☐
Relationship has broken down between the practice and the patient (removal within 7 days)
☐
Other Reason:
Kind Regards,
Almshouse Surgery & Sandal Castle Medical Centre
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Appendix 8 – Record of Removal & Refusals (Template)
Almshouse Surgery & Sandal Castle Medical Centre
Record of Refusal and Removal of patients
Date
e.g. 1/1/2015
NHS No.
1234567890
Name
Mickey Mouse
Refusal/Removal
Refusal
Reason
Out of practice area
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Appendix 9 – Letter informing patients of Named GP
Dr Power & Partners
Web address: www.almshouseandsandal.com
The Almshouse Surgery, Trinity Medical Centre, Thornhill Street, Wakefield. Tel No: 01924 784103
Sandal Castle Medical Centre, Asdale Road, Sandal, Wakefield, Tel No: 01924 258955
<Title> <Forename> <Surname>
<Patient address>
<Todays date>
Dear <Title> <Surname>
New service for patients
You may be aware that practices are required to provide all their patients with a named GP who will have overall
responsibility for the care and support that our surgery provides to them.
I am writing to inform you that your named GP will be
This GP will have overall responsibility for the care and support that our surgery provides to you. This does not
prevent you from seeing any GP in the practice.
You do not need to take any further action, but if you have any questions, or wish to discuss this further with us,
please contact us on 01924 784103.
Kind Regards
Almshouse Surgery & Sandal Castle Medical Centre
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Appendix 10 – Amendments Request
Almshouse Surgery & Sandal Castle Medical Centre
Updated Patient Details & Consent
PREVIOUS DETAILS
Please complete all sections
Title
Forename
PREVIOUS DETAILS
Surname
Previous surname
(if changed in last 3 years)
Current Address
Post Code:
Home Phone
Mobile
Email
NEW/UPDATED DETAILS
Please enter below any of the details that are changing from the ones you have provided above.
NEW/UPDATED DETAILS
Title
Forename
Surname
Previous surname
(if changed in last 3 years)
Current Address
Post Code:
Home Phone
Mobile
Email
Consent to receive important communications from the surgery via SMS at the mobile number provided above
Consent to receive important communications from the surgery via EMAIL at the address provided above
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Appendix 11 – New Baby Registration Letter
Dr Power & Partners
Web address: www.almshouseandsandal.com
The Almshouse Surgery, Trinity Medical Centre, Thornhill Street, Wakefield. Tel No: 01924 784103
Sandal Castle Medical Centre, Asdale Road, Sandal, Wakefield, Tel No: 01924 258955
<Title> <Forename> <Surname>
<Patient address>
<Todays date>
Dear <Title> <Forename> <Surname>
The surgery would like to offer congratulations on the birth of your new baby.
We have enclosed a registration pack to enable you to register your baby at the surgery.
We ask that you please register your baby as soon as possible to ensure we always have up to date records
for your child.
Once your baby is registered we invite you to book an 8 week check for both your baby and for your
postnatal check. Please contact either surgery to book this appointment.
Kind Regards,
Almshouse Surgery & Sandal Castle Medical Centre
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