I do wonder if those demanding that GPs give reasons for de-registration and calling for 'some agreed method' (Letters, 13 August) have thought through the implications.

At present, GPs may choose to offer a reason, but in most cases patients will know full well why they have been removed. Any system obliging GPs to give reasons will result in either anodyne or spurious answers - but then what? Is the GP expected to re-list the patient? Does the patient express thanks and walk away? What if the patient considers the reason to be false or damaging - do they then pursue a civil legal remedy?

The annual general meeting of the Association of Community Health Councils for England and Wales sought to establish 'an independent appeal and review system', creating yet another costly, bureaucratic NHS nightmare.

If the doctor-patient relationship had been merely weak at the point of striking off, there is a fair chance that after an appeal or review process, it would have irretrievably broken down.

What if the panel upholds the patient's appeal? Is the GP then required to retain the patient? Future consultations would prove interesting.

The AGM resolution believed, reasonably, that there should be 'no discrimination in the provision of healthcare based on age, gender, colour, race, social class, religion, sexuality, physical disability...' However, I have heard all those grounds and more from patients dissatisfied with, leaving or seeking GPs. So, if GPs are going to be required to give reasons or be hauled before a tribunal, the least we can expect from patients is that they, too, are required to give reasons for leaving a GP's list.

Far better, CHC chief officers should seek dialogue where both patient and GP are receptive.

With around 5,000 members and a minimum of 1,000 patient contacts a day overall, CHCs are a more substantive representative of patients than the Patients Association - a body with more front than Blackpool.

Edward J Ashley

Chief officer

South East Staffs CHC