I am a local medical committee secretary. while I appreciate that some patients might like to know why they have been removed from GPs' lists ('Omission to explain', page 27, 30 July; Letters, 13 and 20 August), I am sure that in almost all cases it is fairly clear.
In this part of south Wales, three reasons account for the overwhelming majority of patients removed from lists:
the patient has moved outside the practice area and has not informed the practice; they are removed once the practice becomes aware of an address change;
violence and threatening behaviour - often (but not always) related to substance abuse;
the breakdown of the doctor-patient relationship at a personal level.
Other reasons for removing a patient might include an abuse of the service by patients - making unreasonable demands, for example.
In general, GPs feel that just as patients should be free to choose their doctor, doctors should be free to choose their patients.
GPs are often interested to know why a patient has left their list, but the patient has to give no reason why.
Equally, patients may complain about doctors' behaviour which could result in disciplinary action. However, there is no reciprocal procedure for doctors. Consequently, the GP has only one effective option for patients who continue to make reasonable demands on the service - remove them. If there were options open to aggrieved GPs, fewer patients might be removed.