​When GP practices have a patient who is violent or exhibiting behaviour that makes them fear for their safety, the patient should immediately be removed from the practice list.

This guidance explains how to do so, minimising the risk to staff while complying with GMS regulations. See the equivalent for PMS practices.

The special allocation scheme

The SAS (special allocation scheme) provides primary care medical services in a secure environment to patients who meet the criteria.

Designated GP practices provide services to patients by appointment at specific locations and times as detailed in individually agreed contracts. Patients join the scheme after being immediately removed as a result of an incident that was reported to the police.

Purpose of the scheme

The purpose of the SAS is to deal with patients who are violent or aggressive. It aims to protect GPs, practice staff and patients who have the right to be in the practice without fear of intimidating behaviour. 

Problems with the scheme

The BMA GPs committee is aware of some schemes that require commissioner intervention before a removal is actioned. This is not in line with the regulations and NHS England has addressed this through amendments to a single national process.

Any cases where the regulations seem not to be applied correctly should be raised with LMCs.

To progress an allocation to the SAS, the regulations require a GP practice to report an incident to the police. However, practices do not need to obtain a police incident number or crime number. Not having an incident number is not a barrier to the immediate removal of a patient who meets the criteria.

When removal is appropriate

The practice must have grounds to show that the individual committed an act of violence – or behaved in such a way that they feared for their safety. This could be against a doctor, partner, member of staff, visitor or patient on the premises.

There is no exhaustive list of behaviour and the practice’s judgement is necessarily subjective, but the main types of behaviour that would justify a patient’s immediate removal are:

• assault
• threatening behaviour
• behaviour resulting in damage to property.

The removal process

• Call 999 or your local police station as soon as possible.
• State what happened and if necessary, request police assistance at the incident location. The police will allocate an incident number that can be requested by the practice.
• Notify NHS England at 0333 014 2884 or www.pcse.england.nhs.uk/contact-us The removal takes effect at the time at which the practice contacts PCSE.
• Inform the patient of the removal, as long as it would not be harmful to the patient’s mental or physical health or put any of the people listed above at risk.
• Notify the CQC ‘without delay’, either while a registered activity is provided or as a consequence of it being provided, including incidents involving the police.

The process after the report to PCSE

Responsibility then passes to PCSE. They must ensure the patient no longer remains on the practice list, but that they can continue to receive primary medical services through a commissioned SAS provider.

PCSE will write to the patient to tell them, and should ensure a flag is placed on the patient record to stop them registering at another practice.

​The removal of a patient and their allocation to the SAS remains under review by a panel.