Break down in Dr/Patient relationship practice guidelines 2026

Guideline: Breakdown of Doctor–Patient Clinical Relationship

Knowle House GP Surgery

1. Purpose

This guideline outlines the circumstances in which the doctor–patient clinical relationship may be considered to have irretrievably broken down, and the appropriate steps to manage such situations safely, fairly, and in line with professional and regulatory standards.

2. Principles

The doctor–patient relationship is built on trust, mutual respect, communication, and cooperation. A breakdown may be considered only after reasonable efforts have been made to restore the relationship.

Decisions must:

• Prioritise patient safety and continuity of care
• Be fair, non-discriminatory, and proportionate
• Comply with NHS guidance and professional obligations
• Be clearly documented

3. Situations where patient feels unable to be cared for by a specific clinician

It is recognised that a patient may feel that from their perspective that their trust or clinical relationship with a clinician has broken down. If a patient states that they cannot accept care from a specific clinician, this will be escalated to management.

Knowle House Surgery agrees they can meet the needs of semi-urgent and routine care around a breakdown of a single doctor-patient relationship. The patient needs to accept that in cases of same day or very urgent care being required that we cannot guarantee that an alternative clinician will be available. Therefore, by staying registered at Knowle House Surgery a patient must accept that they are happy to receive care from any clinician in these circumstances.

If the patient accepts the above, then a note will be added to their record and in the pop up stating the clinician that should not be involved in routine care. This clinician will be informed. The patient will have their registered GP changed to an alternative clinician (if required).

In the situation where the patient then feels their relationship has broken down with a second clinician at Knowle House Surgery then this will be escalated to a senior management. Due to staffing it is unlikely the medical needs would be adequately managed in this circumstance. In this circumstance then the patient will be advised that their needs are likely to be better met at an alternative surgery and they will be supported in re-registering.

4. Indicators of Relationship Breakdown (from clinician perspective)

A relationship may be considered broken down where one or more of the following occur persistently or severely:

4.1 Breakdown in Trust

• Repeated expressions of distrust in clinical judgement despite reassurance
• Refusal to engage with agreed care plans without valid reason
• Allegations against staff that are found to be unfounded and harmful

4.2 Communication Failure

• Inability to establish effective communication despite reasonable adjustments
• Persistent refusal to engage in consultations (in-person, phone, or digital)
• Repeated misunderstandings leading to unsafe care situations

4.3 Unreasonable Behaviour

• Aggressive, abusive, or threatening behaviour towards staff or other patients
• Harassment (verbal, written, or online)
• Persistent disruptive conduct impacting service delivery

4.4 Non-Adherence Impacting Safety

• Repeated refusal of essential investigations or treatments where this creates significant clinical risk
• Consistent non-attendance at critical appointments without explanation

4.5 Boundary Violations

• Inappropriate personal behaviour toward clinicians or staff
• Attempts to manipulate prescribing or clinical decisions
• Breach of agreed practice policies

5. Steps Before Declaring Breakdown

Before concluding that the relationship has broken down, the following should be considered:

1. Clarify Concerns
2. Attempt Resolution
3. Reasonable Adjustments
4. Warning (if appropriate)
5. Documentation

6. Decision to End the Relationship

A decision may be made when:

• All reasonable steps to repair the relationship have failed, or
• There is an immediate risk to staff or other patients (in which case action may be expedited)

The decision should:

• Be made by a Partner and/or practice leadership
• Be consistent with practice policy and NHS regulations
• Be justified, proportionate, and documented

7. Actions Following Breakdown

• Notify the patient in writing, explaining the reason in a factual and non-confrontational manner
• Provide information on how to register with another GP practice
• Ensure continuity of care, including:
  • Urgent or immediately necessary treatment
  • Transfer of medical records promptly

8. Exceptions

The practice must not remove a patient solely on the basis of:

• Protected characteristics (e.g., race, gender, disability, religion)
• Medical condition or complexity of care
• Making a complaint

9. Immediate Removal

In cases involving violence or serious threats:

• The patient may be removed immediately
• The incident should be reported to appropriate authorities
• Staff safety protocols must be followed

10. Review and Governance

• All cases of relationship breakdown should be reviewed internally
• Trends or recurring issues should inform service improvement
• This guideline should be reviewed periodically