Unwelcome customers? The epidemiology of removal from general practitioner lists in Sheffield.

BACKGROUND The 1990 contract and the 1991 fundholding scheme encouraged speculation that general practitioners (GPs) may remove patients from their lists for financial reasons. Despite assertions that patient removals are increasing, little evidence exists on the number or trends in removals. AIM To describe the epidemiology of removals by time, place, and person, and to determine whether removals have increased in recent years. METHOD Descriptive analysis of routine data relating to all removals of Sheffield residents from GP lists during 1991-1996. RESULTS Removal from a doctor's list was a rare event (2.4 per 1000 patients per year) that did not become more common over the period examined. Removal rates varied by age, sex, and practice, with relatively high rates among children, young women, and the over-75s. There was a significant tendency for higher removal rates in more deprived parts of the city. CONCLUSION Removal rates have not increased in Sheffield. The reasons for the variation in rates by age, sex, and practice are unknown. The higher rates noted in the under-fives and young women are consistent with the possibility that the 1990 target payment scheme may have increased removal rates in these age groups.