Patient removals: time to rethink exclusion in general practice?

On 24 July 2025, Pulse reported the death of a Devonshire man who had been removed from mainstream general practice.1 Although no further details were given, the coroner’s investigation has suggested that the man, diagnosed with autism spectrum disorder, had been receiving insufficient care through the ‘Special Allocation Scheme’ (SAS). Previously known as the ‘violent patient service’, the SAS is a national (England-wide) service for patients who have been removed from their regular GP provider after being reported for violence or aggression. It was developed in an attempt to maintain the safety of GP staff, while providing continued primary care to patients in a secure setting.2 Since the introduction of the scheme in 2004, levels of violence and aggression in general practice have been escalating and remain a pressing concern.3 While the SAS has received little attention in the wider media and research, the patient’s death has prompted calls for tighter protocols and safeguarding measures when general practices consider referring patients to the SAS. In July 2024, NHS England updated its guidance recommending that general practices consider disabilities, neurodiversity, and safeguarding before making such referrals.1,2 However, questions remain about when SAS registration is the appropriate course of action, if the service itself is unsuitable for many patients with complex needs.