Yet which practice does not have a hardcore group of irresponsible patients who always know their rights, but never their responsibilities: those who make appointments, then fail to attend; who repeatedly demand inappropriate visits; or who make vexatious complaints in order to settle personal scores? One man, on being reprimanded for his manipulative use of emergency appointments, made a formal complaint about the practice, which cost some £1,200 in staff time to defend - then dropped the complaint half way through.
Then there are those who persistently go to A&E rather than seeing their GP, and patients who demand excessive attention and will not take no for an answer. Behaviour like this only occurs in a small proportion of cases, but their malign influence interferes hugely with the smooth running of the NHS.
Why should doctors and nurses be penalised for behaving inappropriately, but never the patients? Why can't practices charge patients who don't turn up for appointments? Dentists can.
What about patients who imply that if they don't get their own way they will report us to the PCT or GMC, knowing that by threatening to make life hell for us they can manipulate us into doing their bidding? They can also complain with impunity: if their complaint is dismissed they face no penalty. Even if a patient has misbehaved so much that the practice throws them off its list, the patient can report the practice to the Health Service Ombudsman for removing them inappropriately.
This is a bullies' charter, and must change. Healthcare workers should be given the right to complain about patients. Penalties should be applied to those who negligently waste NHS time, make inappropriate demands on services, or instigate vexatious complaints. Sanctions should range from fines to depriving the patient of access to the NHS for a specific period of time.
Earlier this year Gordon Brown talked of 'a contract for patients'. He should first reflect on the fact that a contract is useless without penalty clauses on both sides.
Dr Lancelot is a GP from Lancashire. Email him at GPcolumnists@haymarket.com.