Open Access Highly Accessed Research article

The disappearance of the “revolving door” patient in Scottish general practice: successful policies

Andrea E Williamson1*, Paul CD Johnson2, Kenneth Mullen3 and Philip Wilson4

Author Affiliations

1 General Practice and Primary Care, College of MVLS, University of Glasgow, 1 Horselethill Rd, Glasgow, G12 ORR, UK

2 Robertson Centre for Biostatistics, Institute of Health and Wellbeing, College of MVLS, University Avenue, University of Glasgow, Glasgow, G12 8QQ, UK

3 School of Medicine, College of MVLS, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, UK

4 University of Aberdeen, The Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK

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BMC Family Practice 2012, 13:95  doi:10.1186/1471-2296-13-95

Published: 4 October 2012



We describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy.


A mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with “revolving door” patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of “revolving door” patients identified from 1999 to 2005 in Scotland.


A “revolving door” patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of “revolving door” patients during the course of the study.


“Revolving door” patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS.