Q. I am a dentist working as a performer for a colleague who has a provider's contract with the PCT. I have just seen a new NHS patient with a badly broken down dentition. He was extremely aggressive and rude to both me and the dental nurse and I would prefer not to see him again. Can I refuse to treat him?

If this is an NHS patient then he is actually a patient of the provider for whom you work and so you should agree whatever action you need to take in conjunction with the provider.

You should write to the patient stating that the practice does not tolerate rudeness or aggression from any patient. You may also feel that there has been a breakdown in the relationship between yourself and the patient. If you feel it is not right to continue treating the patient you should say that you are ceasing to do so.

If you have completed this particular course of treatment then it is relatively simple to achieve and you should tell your staff not to book the patient in again if he applies for further course of treatment. If you are halfway through a course then you should bear in mind what the patient's current situation is, and you may wish to offer 30 days emergency treatment, perhaps provided by someone else in your practice, but tell the patient that they should seek out another dentist as quickly as possible. The PCT can provide a list of all the locally contracting dentists and it would be helpful to offer the patient their telephone number.

The provider holding the contract with the PCT should write and tell them that the practice is no longer willing to treat the patient because of a breakdown of the relationship. The letter should include a list of any outstanding treatment.

Aggression and violence from patients is not tolerated by the NHS and their position on tackling violence in the primary care setting can be found here.