Family doctors have been warned by the health service ombudsman to "get the basics of communication right" amid a rising number of complaints investigated by her office from patients who have been struck off GP lists.
Ann Abraham said just over one in five, or 21%, of complaints about GPs investigated by her office last year were about people being removed from GP patient lists, an increase of 6% since 2009/10.
Her office accepted 13 complaints for investigation about removal from GP patient lists and completed 10, all of which were upheld, she said in a review of complaint handling by the NHS in England in 2010/11.
Overall the number of complaints received about GPs stood at 2,581 last year, or 17% of a total of 15,066 health service complaints received by her office.
Ms Abraham said aggression or abuse were "never acceptable" but NHS contracts obliged GPs to give a warning before removing patients, with the exception of cases where this would pose a risk or was unreasonable to do so.
She said there was evidence that some GPs were not following British Medical Association (BMA) guidance that the behaviour of one family member should not mean the automatic removal of other relatives.
"In the cases we have seen, GPs have applied zero tolerance policies without listening to and understanding their patients or considering individual circumstances," she said in her report.
"Decisions to remove a patient from their GP's list can be unfair and disproportionate and can leave entire families without access to primary healthcare services following an incident with one individual.
"It is not easy for front-line staff to deal with challenging behaviour, and aggression or abuse is never acceptable.
"However, patients must normally be given a prior warning before being removed from a GP's list."