I was very disappointed by the tone of Steve Ainsworth's article ('Omission to explain', page 27, 30 July) arguing that GPs should not need to give patients reasons for removal from their lists.

He tritely compared the relationship of patient and GP with that between a client and a solicitor or hairdresser. I would be devastated to be struck off either list without explanation.

The Patients Association runs a patient line which helps with all sorts of concerns. Most calls are about GPs, and many are about patients being struck off and not given reasons. Sometimes groups of people are struck off. This appeared to be at its peak last year in urban areas. Many people said other lists were closed, that they would have to travel long distances or that because they were struck off one list they were blacklisted from others.

Doctors are supposed to provide continuity of care, and doctors themselves present it as a very special 24-hour relationship. To most people a reason is helpful and all they want.

I have every sympathy with GPs who work for years with difficult patients before getting to the stage when they feel the only way forward is to remove them from their lists. As Steve Ainsworth indicates, the actual number of GPs involved is relatively small.

The Patients Association considers that all patients should be given a reason for being struck off. There should be some method agreed by the GPs and the health authority to give an explanation and provide accessible healthcare.

Eve Richardson

Chief executive

The Patients Association

But some CHCs say they have no desire to raise the issue

Steve Ainsworth writes that 'since 1974 community health councils have raised on many occasions the issue of GPs not giving explanations and have called for changes to the rules'.

Such a sweeping generalisation is unfair, as many CHCs have not raised this issue for the very reasons otherwise so accurately set down by Steve Ainsworth.

Edward J Ashley

Chief officer

South East Staffordshire community health council