Representatives of the British Medical Association (BMA) and the Royal College of General Practitioners (RCGP) told the House of Commons Select Committee on Public Administration that very few patients were removed from doctors' lists.

They warned that any attempt to change GPs' terms of service to force them to offer an explanation could put them at risk from violent patients.

At present, doctors can remove patients from their list without giving a reason, although the BMA advises its members that this should only be done in exceptional circumstances.

Professor Scott Brown, vice-chairman of the RCGP, said he had only ever struck one patient off his list and that was after a knife was held to his throat.

He said that the day after the attack, the receptionist's car was smashed up.

Dr Mac Armstrong, secretary of the BMA, said it was not acceptable in normal circumstances for a reason not to be given for a patient being removed from a GP's list.

But he said some doctors struck off patients who repeatedly insisted on having internal examinations, for example, and it may not be wise to put this on the record.

Labour MP Helen Jones said: "Adults have to take responsibility for what they do. If someone behaves badly and is removed from a list, they have a right to know the reason why because they have to accept responsibility for that."

Dr David Pickersgill, of the BMA, said progress on such issues was not always best achieved by compulsion but by issuing doctors with sound advice and guidance.

He highlighted surveys showing that, out of a GP's average list of 10,000 patients, there was only one complaint a year from someone struck off a list without being given a reason.

Patients not struck off on cost grounds

Helen Jones: patients have a right to an explanation

Dr Pickersgill also stressed that the BMA never condoned GPs who refused to take on patients simply on the grounds that they could prove expensive to treat.

Neighbouring GPs would complain bitterly if any doctor was found to be refusing patients on grounds of age, and this would soon get reported to the General Medical Council (GMC).

However, he conceded that there had been problems where local authorities had given planning permission for a large number of residential and nursing homes in one area, causing a knock-on effect for local GPs.

"There comes a point where the GP can't cope with any further increase in the workload," he said.

He also insisted there was little evidence of patients being deterred from making complaints about their doctors for fear of being removed from the list.