Unfortunately, GP practices may sometimes be faced by a violent or aggressive patient – what’s the best way to remove such patients safely?
CREDIT: This is an edited version of an article that originally appeared on BMA
When GP practices have a patient who is violent, or exhibiting behaviour that makes staff fear for their safety, this patient should immediately be removed from the practice list.
The special allocation scheme
The special allocation scheme (SAS) can help with services to patients in this situation; patients join the scheme after being immediately removed as a result of an incident that was reported to the police. The SAS provides primary care medical services in a secure environment for patients who meet the criteria. Designated GP practices provide these services to patients by appointment at specific locations and times as detailed in individually agreed contracts.
Purpose of the scheme
The purpose of the SAS is to deal with patients who are violent or aggressive. It aims to protect GPs, practice staff and patients who have the right to be in the practice without fear of intimidating behaviour.
Problems with the scheme
The BMA GPs’ committee is aware of some schemes that require commissioner intervention before a removal is actioned. This is not in line with the regulations, and NHS England has addressed this through amendments to a single national process. Any cases where the regulations seem not to be applied correctly should be raised with LMCs.
In order to progress an allocation to the SAS, the regulations require a GP practice to report an incident to the police; however, practices do not need to obtain a police incident number or crime number and not having an incident number is not a barrier to the immediate removal of a patient who meets the criteria.
When removal is appropriate
The practice must have grounds to show that the individual committed an act of violence – or behaved in such a way that they feared for their safety. This could be against a doctor, partner, member of staff, visitor or patient on the premises.
There is no exhaustive list of behaviours, and the practice’s judgement is necessarily subjective, but the main types of behaviour that would justify a patient’s immediate removal are:
assault;
threatening behaviour;
behaviour resulting in damage to property.
The removal process
Call 999 or your local police station as soon as possible.
State what has happened and, if necessary, request police assistance at the incident location. The police will allocate an incident number that can be requested by the practice.
Notify NHS England on 0333 014 2884 or www.pcse.england.nhs.uk/contact-us. The removal takes effect at the time at which the practice contacts the Primary Care Support England (PCSE).
As long as it would not be harmful to the patient’s mental or physical health, or put any of the people listed above at risk, inform the patient of the removal.
Notify the CQC without delay, either while a registered activity is provided or as a consequence of it being provided, including incidents involving the police.
The process after the report to PCSE
Responsibility then passes to the PCSE. They must ensure the patient no longer remains on the practice list, and also to ensure that they can continue to receive primary medical services through a commissioned SAS provider.
The PCSE will write to the patient to tell them this and should ensure that a flag is placed on the patient record to stop them registering at another practice.
The removal of a patient and their allocation to the SAS remains under review by a panel.
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