When patients turn perilous: how to (passively) tackle the rise in general practice violence

General practice is thought of as a place that heals wounds – but what happens when patients start inflicting them on healthcare staff? Worryingly, violence is on the rise in general practice, with some practices even training their staff in self-defence. Practice Business delves into the issue and offers some solutions to help practice managers and other employees prevent or de-escalate incidents of a violent nature that they may encounter on the job 

Last February, the BBC published an article about the incidence of violence in general practice. Their figures revealed that over 3,000 aggressive patients in England were barred from visiting their GPs in 2018. 

A poll by GPonline exposed that one-in-three GPs have felt threatened by a patient, and one-in-six report that they or a colleague have been attacked in their practice in the past year. A previous poll, conducted in 2014, found that only a quarter of GPs had felt threatened, and that one-in-eight had been, or had witnessed, an attack in their practice within the past year. 

Clearly, violence in general practice is on the rise. 

Whilst these figures give insight into the amount of verbal and physical abuse aimed at clinicians, the incidences among front-of-house staff and practice managers are bound to be even higher. Violence is most likely to be experienced by receptionists and administrative staff – and incidents are usually escalated to practice managers. 

Disturbingly, results published from a survey by Cogora in March 2019 revealed that 79% of practice manager respondents had received verbal abuse from patients in the past year, contributing to greater levels of stress and job dissatisfaction. This figure is staggeringly higher than the average for verbal abuse experienced across all professions, including GPs and pharmacists, which was found to be around 18%.

Zero tolerance?

This is despite the re-instated ‘zero tolerance’ policy implemented by the Department of Health and Social Care, which states that GPs and practice staff have a right to care for others without fear of being attacked or abused, and that any offenders should be punished quickly and effectively.

It is evident that more needs to be done to tackle the many kinds of violence that may be encountered in general practice. Examples of violence that may be seen in surgeries include, but are not restricted to: 

• Verbal abuse, such as swearing at, threatening or insulting practice staff. 
• Any physical violence towards practice staff or other patients, such as pushing and shoving, or more extreme acts of physical violence, like punching. 
• Other indirect physical expressions of violence, such as spitting at practice staff or other patients. 
• Verbal and physical abuse with a racial component towards practice staff or other patients. 
• Sexual harassment towards practice staff or other patients. 
• The deliberate spreading of germs or attempted contamination, such as directed coughing, spitting or urinating on practice premises, patients or staff. 
• Causing damage to practice premises or to cars parked outside. 
• Stalking practice staff.

It is, therefore, vital that the practice manager have strategies in place to help themselves and their staff cope in the event of patient violence. So, what can you do prevent acts of violence occurring in your practice and, in the event that it does occur, how best do you cope? 

• Realise that violence aimed at practice staff may be more of a systemic, than personal, issue

Some practices cater to demographics with higher rates of drug abuse. Some patients are conflict-seekers. Some have physical and mental illnesses that may drive them to commit violent acts. It could be argued that the current state of the NHS is exacerbating the situation, leading to the perpetration of more acts of violence against its staff[JHJ1] . For example, through no fault of your own, waiting times for appointments are often far too long – leading patients to become frustrated and more likely to act out. It is never acceptable for a patient to act aggressively towards healthcare professionals but, perhaps, this behaviour is, sadly, to be expected – which is all the more reason to be prepared for it. 

You can make small steps towards making systemic issues less prevalent in your practice – such as ensuring appointment waiting times are reduced as much as possible and helping clinicians run to time so that patients don’t have to hang around in the waiting room. However, also realise that any violence committed against you is not your fault and that you, or any of your practice staff, do not deserve to be verbally or physically abused. 

• Make patients aware of your ‘zero tolerance’ policy
  
  This may involve having a sign on the wall of the waiting room which states that violence, under any circumstances, towards practice staff or other patients will result in immediate removal from the practice, the patient list, and may justify police involvement. It is also a wise idea to display this information on your practice website, where you can provide a more in-depth account of what ‘zero tolerance’ towards violence entails. The Hope Farm Medical Centre, a GP practice in Great Sutton, have a fantastic example of this, which can be found here. 
  
• Make your complaints procedures tight, and well-known to patients 
  
  Doing so empowers patients to follow a legal complaints procedure instead of resorting to violence. Make sure all complaints are handled in a timely, professional manner and that, if appropriate, steps are taken to make practice systems, procedures and consultations more effective for patients and staff. 
  
• Train your staff in how best to handle violence 

Training may involve increasing awareness of the possibility of violence in your practice, as well as the types of violence staff or patients may encounter whilst in the surgery. Training can also familiarise staff with the practice complaints procedure, how to de-escalate violence, when to involve the police and how to write a violence report to the NHS, which can be authorised by the signature of a GP partner, practice manager or deputy practice manager. 

A practice manager in West Yorkshire became so concerned about the levels of violence in their practice that they offered staff self-defence training. If violence has become a particular issue in your practice, you may also deem this necessary. 

With violence on the rise in general practise, it is wise to review the procedures you have in place to deal with incidences of aggressive behaviour in your surgery.