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Keep calm and carry on – Defusing aggressive patients

by in Patients, Training

Keep calm and carry on - Diffusing aggressive patientsUnfortunately, attacks on practice staff are an ongoing problem. Only last September a GP in Nottingham was violently attacked by a mentally ill patient demanding access to his medical records. Unfortunately, such incidents don’t only occur once in a blue moon; in Nottingham alone this defendant is one of 29 patients listed on the local NHS violent patient register, while a quick Google search reveals a number of harrowing news stories involving attacks on practice staff, who are just as likely to be victims of abuse as GPs are.

So what can practice managers and their reception teams do to defuse difficult situations on the front desk?

While no-one can predict when and which patients will become angry before it happens – a number of steps can be taken to ensure the safest working environment possible.

Line of duty

A spokesperson at Acas told us: “As practice manager you have a duty of care towards your staff and, like any other employer, you need to be very clear about where the lines are in terms of unacceptable or acceptable behaviour. This includes clarifying what bullying and harassment actually look like. Sometimes people are unclear what bullying and harassment actually mean but if your staff are clear on this then they will know what to do if it happens. There should be a clear pathway for dealing with unwanted behaviour from members of the public.”

To create a safe working environment there’s a need to educate staff and patients. One way is through signage; educate patients that bullying isn’t acceptable and stress that there’s a no tolerance policy within the practice. The second way is educating all staff members on how to deal with difficult situations should they arise.

Prevent escalation

Prevention, sadly, won’t prevent all rude and aggressive patients from confronting staff. So how should staff deal with these situations?

The first step is to try and stop the situation from escalating. One practice on Merseyside that is willing to take on patients listed on the violent patient register says that its staff are trained in de-escalation techniques. This means enabling staff to recognise the early signs of agitation, irritation, anger and aggression, use techniques for distraction and calming, and learn ways to encourage relaxation. NHS Protect runs suitable training courses, as does HSE, the Health and Safety Executive.

Designing out violence

In addition to the above, practices could consider how their premises can be redesigned to reduce the risk of violence. This includes both ‘negative’ aspects, designed to stop someone carrying out a violent act, and ‘positive’ aspects, designed to stop them feeling angered and frustrated – and therefore prone to violence – in the first place.

Negative areas could include:

  • barriers/screens to reduce the risk of assault on reception staff
  • consulting rooms designed so that staff cannot be trapped inside
  • furniture which can’t be used as weapons – for example, because it is bolted down or designed with no sharp edges
  • installation of alarm systems

The more positive side includes:

  • the use of colour and light to influence mood – for example, airy waiting rooms painted in pastel colours
  • noise reduction
  • information screens

The last resort

The latest NICE guidelines recommend that physical restraint should only be used as a last resort, once all other methods of preventing or calming the situation have failed. However, if restraint is the only course of action available, the guideline includes clear recommendations on how it should be done to ensure the safety of both staff and the individual. More information can be found here.

The guideline focuses on how to assess risk and prevent violence, including how to recognise warning signs, how to calm potentially violent patients and how to manage difficult situations as well as to intervene safely when violence happens.

Report the problem

GP practices are also encouraged to report ALL incidents, no matter how small they seem, to police so that crime figures can be used to persuade the powers at be to invest properly going forward; and to ensure that potentially dangerous patients are identified.

The practice manager should immediately speak to the staff member to obtain full information about the situation and complete a thorough investigation in order to get a clear picture of all events. If a resolution can’t be found which the victim is totally happy with, the patient should be removed from the practice. Keep in mind that during any investigation period the staff member and patient should not make contact.


One practice manager added that while there will always be patients inclined to be violent, simple measures can go a long towards reducing aggression. “Simply having a system in place that treats patients in a timely and respectful manner, and provides them with adequate information, goes a long way to calming people down.”

Tackling aggression in practices boils down to three steps. Policy, training and action. By having these three areas covered, your staff need not live in fear of the next stressed patient to enter the waiting room. Instead, they can get on with their working day and do what they do best.


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