Practices should have explicit policies on zero tolerance of abuse, specifying what kinds of abuse will lead to patients being removed from lists, according to new guidance.

The guidance says that removing a patient from a list will normally be “exceptional,” and can be done where someone’s safety is at risk. Normally removal would be preceded by a written warning, it says.

Setting out the types of behaviour that could trigger further action, it says they include swearing and using bad language, racial or sexual abuse, unnecessarily persistent or unrealistic service demands causing disruption, damaging practice premises and stealing from practices.

The Medical Defence Union said it was right that practices should review policies and ensure they include explicit positions on not tolerating discrimination, harassment or victimisation.

Dr Ellie Mein, from the MDU, said: “There is increasing evidence that abuse and violence against primary care staff has worsened over the last two years and we support many practices to take action following an incident. In an MDU survey of over 400 doctors in 2021, nearly 8 out of 10 GPs reported increasing levels of abuse.

“It is never acceptable for healthcare professionals to be abused in the course of their work and this guidance will go some way to reassuring practice teams, who have worked so hard at a time of immense pressure, of the situations when action should be taken. We encourage GP practices in England to review and update their policies accordingly.”