Violence and abusive behaviour towards GPs and practice staff hit the headlines again this month when a GP in Water Eaton, Milton Keynes, spoke out about the daily abuse he and his staff are subjected to from patients.

Talking to the Eastern Eye, Dr Muhammad Faisal from Water Eaton Health Centre outlined how patients have damaged his car when they were refused sick notes and how he and his staff are subjected to threats and abuse.

Patients, some of whom who are suspected to be drug addicts, are demanding controlled drugs such as morphine, tramadol and diazepam. Some also arrive late for their appointments and “demand” to be seen, Dr Faisal said, adding that the patients have a “do what I say” attitude. At times, patients have barged into the doctor’s room when they were seeing other patients.

“They feel like we are their servants and they dictate. Not only to the doctors in the practice, but the rest of the staff. The abuse happens on a daily basis. Some patients lose their temper very easily. We’ve had to remove them for rude behaviour. We are struggling. It is so difficult. It’s so abusive. I will not be able to recruit any staff. It’s a shame,” he said.

Dr Faisal’s comments will ring true with so many practice staff up and down the country. Indeed, Primary Concerns 2016, a report based on a survey of health professionals, showed that 70% of GP practice staff had faced some sort of abuse in 2016, a rise of 57% from the previous year. The most common form of abuse was verbal, with 64% reporting such incidents; 6% had faced physical abuse.

As it’s clearly a problem, what can be done about abusive patients?

Strike them off

The ultimate sanction any practice can take is to remove a patient from their list. Where patients are particularly threatening and abusive then immediate removal is an option, following the reporting of the incident to police and the local CCG. The CCG will then assign that patient to a new practice, who will in turn be made aware of that patient’s history.

In other cases, a programme of warnings may be more appropriate. An interesting thread on this topic can be found on the Practice Index Forum, where one Practice Manager suggested: “With verbal abuse, we sent warnings, but anything physical or involving direct threats we removed immediately. We always tried to get the patient added to the local scheme for violent patients too.”

The number of warning letters and the length of time taken to remove a patient are talking points and something for practices to discuss internally, but one thing to bear in mind is the need for entries in patient’s notes – only that way will the new practice have any idea what and who they’re taking on.

Prevention, not cure

While patient removal can deal with the problem, one practice manager told us that they’re more success by combining a hardline removal regime with a more sympathetic approach.

“I manage a practice in what can only be described as a less salubrious area and we do witness plenty of abuse,” the PM told us. “As was said on the Forum, we won’t tolerate physical abuse, but whenever it’s verbal we have a policy of trying to talk to the individual, which is working for us.

“We sent our receptionists – who are generally on the receiving end – on a training course showing how they can deal with abusive patients, which helped too. In so many cases abusive patients actually need help and I would rather try than just push them onto another practice, which sadly is the case as the NHS simply doesn’t seem interested in dealing with them via the violent patients list.”

The PM went on to say that the abuse, in her experience, normally comes down to one of the following factors issued by the Health and Safety Executive (HSE):

• inherent aggression caused by mental instability
• impatience due to waiting, lack of information or boredom
• frustration due to lack of information or boredom
• anxiety caused by lack of choice and/or lack of space
• alcohol and drugs
• poor design of premises

“We actually took on board these points and thought about what we could do to try and reduce risks, working with HSE in the process. For example, we created a ‘watchlist’ of patients we were/are dubious about and, in agreement with our GPs, gave them an appointment at the beginning of the session. If necessary, we add in another slot to avoid having them waiting. This also avoided potential conflict with other patients. In another example, where we suspected there were underlying mental health problems we ensured GPs were made aware and we have referred a number for specific treatment.

“There’s definitely a time and a place for removing patients, but we judge everything on a case-by-case basis.”

Unfortunately, abuse is commonplace in practices and is unlikely to go away. And that means supporting staff however you can is of vital importance.

Dr Faisal concludes by saying: “It’s definitely been affecting my staff so I am supporting them now, especially if they are experiencing rude behaviour. We issue a warning letter to patients. If it happens a second time, we remove them. If they use profanities, we remove them. We are taking strong action.

“Doctors are starting to just call the police when a patient is abusive. We’d rather call the police than give them what they want,” he said.

Further reading

Following on from a comment above, a handy reference tool for practices is the specific page on the HSE website dealing with this issue – further information can be found here.

How do you deal with abusive patients? We would love to hear your thoughts, either by commenting below or joining the discussion on the Practice Index Forum thread here.

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