INTRODUCTION

The purpose of this policy is to address instances of unacceptable behaviour which may cause harm or the fear of harm to any person within the Practice. The scope of this policy is therefore: Instances of physical or verbal violence or aggression committed by: -

 

• Any person, whether patient, visitor or any other person working within the Practice.

 

• Any patient, visitor, or other person working within the Practice.

 

DEFINITION

Violence and aggression are defined as: -

 

• Violence is the use of force against a person and has the same definition as “assault” in law (i.e. an attempt, offer or application of force against the person). This would cover any person unlawfully touching any other person forcefully, spitting at another person, raising fists or feet, or verbally threatening to strike or otherwise apply force to any person.
• Aggression is regarded as threatening or abusive language or gestures, sexual gestures, or behaviour, derogatory sexual or racial remarks, shouting at any person or applying force to any Practice property or the personal property of any person on the Practice. This would also include people banging on desks or counters or shouting in an intimidating manner.

 

This policy applies throughout the premises, including any car park and grounds. It also applies to any employee or partner away from the Practice but only in so far as it relates to the business of the Practice.

 

RESPONSIBILITIES

• Employees have the responsibility to ensure their own safety and that of their colleagues at work. It is essential, therefore, that the practice team is familiar with Practice policies and procedures, equipment and precautions adopted to combat the risk of physical and verbal abuse.
• Familiarise themselves with Practices policies and procedures, guidelines, and instructions.
• Use any equipment or devices provided for ‘at risk’ situations i.e. alarms.
• Participate in relevant training made available by the Practice.
• Report all incidents of physical and verbal abuse (threatened or actual).
• Record details of incidents in compliance with Practice procedures.
• Contribute towards reviews by nominated managers concerning any incidents in which they have been involved.
• Suggest precautionary measures involving changes in the layout of the work environment that can reduce risk where appropriate.
• Make use of any available staff support and counselling through the practice.
• Advise the practice manager/line manager of any perceived risks involved in work activities.

 

Practice Responsibilities

• Carry out Risk Assessments to assess and review the duties of the practice team, identifying any ‘at risk’ situations and taking appropriate steps to reduce or remove the risk to employees.
• Assess and review the duties of employees, identifying any ‘at risk’ situations and taking appropriate steps to reduce or remove risk to employees particularly if they are working alone.
• Assess and review the layout of premises to reduce the risk to employees.
• Assess and review the provision of personal safety equipment i.e. alarms.
• Develop Practice policies, procedures, and guidelines for dealing with physical and verbal abuse.

• Provide support and counselling for victims or refer to suitably qualified health professionals.

• Make employees aware of risks and ensure employee involvement in suitable training courses.
• Record any incidents and take any remedial action to ensure similar incidents are prevented.

 

If violence and aggression is encountered, the process should be as follows.

• Patient presents at GP Practice where an incident takes place. The GP Practice should call the Police and obtain a police incident number if the incident is of a violent or threatening nature.
• If the patient is referred on to the scheme, the GP contacts PCSE directly on 0333 014 2884 email: immediateremovals@nhs.net for immediate removal of patient and completes the incident/patient removal request report.
• PCSE remove the patient from the list and the patient is registered with PDS Medical who will arrange for the patient to be allocated to another GP within 24 hours.
• PDS Medical contact PCSE to inform them of which GP and Practice location the patient will be seen at and PCSE issue a letter to the patient with appointment details/arrangements. The removal will take place on the same day of the removal request (unless the removal request is received after 3pm).
• PDS Medical will contact the patient directly and liaise with Northern Security Services and the CSU Local Security Management Team, to ensure that security arrangements are in place for the new GP appointment.
• The CSU Local Security Management Team will provide support to PDS Medical with difficult patients who do not conform to expected standards of behaviour.
• If the patient continues to visit the surgery where they have been removed from, please contact PDS Medical on 01253 955 213 or email pdsmedical@nhs.net.
• Please note that the PDS Medical LTD telephone number 01253 955 213 should not be given out to patients.
• All patients that need to contact PDS Medical Ltd directly should ring 0300 123 7799.

 

If the incident is not of a violent/threatening nature, the CSU Local Security Management Specialist will review the GP/Practice Manager and whether the patient meets the criteria for the Zero Tolerance Scheme or not. The email contact address is lcsu.zerotolerance@nhs.net

• In all cases of zero tolerance a significant event report should be completed by all staff members involved. It should detail chronological order what has taken place and the exact words used, this should be completed prior to the staff member leaving the building at the end of their working day.
• For police involvement add major alert to patients records – stating “zero tolerance incident” and the date of incident – add initials of person recording. When selecting how the alert message appears choose “allow this warning to be shared with other agencies”
• It is the policy to press for charges against any person who damages or steals Practice property or assaults any member of staff or visitor/patient.

 

 

Any employee or patient/visitor who receives any injury, no matter how small, should be the subject of an entry in both the accident and significant event report and should always be strongly advised to be examined by a doctor or nurse before they leave the premises.

Every violent incident involving staff will be reasonably supported by the provision of medical or other treatment as necessary and all incidents should be brought to the attention of a member of the management team immediately if not already involved in the incident.

The Partners re-affirm their commitment to do everything possible to protect staff, patients, and visitors from unacceptable behaviour and their zero tolerance of any incident that causes hurt, alarm damage or distress.

 

SUPPORT FOR EMPLOYEES SUBJECTED TO ABUSE

 

The practice takes a serious view of any incidents of physical and verbal abuse against its the practice team and will support them if assaulted, threatened, or harassed.

All threats or aggressive behaviour will be taken seriously whether made in person, by phone, by email or by social media.

The first concern of managers after an incident is to provide appropriate debriefing and counselling for affected employees. Depending on the severity of the incident this counselling may be undertaken by trained professionals.

The partners and managers will assist victims of violence with the completion of the formal record of the incident and where appropriate will report the incident to the police.

In the event of serious physical and verbal abuse patients will be removed from the practice list

 

CHALLENGING BEHAVIOUR

 

Where a practice identifies a patient with challenging behaviour this does not necessarily warrant the patient being placed under the Zero Tolerance Scheme however support can be obtained from the Medical Team at NHS England, they will provide guidance on managing these patients in relation to possible risk assessments and corresponding with patients.

 

If appropriate any person making threats should be warned that their behaviour is unacceptable where the circumstances are appropriate to do this. If this is done face to face, ensure two members of staff are in the room and that all details of the events are documented in the patient’s medical records in case of repeated incidents.

 

The same applies for abusive comments, doctors have a duty of care to all their patients but should not have to put up with abusive comments in any shape or form.

 

If a patient makes a racist or abusive comment about a staff member, that staff member should ideally inform the patient they find the comment offensive if this does not compromise their safety. If a patient continues to be racist or abusive despite being warned a patient can be removed under the “seven-day rule” whereby NHS England have a responsibility to find an alternative GP practice within seven days as there would a break down in doctor patient relationship.

 

Should there be a threat to physical safety or extreme behaviour the practice may remove a patient with immediate effect if there is police involvement on the same day. That is the incident, police involvement including a crime reference number and the reporting to NHSE all needs to occur on the same day. The patients will be transferred to a practice that offers the violent patient scheme a directed enhanced service in England that provides medical care to violent or aggressive patients for at least 12 months.

 

NHS England has a responsibility to notify ICB of all incidents reported to or investigated by the police. This is under Regulation 18(2) on the CQC website, where the notification form is also available.

 

 

REMOVAL OF PATIENTS UNDER ZERO TOLERANCE

Removal of patients under Zero Tolerance need to be done using the PCSE website.

 

NHS ENGLAND NORTHWEST CONTACT DETAILS

england.businessoffice@nhs.net

 

Acknowledgement

With grateful thanks to our Patient Participation Group (PPG) members for their help in the production of this policy.

 

 

 

APPENDIX 1

 

POSTER

 

 

OUR PRACTICE STAFF ARE HERE TO HELP YOU.

OUR AIM IS TO BE AS POLITE AND HELPFUL AS POSSIBLE TO ALL PATIENTS AND VISITORS.

 

IF YOU CONSIDER THAT YOU HAVE BEEN TREATED UNFAIRLY OR INAPPROPRIATELY, PLEASE ASK THE RECEPTION STAFF TO CONTACT A MEMBER OF THE MANAGEMENT TEAM, WHO WILL BE HAPPY TO ADDRESS YOUR CONCERNS.

 

HOWEVER, SHOUTING AND SWEARING AT PRACTICE STAFF WILL NOT BE TOLERATED UNDER ANY CIRCUMSTANCES AND PATIENTS WHO ARE ABUSIVE MAY BE REMOVED FROM THE PATIENT LIST.

 

PLEASE HELP US TO HELP YOU.

THANK YOU.