Introduction
The practice has adopted a policy of zero tolerance in relation to violence and verbal abuse against staff
Everyone has a duty to behave in an acceptable and appropriate manner. Staff have a right to work, as patients have a right to be treated, free from fear of assault and abuse in an environment that properly safe and secure.
It is very difficult to provide a comprehensive description of all types of incidents that are covered under this policy, however, examples of the types of behaviour covered are summarised below:
- physical assault
- offensive language, verbal abuse and swearing which prevent staff from doing their job or makes them feel unsafe
- loud and intrusive conversation
- unwanted or abusive remarks
- negative, malicious or stereotypical comments
- invasion of personal space
- brandishing of objects or weapons
- near misses i.e. unsuccessful physical assaults
- offensive gestures
- threats or risk of serious injury to a member of staff, fellow patients or visitors
- bullying, victimisation or intimidation
- stalking
- spitting
- alcohol or drug fuelled abuse
- unreasonable behaviour and non-cooperation such as repeated disregard of surgery opening hours
- Any of the above linked to destruction of or damage to property
It is important to remember that such behaviour can be in person, by telephone, letter or e-mail or other form of communication such as graffiti on NHS property for example.
A range of measures can be taken by the surgery depending on the severity of the incident which may assist in the management of unacceptable behaviour by seeking to reduce the risks and demonstrate acceptable standards of behaviour, these may include:
- verbal warnings
- written warnings
- removal from practice list
- criminal prosecution
Reporting
All physical or non-physical assaults should be reported directly to the appropriate line manager, who will deal with the incident in the first instance. The line manager will inform the practice manager and the incident will be investigated fully. The clinical condition of the assailant will be considered as part of the decision-making process.
The following is a list of possible aggravating factors which should be considered when deciding to report an incident to the police. It is by no means exhaustive:
- the effect on the victim and / or others present
- the assailant’s behaviour is motivated by hostility towards a particular group or individual on the grounds of race, religious belief (or lack of), nationality, gender, sexual orientation, age, disability or political affiliation
- a weapon or object capable of being used as a weapon, is brandish or used to damage property
- the incident was an attempted, incomplete or unsuccessful physical assault
- the incident involves action by more than one assailant
- the incident is not the first to involve the same assailant
- there is an indication that a particular member of staff is being targeted
- there is serious concern that any threats made will be carried out
- there is concern that individual’s behaviour may deteriorate what that NHS organisations should be advised or alerted
Investigation
Following the abuse or assault on a member of staff, the incident must be reported appropriately. In appropriate cases the police must be contacted as soon as reasonably possible and full co-operation must be given to the police in any subsequent investigation
In all instances, regardless of whether or not the police decide to prosecute, the practice considers, in consultation with the relevant staff, what preventative action, if any, should be taken to reduce further or related incidents.
The details of the incident must be recorded on the incident form found on the intranet and passed to the Practice Manager.
The victim of the incident will be informed of the progress of any investigation and action taken and will be offered the full support of the surgery such as counselling or other appropriate support as necessary or desirable in the circumstances.
Thorough investigation will form the basis of any subsequent action. Investigation is essential in order to ensure that contributing factors are identified which will ensure that lessons are learned and vital information utilised for the purposes of preventative action. However, where appropriate, evidence gathered will also ensure that appropriate sanctions are sought.
It is important that each case is judged on its own merits. The sections below outline the options that can be taken in order to effectively tackle assaults, depending on the severity of the incident and aggravating factors.
Outcomes
Verbal Warnings
Verbal warnings are a method of addressing unacceptable behaviour with a view to achieving realistic and workable solutions.
They are not a method of appeasing difficult patients, relatives or visitors in an attempt to modify their behaviour or to punish them, but instead to determine the cause of the behaviour so that the problem can be addressed or the risk of it reoccurring minimised.
It is important that patients, relatives and visitors are dealt with in a demonstrable, fair and objective manner. However, whilst staff have a duty of care, this does not include accepting abusive behaviour. Every attempt should be made to de-escalate a situation that could potentially become abusive. Where de-escalation fails, the patients should be warned of the consequences of future unacceptable behaviour. The incident should also be recorded locally.
Where it is deemed appropriate to approach a patient, relative or visitor in respect of their behaviour, this should (where applicable) be done informally, privately and at a time when all parties involved are composed.
The aim of the verbal warning process is two fold:
- to ascertain the reason for the behaviour as a means of preventing further incidents in reducing the risk of reoccurring.
- to ensure that the patient, relative or visitor is aware of the consequences of further unacceptable behaviour.
A meeting should be arranged and conducted in a fair and objective manner. A formal record should be made and maintained, utilising the surgery’s incident reporting system.
Verbal warnings will not always be appropriate and should only be attempted when it is safe to do so with relevant and appropriate staff present.
Where the process has no effect and unacceptable behaviour continues, alternative action must be considered.
Patient Exclusion
Practices have the right to move from their list, with immediate effect, any patient who has been violent or threatened violence to the GP or member of staff where the incident has been reported to police.
In deciding whether or not to remove a patient from the practice list, GPs should use their clinical judgement to determine if the behaviour was a result of a clinical condition or treatment administered. GPs should exercise their judgement to ensure that the risks identified are balanced against the health care needs of the patient.
In exceptional circumstances it may be appropriate to exclude a patient where the behaviour of other members of the household is considered unacceptable. In such circumstances it may be appropriate for the GPs to terminate responsibility for the entire household.
Any decision to withhold treatment must immediately be notified to the PCT in order to ensure the continued provision of health care for that patient.
Employer’s Legal Responsibilities
Health and Safety at Work etc. Act 1974
Employers must:
- Protect the health and safety at work of their employees, and
- Protect the health and safety of others who might be affected by the practice work activities.
Management of Health and Safety at Work Regulations 1999
Employers must:
- assess all risks to the health and safety of their employees,
- implement the precautions identified in the risk assessment,
- make arrangements for the effective management of precautions,
- appoint competent people to advise them on health and safety,
- provide information and training to employees.
- co-operate and co-ordinate with other employers sharing the same place of work.
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR)
Employers must:
- report all cases in which employees have suffered death or major injury or have been off work or incapacitated for more than three days or more following an assault which has resulted in an injury.
(Normally report completed by the Health & Safety Manager).
Safety Representatives and Safety Committees Regulations 1977, and Health and Safety (Consultation With Employees) Regulations 1996)
Employers must:
- consult with safety representatives and employees on health and safety matters.
The Employment Rights Act 1996
Provides employment protection in connection with health and safety.
Additionally, under the Management of Health and Safety at Work Regulations 1999, (Reg. 12) employees have a duty to report hazards and unsafe working conditions to their employer.