Violence, Abuse & Unacceptable Behaviour
Parklands Surgery aims to provide the best possible health care for our patients. However, there may be circumstances when it would be considered reasonable, or in the best interests of the patient, to remove them from our practice list. The purpose of this policy, therefore, is to define the practice guidelines for when it is reasonable to remove a patient for unacceptable behaviour.
We ensure that any concerns about removing patients from our list are dealt with fairly.
The practice supports the Government’s Zero Tolerance Campaign in relation to violence and abuse. The staff and GPs at the surgery have the right to care for others without the fear of being attacked or abused (verbally as well as physically). Violent patients can be reported to the police and offending patients will be removed from the GPs list. We ask that you treat your GP and practice staff without any verbal abuse, intimidation or violence. Situations which justify removal:
When a patient:-
• Is physically violent or threatening towards a doctor, practice staff or other patients on the practice premises. This may include, but is not limited to, swearing, throwing objects, spitting, threatening behaviour, being rude, raising voice, shouting or raising one’s voice beyond reasonable levels, sarcasm, pointing fingers aggressively, Intimidating staff or repeatedly insisting points being made for argumentative purposes, any mention or display of any object that could be used as a weapon. This may be via any forms of communication e.g. face to face/telephone, email or letter.
• Causes physical damage to practice premises or other patient’s property.
• Gives verbal abuse or makes threats towards the doctor, practice staff or other patients.
• Gives racist abuse, orally or physically.
• Is violent or uses or condones threatening behaviour to doctors (or some other members of the primary health care team) while visiting the patient’s home. Such behaviour may involve the patient, a relative, a household member, or pets (such as unchained dogs).
Irretrievable Breakdown of the Doctor-Patient Relationship
• Where a patient’s behaviour falls outside that which is normally considered reasonable and leads to an irretrievable breakdown of the doctor-patient relationship. This includes where a patient:-
• Fraudulently obtains drugs for non-medical reasons.
• Deliberately lies to the doctor or other member of the primary/secondary health care team (e.g. by giving a false name or false medical history) in order to obtain a service or benefit by deception.
• Attempts to use the doctor to conceal or aid any criminal activity.
• Steals from practice premises.
Guidance on removing patients due to irretrievable breakdown of the doctor-patient relationship
Occasionally patients persistently act inconsiderately and their behaviour falls outside that which is normally considered to be reasonable. In such circumstances there may be a complete breakdown in the doctor-patient relationship.
The patient will be warned verbally or in writing that they are at risk of removal from the practice. Should the patient not heed the verbal or written warning then they may be removed from the practice list.
However no warning is required if:
• The practice has reasonable grounds for believing that the issue of such a warning would be harmful to the physical or mental health of the patient
• The practice has reasonable grounds for believing that the issue of such a warning would put at risk the safety of members of the practice or those entitled to be on the practice premises
• It is, in the opinion of the contractor, not otherwise reasonable or practical for a warning to be given.
• If no reason is given an explanation in writing should be made and retained for potential future inspection by the PCO or NHS England.
When a decision is made to remove a patient from the practice list, the removal may well be extended to other members of the family or household i.e. if the patient is deemed violent and we worry for the staff’s safety, or the named responsible person for children is deregistered. The practice manager or GP Partner will write to the family / household offering an explanation for the removal. They will be allowed 4 weeks to re-register rather than being removed from the practice list immediately.