Managing patient abuse – tips from affected practices

Surgeries that have suffered patient abuse first hand describe some of the changes they made that have led to a reduction in incidents and staff feeling safer. Katherine Price reports

On top of rising workloads, GP practices have been having to manage an alarming rise in patient abuse in recent years. According to a survey earlier this year, three quarters of GPs and their staff now experience verbal abuse from patients on a weekly basis, incidents which can have a long-lasting impact on practice staff.

As part of Management in Practice’s ‘Keep your Practice Safe’ campaign, here are five measures affected practices have adopted to reduce incidents and protect their teams:

Encourage feedback and respond to it

Following a spike in patient aggression and intimidation during the Covid-19 pandemic, Petworth Surgery in West Sussex put feedback forms at the front desk and in prescription bags. Feedback is then discussed at weekly team meetings and has allowed the surgery to proactively identify and eliminate sources of patient frustration. This has included making changes to the telephone systems, so patients have a better idea of how long they’re likely to be waiting in a queue when they call in. If they leave contact details with their feedback, a team member will respond with information on measures being implemented or planned to address the issues raised.

Operations lead Samuel Butler says he will also use the opportunity to share data with patients on the challenges the team is facing. ‘If they waited a long time on the phone then I will include on the response data such as how many calls we had that day, or if we had any staffing issues that day,’ he explains.

Record your calls

Petworth Surgery has also started recording its telephone calls. If a member of staff reports a patient has been abusive over the phone, management will listen to the recording and investigate the patient’s history. The patient may then be invited to come into the surgery to listen to the recording themselves and discuss their behaviour.

‘Obviously, we do have to have an awareness of mental health and a certain amount of tolerance,’ says Mr Butler.

‘We would look at it on a case-by-case basis and only if appropriate and there really was no reasonable excuse then we would contact the patient and remind them we’ve got a zero-tolerance policy, and that it may result in them being deducted if we saw behaviours like that again.’

Although no patients have yet taken the practice up on this offer to hear their recording, Mr Butler says there has subsequently been no repeat of bad behaviours from the individuals concerned and incidents of abuse are very rare now. ‘It got the message across,’ he says.

‘We’ve seen a real improvement… patients know we’re not going to tolerate it. I think patients are learning that it’s not going to get them anywhere.’

Although investigating incidents thoroughly can be time-consuming, he says it’s worth the investment to develop a culture where both sides feel listened to and supported, and individuals are given the opportunity to learn or change.

Engage with the community

Some receptionists at the Haxby Group, which runs 13 GP surgeries across York, Scarborough and Hull serving more than 92,000 patients, have been abused to the point of tears and the inability to continue their shifts. Professor Mike Holmes, a GP partner, recalls one occasion where a receptionist was called ‘a worthless person’.

This has resulted in staff not wanting to work on certain sites, compounding the problem, and the group has had to reduce the opening hours at its Old Forge Surgery in the village of Upper Poppleton, York, while it tries to recruit more staff.

The Old Forge surgery took part in a public meeting hosted by the Upper Poppleton parish council in January which was attended by 250 people. Professor Holmes attended the meeting along with a partner, pharmacist and practice manager from the group, which gave them the opportunity to address patient concerns, with questions submitted in advance and time allocated for a Q&A.

‘We were a little bit uncertain as to whether that was the right thing to do, but although the meeting in and of itself was quite challenging, we aired the problems, we were very transparent about what was going on,’ says Professor Holmes.

‘We’re trying to deliver a service within the resource envelope that we have and we’re on the side of patients trying to make it as good as it can be within that. Having the ability to explain that was very good. You could be forgiven for assuming people recognise that, but I don’t think that’s necessarily always the case.’

He adds: ‘There was some uncomfortable communication from patients to us about the service and there was some uncomfortable communication from us to the patients about behaviours and the way receptionists were treated. But that mutual understanding has improved things.’

There has subsequently been support from the village to try and address the workforce issues and the practice has been able to put a plan in place aiming to return to its full opening hours within the next six months.

Several of the practices Management in Practice spoke to said that similarly speaking out about abusive incidents on social media and in the local press had helped raise awareness of the challenges GP practices are dealing with. Although, Professor Holmes advised caution on deciding when to engage with the media and did not advise inviting press into meetings where open, honest conversations are needed between service users and deliverers.

These measures haven’t completely eradicated abusive incidents, he says, but they have helped reduce them, meaning staff are more comfortable coming to work, and are doing a better job as a result. The group’s recruitment situation has also improved with more applications coming through.

‘We’re optimistic that will continue to improve. The dialogue between ourselves and the population is more open and transparent. That’s probably the biggest lesson here – don’t be afraid to have those conversations, be open and transparent and work together with the population,’ he adds.

Invest in increased security

At the end of last year, Wilson Street Surgery in Derby experienced four incidents in four weeks in which staff triggered the practice’s alarm system due to patient verbal aggression or threats of physical violence, including one where a patient trashed the waiting room.

‘For our staff to come into a place of work and face that level of violence is difficult to bear. Subsequently staff had really struggled to manage that psychological impact and the anxiety,’ says GP partner Dr Shehla Imtiaz-Umer.

As a result, the practice has invested in additional security measures that have helped staff feel safer. Covid screens at reception have been kept in place to provide an additional physical barrier between receptionists and patients, and the surgery has invested in personal alarms for staff as well as in additional CCTV and lighting around the building. The ICB and NHS England have contributed funds to help mitigate the financial impact this has had on the practice.

Although Dr Imtiaz-Umer says having to divert funds towards security measures is not ideal, amid a retention and recruitment crisis, the practice can’t afford for staff to leave because they feel threatened doing their job.

‘The staff are happier and more confident; they have got that physical safety but also that element of psychological safety as well. The positive outcome is that there haven’t been any further incidents,’ she adds.

Establish clear emergency protocols

Wilson Street Surgery has also reinforced its ‘lockdown’ policy so if further incidents occur, all members of the team know the routine and protocols. Like a fire drill, they have practised and are clear on where to go and how to secure the premises as well as ensure the safety of any patients onsite should the alarm be triggered. Dr Imtiaz-Umer explains that it pays to make sure staff don’t panic in the event of an emergency but are instead well-versed in how to manage the situation.

‘The staff do feel it’s provided an element of psychological safety in that they know what measures are in place should that kind of situation arise again. Thankfully, we’ve not had anything like that happen again,’ she says.