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Practices can deregister patients for ‘unrealistic service demands’

by Caitlin Tilley
23 May 2022

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GP practices can now consider deregistering patients who have ‘unnecessarily persistent or unrealistic service demands that cause disruption’, according to new guidance from NHS England.

Stating that protecting GP teams’ mental health is ‘as important’ as protecting their physical health’, NHS England has updated guidance on managing unacceptable patient behaviours to also include non-violent abuse.

These include patients:

  • Using bad language or swearing at practice staff or other service users;
  • Unnecessarily persistent or unrealistic service demands that cause disruption;
  • Verbal, non-verbal and environmental slights, snubs and insults which communicate hostile, derogatory or negative messages;
  • Behaviours that target a person based on their protected characteristic or belonging to a marginalised group. These can be intentional and unintentional and are based on biases (either conscious and unconscious).

The guidance goes on to say that ‘where a patient has acted inappropriately or unacceptably, the provider will need to carefully consider’ if the incident ‘meets the relevant criteria for removal from the practice patient list’.

In doing so, the practices should take into account ‘the nature and severity of the incident/behaviour, the impact on practice services, staff or other service users and the patient’s own circumstances’, and:

  • If the incident does meet the relevant criteria for removal from the practice patient list a practice will need to decide whether it is ‘nevertheless willing to continue to manage its relationship with the patient or proceed with the removal’.
  • If the incident does not meet the relevant criteria for removal from the practice patient list, the practice will need to decide ‘how it will manage its continuing relationship with the patient’.

NHS England’s guidance added that removing a patient from the practice list is ‘expected to be an exceptional event’.

Urging GP practices to update their policies on unacceptable behaviours, NHS England said it ‘supports and requests that providers practice policies addressing inappropriate and unacceptable patient behaviours also explicitly include positions on not tolerating any form of discrimination, harassment or victimisation’.

Practices advised to review their policies

The Medical Defence Union (MDU) has advised practices to look at their policies on unacceptable patient behaviour to ‘explicitly’ include not tolerating any form of discrimination, harassment or victimisation.

MDU medico-legal adviser Dr Ellie Mein said NHS England’s new guidance will ‘go some way to reassuring practice teams, who have worked so hard at a time of immense pressure, of the situations when action should be taken’.

‘There is increasing evidence that abuse and violence against primary care staff has worsened over the last two years and we support many practices to take action following an incident,’ she added.

‘We encourage GP practices in England to review and update their policies accordingly.’

GPs can also approach their indemnity provider for ‘advice on whether to issue a patient with a warning, instigate an acceptable behaviour agreement or remove a patient from the practice list,’ Dr Mein said.

Earlier this month, a GP practice stopped offering a face-to-face reception to protect staff after they suffered ‘excessive verbal abuse and physical intimidation’ from patients.

And almost one in three GPs and practice staff have been physically abused at work by patients, according to the shocking results of a recent survey.

How to be prepared for aggressive behaviour

If a patient has already shown signs of impatience or more overt aggression prior to a consultation, it’s worth doing a bit of extra preparation before seeing or speaking to them, such as:

  • Check the last few consultation records
  • Read any recent hospital letters, OOH letters, casualty letters
  • Check results of any recent blood work or imaging
  • Also check for alerts warning about aggression or previous violent behaviour or risk of carrying weapons
  • Are there mental health disorders that may increase the risk of aggression, for example antisocial personality disorder?

These checks may help pre-empt the patient’s concerns and create a positive direction to a consultation focused on their goals. If it is flagged that a consultation has the potential to be more problematic and the patient needs to be seen face to face, this can be done with another member of staff as chaperone – either waiting outside the room or, if there are serious concerns, the practice is within its rights to have a chaperone in the consultation room with the clinician.

Source: Pulse Intelligence

To access the full article, How to deal with aggressive patients, see here.

How to deregister abusive patients

If a practice wishes to remove a patient it ‘must normally provide the reason for removal in writing to the patient’. It should also have ‘warned the patient in writing that they are at risk of removal’ within the past 12 months.

However, if an incident was bad enough for practice staff or patients to have ‘feared for their safety’, the patient can be immediately deregistered. These incidents must also be reported to the police.

All patient removals ‘must be recorded by the practice, including the reasons and circumstances of the removal’.

Patients ‘may experience difficulties in registering where they have been removed from a practice list’, however, ‘this should not ordinarily be a factor considered by practices when approached by new patients’ – except on the grounds of ‘violence or threatening behaviour’.

Source: NHS England

A version of this story was initially published on our sister title Pulse.