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Managing patient abuse – how one practice removed its in-person reception

by Beth Gault
20 June 2022

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Abuse in general practice has been on the rise. Almost one third of GPs and practice staff have been physically abused at work by patients, while three quarters of GPs have reported facing increased abuse in the past year, according to two separate studies.

In response, Management in Practice has launched its ‘Keep your Practice Safe’ information campaign. Over the coming months, we will publish case studies, blogs, guides and other resources aimed at providing practical tips and advice to support you and your team. Our aim is to help you manage and head off any abuse or aggression you face in order to keep yourselves protected and patient services running smoothly.

To kickstart the campaign, we spoke to Oakham Medical Practice in Rutland, which, in May, decided the level of abuse it was experiencing was so extreme, the only safe option was to temporarily remove all reception staff from the front desk. This was after staff faced verbal abuse from patients as well as physical intimidation – one patient tried to scale the reception desk.

GP partner at the practice, Dr Adam Crowther, explains here about how the practice made the decision, what practicalities were involved, and whether he would recommend this model to other practices.

Why did you make the decision to remove your in-person reception?

We’d been getting an increasing amount of verbal abuse. One day, a patient seemed to indicate they would jump over our reception desk. We do have protective screens in place but there is one small section that is open, so less protected.  

After this happened, quite a few members of our reception team voiced concerns, effectively saying they didn’t feel safe at work. They’re not security guards – they’re people trying to provide a service for our patients, and they work really hard.

I think general practice staff across the country have been subjected to some unfair criticism recently. A lot of the issues patients have experienced are situational in terms of demand and service provision and staffing.

Our reception team are critically important to us being able to maintain services, we’re very much a team as far as I’m concerned. So, by taking action that protects our staff and removing them from the front desk, we’ve also protected the majority of services for patients.

But the abuse is getting so extreme that some staff don’t want to do the job anymore, and that’s a big threat – perhaps the biggest threat – to patient care.

We hoped this temporary measure would be a bit of a reset for patients and staff, and that reception staff might feel comfortable enough to check in patients again after this period.

How did you switch to a remote reception?

Patients could already contact the surgery and book in for an appointment using our telephone and online services. We also already had check-in screens in our foyer, for patients to use when arriving for their appointments. So, although we closed our front desk, there are other ways for patients to access appointments, or notify us when they are at the practice.

Generally, we have good online access anyway – more than 50% of our patients used online services in some way beforehand. Having that technology already established made it easier for us to remove face-to-face reception services for a period of time.

To let patients know about the change and explain the reason for it, there are signs on our front the door and we have posted about it on our website.

We also posted about it on social media platforms and take the opportunity to chat and explain about it to patients when we can. We had local media coverage too, which again helped spread the word.

It was a difficult decision to make, but I’m sure we won’t be the only practice to do this.

How has the model been received?  

Our patients have adapted well. While we get the odd grumble as you might expect, the vast majority of patients are very supportive. In most cases, there’s no need for a face-to-face reception service. Ultimately, they’ve found another way to access services.

In some regards, not having someone on reception has freed up staff to take more calls. We’ve found that more people are able to get through on the telephones and speak to someone and the system has become more efficient because of it.

Staff have felt more comfortable and less threatened doing their jobs. They no longer feel as vulnerable or as fearful as they did when on the reception desk facing abuse from someone in front of them. Unfortunately, they do still experience some abuse on the telephones, as they always have done, but the threat isn’t physical.

Do you think you’ll continue this arrangement or go back to face-to-face?

In two weeks’ time we’ll decide whether to extend this remote model for another short period of time or to phase face-to-face reception back in. Ultimately, it will be the reception staff’s decision. If they say they don’t feel safe, then we have to listen to that.

If we do phase the reception back in, it will be for a trial period and only during quieter times of the day when it feels a little safer.  It’ll be a gradual process because we don’t want to expose the team to danger again too soon. We don’t want people to feel threatened at work or feel like they can’t come to work.

Would you recommend remote receptions to practices who are in similar situations?

I’d always recommend for practices to listen to their staff, and to implement measures that maintain and protect their practice and services for the majority of patients.

If physical threat is a fear, then yes absolutely, I’d say halt face-to-face reception.

Are there any lessons you’ve learned?

It’s important to know the value of your team and understand and respect your staff. We have to protect them. Patients will adapt to whatever arrangements you provide, but without reception staff, patients can’t access anything. 

If you would like to get more involved in our Keeping our Practice Safe campaign, express a view, share an experience or write a blog/other article on the subject, please get in touch with editor Rima Evans.