Abuse from patients may be on the rise in general practice, but practices can be proactive about helping reduce its impact on staff. HR expert Liz Willett suggests how

It is no secret that general practice is under pressure with high patient demand and fewer GPs to deliver services.  Inevitably, there are occasions when a patient wants something that can’t be delivered – and sometimes that’s when abusive behaviour starts.  

Practices report that it’s becoming more common for patients to become confrontational or aggressive if their expectations are not met. The trigger may be a receptionist telling a patient that there are no appointments available, or a clinician explaining that they can’t give the care/prescription that’s been requested.

Essentially, staff can find themselves at the wrong end of someone’s bad day for all sorts of reasons. It can be shocking and upsetting to be the target of unwarranted anger, especially when the abuse becomes personal.  And no matter what has prompted the outburst, it’s never ok.

There are times when practice staff will fear for their physical safety. Even when that’s not the case, the impact can be significant. Ultimately, abuse can lead to unhealthy stress levels and may adversely affect mental health. When staff feel that their job is becoming emotionally damaging on a severe scale, they are more likely to take sick leave or even choose to leave their job and general practice altogether.  

Most practices want to do the best by their staff, of course.  But, that aside, there is a legal obligation on practices to manage and protect employees’ health, safety and welfare at work.  This includes their emotional safety. 

So, what steps can practices take in response to rising abuse?  There are three steps to keeping your staff safe:

1. 1. Identify the different causes of stress

The HSE Stress Indicator Tool may be a useful resource to help you. You may also wish to review factors that can indicate stress in the workplace. Typically, these include high levels of absenteeism or turnover.

2. Examine what is currently in place to manage those causes of stress and risks

This will include looking at the systems and policies for dealing with abuse. It should also include assessing whether the technology and equipment staff use adequately supports them in being able to communicate effectively (i.e. are audio and visual systems clear, do the IT systems work properly, can teams access the information they need to deal with patients?)

You’ll also want to consider training.  Assess whether employees have been properly trained to deal with and respond to the issues they are presented with.

3. Put plans for improvement in place

After you’ve gone through these first two steps, you’ve taken stock of the current situation. This next step is about consulting with others on what comes next.  Talk to partners, managers and employees to hear what they think could be improved, and how. 

This might include discussions on what issues or situations can end up with patients being aggressive. If there are common triggers, consider how you might manage those situations differently.  You could also look at other possible mitigating measures such as rotating people between known areas of conflict to ensure that they get meaningful breaks. It’s also important to monitor working hours to ensure that employees are not overworking, since this can affect wellbeing.

As a practice, review whether policies and procedures for dealing with offensive or abusive patients is working. Are they fit for purpose and applied consistently?  Think about how you communicate these policies to patients.  Many GP surgeries record messages on the phone system and display signs in their reception that make clear how they deal with abuse.

Do you train your staff in conflict management? Find out whether people feel their training has been adequate.

You may also wish to review supervision to include wellbeing. If you go down that road, ask supervisors whether they feel able to support the wellbeing of staff.  The introduction of resilience training and mental health first aiders is worth considering.

If necessary, train managers, supervisors and staff in how to identify symptoms of stress.  It’s also important to set up arrangements for individuals to report work-related stress. And, when they do, ensure that action is taken to identify underlying causes and, where possible, removed.

Ensure that employees know what support they can access if they are finding their mental health is suffering. For some practices, it may be worth looking at offering employee benefits such as occupational health or staff support programmes.

What resources are available?

The NHS is recognising the impact that patient abuse and stress can have on staff and has provided resources for practices to access for their employees.  The ‘Looking After You’ programme offers coaching support for those working in primary care specifically around wellbeing issues. You can also find out more about various NHS England health and wellbeing programmes here.

Get in touch with your LMC to find out if there are any initiatives being run locally.  The LMC may be offering programmes that support wellbeing in primary care or be able to signpost you to other available programmes.

Do also contact your HR service for specific support, when needed.

Liz Willett is Head of Business Partnership at  Kraft HR Consulting Ltd , which works closely with practices, federations and PCNs in the Midlands and further afield.

Follow our campaign #KeepYourPracticeSafe to hear more on how practices are tackling abuse in their workplace.