As part of our Keep Your Practice Safe campaign, Management in Practice chatted to a practice manager of a surgery that has lost eight staff members due to high levels of abuse. Blake Foster, practice manager at Chapelgreen practice in Sheffield, explains how they’re tackling the issue.

How have you experienced patient abuse within the practice?

There’s been a high level of abuse and intolerance for several months. The face-to-face aggression was certainly at its worst a few months ago, but it hasn’t gone away – the pattern continues in peaks and troughs. On social media, though, there is a sustained level of aggression.

Generally, there is a high level of demand and expectation and an unwillingness to wait. People want everything now and, on their terms, and we just can’t deliver that. It tends to worsen after media coverage where a negative opinion has been shared on general practice or the NHS, perhaps by politicians.  That seems to ignite the flame and make the abuse worse.

In terms of face-to-face and verbal abuse, that’s mainly directed at the receptionists. The social media aggression is towards me as the practice manager.

What was the latest situation where you faced abuse in the practice?

One of the most recent was a patient who was an alcoholic. She’d had multiple consultations throughout the week, so access wasn’t a problem for her. But she wasn’t getting what she wanted in consultations.

She became verbally aggressive and swore at one of our GPs. And because she had breached our unacceptable behaviour policy, she was told to find another GP. After that, she rang up the practice and threatened to attack the deputy manager.

On that occasion, the police were called and we locked down the building, only admitting people who had appointments. But there’s only so much you can do.

Have you ever had to call the police before that?

Yes, several times. We’ve had patients refuse to leave the building unless they get what they want. We deal with it by trying to de-escalate the situation then, if that doesn’t work, we call the police.

There have also been occasions when we’ve had significant threats of violence both to individuals as well as damage to the property. In those circumstances, we have to call the police.

How has Covid impacted the levels of patient abuse?

The complaints have always been there, but Covid has seen it worsen and expand.  It’s as if there’s no memory of what the system was like before.

We’re still operating a system that is largely based around urgent care, which means patients have a consultation on the same day. Some people are upset about this. But if they cast their minds back, in pre-Covid times, we similarly only dealt with a small number of people on the day. Patients had to wait three weeks for a routine appointment.

What have you put in place within the practice to deal with abuse and encourage better behaviour?

We have upped our communication with patients.  We put lots of information out to patients via social media and our website.  Our GP partners have recorded videos telling them of the pressure we’re under and what we’re trying to do. We back it up with stats, for example, we share the number of appointments we have each day as well as the volume of calls we deal with on a daily basis. But patients have accused us of making this up.

To help address patient frustration, we’re constantly trying to tweak the appointment system. Rather than restricting our service to what we can deliver, we adjust the system to make it more aligned with what patients want.  

Staffing shortages makes it more challenging for us to meet patient expectations so we’re constantly recruiting additional staff. But as quickly as we’re training them, they’re then leaving because of the aggression they face from patients.

How many staff have you lost because of patient abuse?  

I’ve currently got eight members of staff in probationary periods, so it’s at least eight in the last six months.

It’s generally administrators and receptionists who face aggression and they don’t get paid enough to deal with this kind of thing, so they leave.  And they become increasingly difficult to replace. These staff members are usually from the local population and, when they see the abuse on social media, they think: ‘Why would I go for a job there?’ So, we’re trying to hire new members of staff from a shrinking pool of people.

Did a zero-tolerance policy help the situation?

It helped for a short time, but then levels of abuse went back up again.  Sometimes our efforts to address the problem have backfired because there’s a level of cruelty on social media. We might post something to explain the pressure we’re under – to try and get a bit of empathy – and people respond with laughing emojis. It feels like an endless battle sometimes.

How do you try and look after staff who experience this day-to-day?

We try to demonstrate to staff that we’re supportive of them and that we will do what we can to protect them both physically and emotionally.

Emotional assistance can feel difficult because obviously I’m not a counsellor. So, we’ve invested in Employee Assistance Programmes to give staff the support they might need.  We’re also investing in more training, which will hopefully give staff stronger skill sets to deal with situations and how they respond.  

In terms of physical protection, we make sure we call the police when it’s necessary and lock the building down. We try to provide as much physical protection as possible but we are limited because, unlike in hospitals, we don’t have security officers in general practice. We’ve recently invested in security cameras to provide a deterrent, but the impact has been limited.

We’re also constantly trying to increase staff numbers. That helps share the burden of a public-facing role and it also improves the service.

What can be done about it?

We need to educate people to reset their expectations of general practice.

The public are directed to general practice all the time. They’re told that if they’re unsure about this or that, seek advice from your GP – and that can be for absolutely anything. In an ideal world, that is the right course of action. The trouble is, we don’t have the capacity to see everyone on the same day, and urgent patients need to be prioritised.

It would also be helpful if people had a greater awareness of the various clinicians in general practice. Primary care is changing and we have a multitude of different roles now. But some patients are unwilling to see them because they’ve been told they’re supposed to see their GP.

The upshot is that the public need to know what the general practice service actually is – and what it’s not.