GP practices report dealing with an increasing level of abuse from patients. Staff have been facing aggressive behaviour and threats over the phone, in person, and even on social media. This week, a practice in Bristol was vandalised with foul ‘anti-GP’ graffiti, leading to calls for more public support for general practice. 

We spoke to two practice managers about how their practices have been impacted and what their response has been.

Hafiza Bhabha, practice manager at Petworth Surgery, West Sussex

Patients have directed ‘aggressive tones and swearing’ towards the practice team

The practice would typically get a complaint about something once every two or three months, Ms Bhabha says, but since Covid-19 they have been hearing a lot more from patients who are being more ‘direct’ in expressing their frustrations. 

This includes ‘aggressive tones and swearing’ aimed at staff, for example, from patients who are upset about not being able to see a particular GP, or finding they are not eligible for a priority flu vaccination.

‘It’s evident that some people haven’t either absorbed the information they’ve got, or it’s been quite unclear or confusing.

‘Some patients aged between 50-64 weren’t aware that we didn’t have their vaccine yet, and that, in any case, we have been instructed to wait until their [cohort is included]. A lot of people mistakenly think they are in an at-risk group or that they are shielding, when they are actually quite healthy.’

One patient called to accuse the practice of being closed – quoting a Twitter post from a local MP that claimed that GPs were being ‘ordered’ to give patients face-to-face appointments. The letter in question, from NHS England, ‘reminding’ practices to do so, has caused outrage within the sector.

The patient was ‘forceful’ in arguing that the practice was not seeing patients, despite the fact it had been doing so, says Ms Bhabha.

A lack of information for patients or misleading headlines may be a contributing factor in this problem, she suggests. ‘Some patients are completely unaware of how things are working and why we’re needing to implement changes. Patient engagement has been difficult, because of the increasingly unfair or unclear headlines. I feel general practice could do with more support when it comes to local and national papers, and that would really help us.’

How the practice has responded: 

The practice has recently used social media to reiterate to patients that it has ‘zero tolerance towards violent, threatening or abusive behaviour’, explaining that those who act in this way will be asked to leave the building or that the police may be called, and that they could be removed from the practice’s list. 

Ms Bhabha says: ‘It’s a reminder to patients that we’re not here to be spoken to that way. We had an apprentice join us, straight from school, a few weeks ago, and he got sworn at. My main aim was to show that is not something we accept, and that we support staff, which is important if we want to retain good personnel.’ 

In response to reports in the press that GP practices have been ‘closed’, Ms Bhabha created a poster describing what her practice has been doing over the past few months. This was shared on social media and the practice’s website, and picked up as a story by the local paper. She says this generated lots of positive comments from patients, including expressions of support and gratitude.

Blake Foster, practice manager at Chapelgreen Practice, Sheffield

Recent months have seen an increase in negative attitudes from patients

Mr Foster says that patients were generally ‘very supportive and accepting’ of the changes that the practice had to make during the early stages of the pandemic. People who would usually be averse to communicating through technology, were happy to do so. 

‘Then, as lockdown eased, we found that with the increase in demand came an increase in negative attitude. We have had periods in the past where it was similar, but now it feels more aggressive. I don’t know whether some of it is down to people now releasing their anxieties about the situation.’ 

Some of the swearing and abuse has been directed at receptionists over the phone, while Mr Foster says he is the person usually named and facing the behaviour on social media – with threads started by patients, and even by people not on the practice list, who seem to want to start trouble. 

The situation is ‘very difficult to address,’ he says. In some cases, patients who stand up for the practice online have found themselves also being victimised by the abuse, he adds.

According to Cogora’s latest annual primary care survey, more practice managers have experienced abuse from patients than any other primary care professionals.

With the practice’s telephone lines incredibly busy over the last few months, Mr Foster says this impacted the practice’s ability to consistently answer the phones in a timely fashion, along with the fact that some staff occasionally have to isolate. The practice has also found that the average call length has increased dramatically over this period. 

Some patients have reacted angrily to being made to wait, with patients ‘leading the call by attacking the practice or receptionist before even dealing with the issue that they actually rang up for,’ Mr Foster says.

‘We’ve also had people that have been aggressive at the front door, as well demanding to come in without face masks, and not accepting why the rules are there.’ 

How the practice has responded: 

The practice has changed the settings on the telephone system, so that instead of having an unlimited queue, as it did pre-Covid, patients hear an engaged tone after a certain amount of waiting. Mr Foster says the practice is also recruiting additional call handlers, and has put in a new policy, which would see staff moved across from admin duties and onto the phone if receptionists are forced to isolate. 

The practice also asked its patient group for support, Mr Foster says. ‘One member very helpfully suggested that we record a video diary [to post on social media], as some people may not be interested in reading our messages.’ 

This will provide an inside look into the practice, and will include one that explains how it is dealing with the pandemic, he explains. He says he hopes ‘getting the message out there’ will lead to a ‘shift’ in behaviour. 

The practice has also posted its zero tolerance policy on social media and on its website, and has printed it on posters that are displayed on the practice’s front door. 

‘And of course,’ Mr Foster says, ‘when matters are brought to my attention by members of staff, then patients are written to directly.’

He argues: ‘Overall, I think there just needs to be a change in terms of the support that is given to general practice, and even to some degree, the attitude in the health sector towards general practice. 

‘The NHS is supposed to have a zero tolerance policy on unacceptable behaviour – but that should be a given. I don’t believe that we are encouraged to enforce that.’