Zero tolerance policy

1. Aims of the policy

To inform the public that violence against staff working in the NHS is unacceptable
To inform all staff that violence and intimidation is unacceptable and is being tackled

This protocol is relevant to all people who interact with Hall Green Health.

General practitioners (GPs) and their staff come into contact with patients who may be abusive, difficult or violent in the course of their work.
Such behaviour is unacceptable and should not be tolerated. As an employer, the practice has a duty to care for the health and safety of its staff therefore; the Practice has a policy of “zero tolerance” of verbal and physical violence towards GP’s, staff and patients.
The NHS Zero Tolerance Zone is a nation-wide campaign to tackle violence against all members of staff working in the NHS. In particular, community based members of staff.
Patients are asked to be considerate and act reasonably. We expect all patients to be responsible and avoid attending the surgery under the influence of alcohol or illegal drugs. Any alteration of prescriptions is illegal and will not be tolerated.

Abusive and threatening language
Aggressive and threatening behaviour
Excessive demands made on the services provided by GPs and their staff
Generally uncooperative behaviour, e.g. persistent failure to attend appointments
Vexatious behaviour, eg a patient who continually makes complaints without justification
Violent patients or potentially violent patients present a more serious risk and the role of the NHS England Area Team is to ensure that alternative service options are in place to minimise any risk to GPs and their staff.
The guidance defines violence as: “Any incident where staff are abused, threatened or assaulted in circumstances related to their work, involving explicit or implicit challenge to their safety, well-being or health”- European commission DG-V 1997

The police will be called if the patient is posing a threat to staff or other patients.
A written record will be made of what has occurred.
- When recording such events it should be borne in mind that patient notes may be forwarded to other practices and may also be requested by the patient themselves.
- The recorded notes should use standard descriptions where appropriate and avoid emotive language.
The incident should be reviewed as part of determining the practice’s response. In particular the following should be taken into consideration:
- Was the patient’s behaviour the result of a medical condition
- Was the patient’s behaviour possibly due to underlying physical causes
- Was the patient’s behaviour influenced by environmental factors in the surgery
- Was this incident part of a pattern of persistent or regular inappropriate behaviour
Following an incident of abusive or difficult behaviour the practice may wish to consider the following options prior to taking more permanent action such as removal from the practice list:
- Undertaking a conciliation process with the patient. This is not intended to appease difficult patients but to ensure that incidents are dealt with in a fair and balanced way after proper investigations and consideration of the facts
- Writing a formal warning letter stating that such behaviour will not be tolerated and that any future occurrence may result in removal from the practice list.

A patient will be warned that they are at risk of removal and will be given an explanation of the reasons for this.
A permanent record of the warning, including the date and reason for the warning, will be made and retained.

A good patient-doctor relationship, based on mutual respect and trust, is the cornerstone of good patient care.
The removal of patients from this practice list is an exceptional and rare event and is a last resort in an impaired patient-practice relationship.
When trust has irretrievably broken down, it is in the patient’s interest, just as much as that of the practice, that they should find a new practice.
GP practices have the right to remove a patient from their list for abusive and difficult behaviour.
This may be an entirely appropriate response following either a single incident of sufficient magnitude to require an immediate response or following a pattern of behaviour, where the patient has been provided with a written warning during the past 12 months.
If practices wish to remove a patient from the list they are responsible for informing NHS England Area Team and providing further details on the incident concerned.
The NHS England Area Team should also be informed of any violent incidents which occur in HGH.

The Practice will take steps to contact the patient to inform them of the action being taken.
The patient will be informed in writing to their home address.
Although the General Practitioner is not obliged to give a reason it is the policy of this practice to inform the patient why they have been removed from the list.

In rare cases, however, because of the possible need to visit patients at home it may be necessary to terminate responsibility for other members of the family or the entire household.
The prospect of visiting patients where a relative who is no longer a patient of the practice by virtue of their unacceptable behaviour resides, or being regularly confronted by the removed patient, may make it too difficult for the practice to continue to look after the whole family.
This is particularly likely where the patient has been removed because of violence or threatening behaviour and keeping the other family members could put doctors or their staff at risk.

All staff are potentially at risk of violence during the course of their work. It is recognised, that because of the nature of the work in which they are engaged, certain staff groups are more likely to be exposed to violence than others.
Consequently, a range of education and training interventions are available and managers will determine the appropriate level of training for individuals or groups of staff.

The Department of Health issued HSC 1999/226 “Campaign to stop violence against staff working in the NHS: NHS zero tolerance zone” and HSC 2000/001 “Tackling violence towards GPs and their staff; The NHS (Choice of Medical Practitioner) Amendment Regulations 1999”.
This guidance stated that professionals and staff working in the health service would no longer tolerate aggression, violence and threatening behaviour by the public.

This policy is in line with current legislation at the time of writing and is subject to periodic review.
In the event of any incident linked to this policy; findings of an audit that identifies a gap or a need for a review or a change of legislation impacting on this policy, the policy will be updated and will supersede this policy.