Introduction

The purpose of this policy is to address instances of unacceptable behaviour which may cause harm or the fear of harm to any person within the Practice. The scope of this policy is therefore:

• Instances of violence or aggression committed by any person, whether patient, visitor or any other person working within the Practice against any patient, visitor, or other person working within the Practice.

 

Definition

Violence and aggression are defined as:

• Violence is the use of force against a person and has the same definition as “assault” in law (i.e. an attempt, offer or application of force against the person). This would cover any person unlawfully touching any other person forcefully, spitting at another person, raising fists or feet or verbally threatening to strike or otherwise apply force to any person.
• Aggression is regarded as threatening or abusive language or gestures, sexual gestures or behaviour, derogatory sexual or racial remarks, shouting at any person or applying force to any practice property or the personal property of any person on the Practice. This would cover people banging on desks or counters or shouting loudly in an intimidating manner.

This policy applies throughout the premises, including the forecourt and grounds. It also applies to any employee or partner away from the Practice but only in so far as it relates to the business of the Practice.

 

Responsibilities

Employee Responsibilities

• Employees have the responsibility to ensure their own safety and that of their colleagues at work. It is essential, therefore, that all employees are familiar with Practice policies and procedures, equipment and precautions adopted to combat the risk of physical and verbal abuse.
• Familiarise themselves with Practices policies and procedures, guidelines and instructions.
• Use any equipment or devices provided for ‘at risk’ situations i.e. alarms.
• Participate in relevant training made available by the Practice.
• Report all incidents of physical and verbal abuse (threatened or actual).
• Record details of incidents in compliance with Practice procedures.
• Contribute towards reviews by the Practice Manager concerning any incidents in which they have been involved.
• Suggest precautionary measures involving changes in the layout of the work environment that can reduce risk.
• Make use of any available staff support and counselling through the Practice.
• Advise the Practice Manager of any perceived risks involved in work activities.

 

Practice Responsibilities

• Carry out risk assessments to assess and review the duties of employees, identifying any ‘at risk’ situations and taking appropriate steps to reduce or remove the risk to employees.
• Assess and review the layout of premises to reduce the risk to employees.
• Assess and review the provision of personal safety equipment i.e. alarms.
• Develop Practice policies, procedures and guidelines for dealing with physical and verbal abuse.
• Provide support and counselling for victims or refer to suitably qualified health professionals.
• Make employees aware of risks and ensure employee involvement in suitable training courses.
• Record any incidents and take any remedial action to ensure similar incidents are prevented.
• Ensure that employee's personal data, including information about their health, collected when preventing and dealing with violence at work (for example during risk assessments and incident investigations) is handled in accordance with the practice's Data Protection Policy.

What To Do

 If violence and aggression is encountered:

• In the first instance a member of the staff should ask the perpetrator to stop behaving in an unacceptable way. Sometimes a calm and quiet approach will be all that is required.  Staff should not in any circumstances respond in a like manner.
• Should the person not stop their behaviour the Practice Manager should be asked to attend, and the member of staff should explain calmly what has taken place, preferably within hearing of the perpetrator.
• If the person is acting in an unlawful manner, causes damage or actually strikes another then the police should be called immediately.
• Should it prove necessary to remove the person from the Practice then the police should be called, and staff should not, except in the most extreme occasions, attempt to manhandle the person from the premises.
• If such a course of action proves necessary then those members of staff involved must complete a Significant Event log, detailing in chronological order what has taken place and the exact words used prior to leaving the building at the end of their working day.
• It is the policy to press for charges against any person who damages or steals Practice property or assaults any member of staff or visitor/patient.

Procedure Following an Incident

• Review the incident with the Practice Manager and Partners immediately in order to determine severity.
• Determine if the patient should be removed from the Practice list forthwith.
• Decide if a written warning should be given.
• Decide whether to take further action if the matter has been sufficiently dealt with by the advice already given.

Any employee or patient/visitor who receives any injury, no matter how small, should be the subject of an entry in the Practice Accident Book and should always be strongly advised to be examined by a doctor before they leave the premises.

Every violent incident involving staff will be reasonably supported by the provision of medical or other treatment as necessary and all incidents should be brought to the attention of the Practice Manager, if not already involved. If an injury has occurred this may be notifiable to the HSE. A Significant Event log must be completed and passed to the Practice Manager.

The Practice re-affirms its commitment to do everything possible to protect staff, patients and visitors from unacceptable behaviour and their zero tolerance of any incident that causes hurt, alarm damage or distress.

 

Marking Patients’ Records

In the event of an act of violence or aggression taking place, it is possible to mark the patient’s record to warn other staff of the potential threat of violence.

On the electronic records system, a marker can be used to alert staff when they securely access the patient’s record.

 

Support for Employees Subjected to Abuse

The Practice takes a serious view of any incidents of physical and verbal abuse against its employees and will support them if assaulted, threatened or harassed.

The first concern of the Practice Manager and Partners after an incident is to provide appropriate debriefing and counselling for affected employees. Depending on the severity of the incident this counselling may be undertaken by trained professionals.

The Practice Manager and Partners will assist victims of violence with the completion of the formal record of the incident and where appropriate will report the incident to the police.

In the event of serious physical and verbal abuse patients will be removed from the Practice list.

 

Legislation

This is a summary of the guidance aimed at protecting employees and people in their care describing the lawful use of restraint or force (it does not give a precise statement of law and is not an exhaustive list of legal requirements and provisions).

• Common Law: created and defined by decisions made in courts and other legal proceedings rather than legislative statutes. It recognises the entitlement to defend oneself or another person from harm if they believe they are in immediate danger, and that necessary and proportional action may include restraint or removal of a person to prevent harm.
• Criminal Law Act 1967: Section 3 allows the use of reasonable force to prevent crimes, that force being necessary and ‘proportionate’ (i.e. the degree of force is the minimum required to achieve the objective).
• Equality Act 2010: those delivering NHS services must comply with the Equality Act 2010 and not discriminate against individuals in relation to protected characteristics
• Criminal Justice and Immigration Act 2008: Section 76 defines the degree of force used to restrain was reasonable in the circumstances
• Health and Safety at Work Act 1974: The employers are responsible for the health, safety and welfare of all employees, users and visitors. They must ensure a safe and secure working environment protecting staff from acts of aggression (physical and verbal).
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: all Practice employees must adhere to the fundamental care standards as set out in the regulations.
• Human Rights Act: apply to any person receiving care and treatment as well as the person’s family and carers, other people receiving treatment, and the staff involved in the person’s care and treatment.
• Mental Capacity Act and Deprivation of Liberty: where possible the patient’s capacity should be assessed before any physical intervention.
• Mental Health Act: This Act gives provision for the legal use of restrictive physical interventions to enforce treatment in certain circumstances.

 

Best Practice Guidance

Department of Health and NICE have best practice guidance available for healthcare settings:

• Positive and Proactive Care: reducing the need for restrictive interventions (2014)
• Mental Health Act Code of Practice
• NICE Clinical Guidance NG10 – Violence and Aggression (2015)
• NICE NG11 (2015) Challenging Behaviour and Learning Disabilities: Prevention and Interventions for People with Learning Disabilities Whose Behaviour Challenges

 

Resources

pathways.nice.org.uk/pathways/violence-and-aggression

 

APPENDIX 1 – POSTER

 

OUR PRACTICE STAFF ARE HERE TO HELP YOU. 

OUR AIM IS TO BE AS POLITE AND HELPFUL AS POSSIBLE TO ALL PATIENTS.

IF YOU CONSIDER THAT YOU HAVE BEEN TREATED UNFAIRLY OR INAPPROPRIATELY, PLEASE ASK THE RECEPTION STAFF TO CONTACT THE PRACTICE MANAGER, WHO WILL BE HAPPY TO ADDRESS YOUR CONCERNS.

HOWEVER, SHOUTING AND SWEARING AT PRACTICE STAFF WILL NOT BE TOLERATED UNDER ANY CIRCUMSTANCES AND PATIENTS WHO ARE ABUSIVE MAY BE REMOVED FROM THE PATIENT LIST.

 

PLEASE HELP US TO HELP YOU.

THANK YOU.

APPENDIX 2 – Action in the event of Panic Button activation.

 

Refer to the Incident Management Procedure ^[*]              

In circumstances where unforeseen behaviours of concern occur staff present should immediately call for assistance by activating panic alarms or shouting for help.

In the event of an unforeseen emergency incident arising in the presence of a member of staff, they have four possible options:

• Negotiate: use communication and de-escalation skills to reduce the risk of escalating to violence.
• Exit: where possible, employee should exit the environment using breakaway techniques, moving away from the risk and evacuate other service users if it is safe to do so.
• Alarm: summon assistance from other members of staff by activating their panic alarm or shouting for help.
• Reasonable Force: If there is an imminent threat of violence, and the member of staff believes other options will not prevent an attack, they may use proportionate force under Common Law principles.

These options above do not necessarily need to follow the same order - the employee needs to decide on which options are appropriate based on the specific circumstances of the emergency as presented.

 

APPENDIX 3 - Do’s and Don’ts when facing angry patients

 

Do	Don’t
Recognise your own feelings	Meet anger with anger
Use calming body language	Raise your voice, point or stare
Put yourself in their shoes	Appear to lecture them
Be prepared to apologise if necessary	Threaten any intervention unless you are prepared to act on it
Assert yourself appropriately	Make them feel trapped or cornered
Allow people to get things off their chest	Feel that you have to win the argument

 

APPENDIX 4 - Draft warning letter to patient re abusive behaviour

 

Dear [Insert Name],

I am [insert name], the Practice Manager for The Saheecha’s Practices. As part of this role, I am responsible for protecting staff at the Practice from [abusive / violent / unacceptable] behaviour.

I am writing to discuss the report/s I received about [the event / behaviour / incident], which took place on [insert date]. As you are already aware [insert details of actions already taken].

A repeat of such behaviour on your part in the future will not be tolerated by the Practice. Please treat this letter as a formal warning that any such behaviour in the future will not be tolerated.

Any repetition of abusive/aggressive behaviour [may/will] result in you being removed from this Practice’s patient list and you will be required to register elsewhere.

We ask you to always treat your GPs and their staff courteously.

If you are not happy with this Practice, then I would suggest that you register with another GP. Should you have difficulty in finding a local GP a list can be obtained from PALS Office, Main Atrium, Queens Hospital, Rom Valley Way, Romford, Essex RM7 0AG. Alternatively, they can be contacted by email at bhrut.pals@nhs.net

 

Yours sincerely,

Practice Manager