Zero tolerance

Bridgemary Medical Centre is committed to providing care in a safe, respectful and professional environment.

Our staff have the right to work without being subjected to violence, threats, abuse, intimidation, harassment, discrimination or persistent unreasonable behaviour. Patients, carers, relatives and visitors are also expected to behave respectfully towards other patients and members of the practice team.

We understand that patients may feel anxious, upset or frustrated when they are unwell or when they are concerned about their care. We will always try to listen, explain and help where we can. However, distress or frustration does not justify abusive, threatening or inappropriate behaviour towards staff.

What we mean by unacceptable behaviour

Unacceptable behaviour includes, but is not limited to:

• shouting, swearing, aggressive language or abusive comments;
• personal insults, name-calling or derogatory remarks about staff;
• threatening behaviour, whether verbal, written, online or in person;
• intimidation, harassment or repeated hostile contact;
• discriminatory, racist, sexist, homophobic, transphobic or otherwise offensive comments;
• making malicious or knowingly false allegations about staff;
• refusing to follow reasonable practice processes, including complaints, appointment or prescription procedures;
• repeatedly contacting the practice in a way that is excessive, abusive or disruptive;
• sending complaint correspondence to individual staff members when asked to use the formal practice route;
• recording staff without their knowledge or agreement, where this is used to intimidate, harass or undermine staff;
• damaging practice property;
• any actual or threatened physical violence.

Misconduct: unacceptable behaviour normally managed in stages

Misconduct means behaviour that is unacceptable but does not, in the practice’s judgement, create an immediate risk to safety.

Examples may include swearing at staff, aggressive tone, repeated unreasonable demands, hostile emails, personal criticism of staff, refusing to follow reasonable processes, or repeated behaviour that causes distress or disruption to the practice team.

Where misconduct occurs, the practice may take one or more of the following steps:

1. Record the incident in the patient’s record or practice incident log.
2. Speak to the patient and explain why the behaviour is unacceptable.
3. Issue a formal warning letter.
4. Ask the patient to agree to an acceptable behaviour agreement.
5. Put reasonable contact arrangements in place, for example requiring contact in writing, through a named route, or through the generic practice email address.
6. Limit non-essential direct contact with individual staff members.
7. Consider removal from the practice list if behaviour continues or if the relationship between the patient and practice has broken down.

A warning will normally remain active for 12 months. If further unacceptable behaviour occurs during that period, the practice may consider further action, including removal from the practice list with notice.

Gross misconduct: serious behaviour that may lead to immediate action

Gross misconduct means behaviour that is so serious that the practice may need to take immediate action to protect staff, patients or others.

Examples may include:

• actual physical violence;
• threatened violence;
• behaviour that causes a member of staff, patient or visitor to fear for their safety;
• serious intimidation or harassment;
• stalking or targeted personal contact with staff;
• discriminatory abuse or hate-related behaviour;
• serious online abuse or malicious personal targeting of staff;
• attending the practice in an aggressive or threatening manner;
• damaging or threatening to damage practice property;
• bringing weapons or dangerous items onto practice premises;
• any behaviour requiring police involvement.

Where gross misconduct occurs, the practice may contact the police, notify appropriate NHS bodies, and request immediate removal from the practice list where the criteria are met.

Patients removed for violent or threatening behaviour may be managed through the NHS Special Allocation Scheme, which provides access to GP services in a secure setting.

Removal from the practice list

Removal from the practice list will never be taken lightly. The practice will consider the circumstances, the impact on staff and patients, the patient’s clinical needs, any known vulnerabilities, and whether the behaviour can be managed safely in another way.

For non-violent cases, the practice will usually issue a warning before removal is considered. If the behaviour continues, or if the relationship between the patient and the practice has broken down, the practice may request removal from the list with notice.

For violent, threatening or seriously intimidating behaviour, the practice may request immediate removal without prior warning where this is necessary to protect staff, patients or others.

The practice will notify the patient in writing where removal is requested, except where doing so would create a risk to safety or where the process is managed by the relevant NHS body.

Complaints and behaviour

Patients have the right to raise concerns and make complaints about their care. Making a complaint will not, in itself, lead to any negative treatment by the practice.

However, complaints must be made in an appropriate and respectful way. The right to complain does not include the right to abuse, threaten, harass or intimidate staff.

Where a patient has a complaint, the practice may require all complaint correspondence to be sent through the formal complaints route rather than to individual members of staff.

Contact restrictions

Where behaviour is unacceptable or causing disruption, the practice may put reasonable contact restrictions in place. These may include:

• requiring contact through a generic practice email address;
• asking the patient to communicate in writing only, except in a medical emergency;
• arranging appointments with specific clinicians or with a chaperone present;
• asking the patient to attend at a specific time;
• limiting repeated calls or emails about the same matter;
• ending calls where the caller is abusive, threatening or refuses to moderate their behaviour.

These measures are intended to protect staff and maintain safe access to care. They do not prevent a patient from accessing necessary medical care.

Staff responsibilities

Staff should not be expected to tolerate abuse. Where unacceptable behaviour occurs, staff should:

1. remain calm where possible;
2. explain that the behaviour is unacceptable;
3. end the interaction if the behaviour continues;
4. seek support from a manager;
5. record the incident clearly and factually;
6. escalate concerns where there is a risk to safety.

In an emergency or where there is immediate risk, staff should call 999.

Our commitment

Bridgemary Medical Centre will treat patients fairly, respectfully and without discrimination. We ask patients, relatives, carers and visitors to treat our team in the same way.

We will listen to concerns, investigate complaints properly, and learn when things have gone wrong. We will also take appropriate action to protect our staff, patients and services from abuse, threats and unacceptable behaviour.