Zero Tolerance Practice Policy

In order for the surgery to maintain good relations with our patients we would like to ask all our patients to read and take note of the occasional types of behaviour we see that are unacceptable:

• Using bad language, shouting or raising of voices at surgery staff
• Any physical violence towards any member of our team or other patients
• Verbal abuse towards staff or patients in any form including shouting
• Racist, xenophobic, sexist, homophobic or other intolerant Language, discrimination or sexual harassment will never be tolerated
• Persistent or unrealistic demands that cause stress to staff will not be accepted. Requests will be met wherever possible and explanations given when they cannot be met
• Being perceived to bully or manipulate a staff member to obtain some-thing
• Causing damage to, stealing or not returning surgery equipment from the surgery’s premises, staff or patients
• Obtaining drugs and/or medical services fraudulently.

The legal position

As a responsible employer, the surgery has a duty as a provider of NHS healthcare to protect the health, safety and welfare of staff under the Health & Safety at Work Act. This includes a risk assessment of violence towards staff and taking steps to mitigate this under the Management of Health and Safety at Work Regulations 1999.

Staff members who are victims of violent conduct or assault have the right to sue their employers for compensation if the risk of violence could have been reduced or removed completely, but the employers did not act upon this information.

Examples of security issues:

• security of grounds and car parking
• security of premises – incl. storage, “out of hours”
• CCTV
• cash and staff - storing, handling and transferring
• security systems
• security of equipment – medical devices, computers
• communication of national security alerts
• information records
• contingency planning.
• security of employees
• staff working on their own  (staff can be lone workers when making domiciliary visits or within a hospital department e.g. out of hours)

This list is not exhaustive.

For example a lone working risk assessment must provide the lone worker full knowledge of the hazards and risks to which he or she is being exposed and what they must need to do will something go wrong. Other responsible persons must know the whereabouts of lone workers and what they are doing.

Violence at work

The surgery acknowledges that there may be instances where violence and / or aggression forms part of a patient’s illness. In these circumstances, the issue will be discussed with the patient and form part of their care planning.

This information will be recorded in the patient’s medical record and flagged to ensure that members of staff are aware. In addition, where deemed necessary, appropriate support will be put in place, e.g. staff members do not see the patient alone.

Definition of physical and verbal abuse and violence

Physical and verbal abuse includes:

• unreasonable and / or offensive remarks or behaviour / rude gestures / innuendoes
• sexual and racial harassment
• threatening behaviour (with or without a weapon)
• actual physical assault (whether or not it results in actual injury) includes being pushed or shoved as well as being hit, punched or attacked with a weapon, or being intentionally struck with bodily fluids or excrement
• attacks on partners, members of staff or the public
• discrimination of any kind
• damage to an employee's or employer's property

Under the Health and Safety at Work Act 1974, the surgery will also undertake the following measures to ensure a safe work environment:

• carry our 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, particularly if they are working alone
• assess and review the layout of the premises to reduce the risk to employees where physically possible.
• assess and review the provision of personal safety equipment, such as alarms
• develop surgery 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 on a Significant Event form and take any remedial action to ensure similar incidents are prevented in future

Removal from the surgery list

The removal of patients from our list is an exceptional and rare event and is a last resort in an impaired patient-surgery relationship. We value and respect good patient-doctor relationships based on mutual respect and trust. When trust has irretrievably broken down, the surgery will consider all factors before removing a patient from their list, and communicate to them that it is in the patient’s best interest that they should find a new surgery. An exception to this is in the case of immediate removal on the grounds of violence e.g. when the Police are involved.

Removing other members of the household

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 to ensure the safety of surgery staff.

The prospect of visiting patients that is the residence of a relative who is no longer a patient of the surgery, or the risk of being regularly confronted by the removed patient, may make it difficult for the surgery to continue to look after the whole family. This is more likely where the removed patient has been violent or displayed threatening behaviour, and keeping the other family members could put doctors or their staff at risk.