The Practice takes it very seriously if a member of staff or one of the doctors or nursing team is treated in an abusive of violent way.

The Practice supports the government's 'Zero Tolerance' campaign for Health Service staff. This states that GPs and their staff have a right to care for others without fear of being attacked or abused. To successfully provide these services a mutual respect between all the staff and patients has to be in place.

All our staff aim to be polite, helpful and sensitive to patients' individual needs and circumstances. We would respectfully remind patients that very often staff could be confronted with a multitude of varying and sometimes difficult tasks and situations, all at the same time. The staff understand that ill patients do not always act in a reasonable manner and will take this into consideration when trying to deal with a misunderstanding or complaint.

However, aggressive behaviour, be it violent or abusive, will not be tolerated and may result in the patient being removed from the Practice list and, in extreme cases, the Police being contacted.

The Practice provides training for staff in techniques that provide them with (1) skills to manage and deal with aggression and/or physical violence and (2) information about triggers for aggression and violence. The aim is to give them an understanding and knowledge to defuse and de-escalate potentially dangerous situations before they become physical. Practice staff must attend refresher courses as and when required. Additional training will be made available to those members of staff who need to develop practical skills and confidence in handling different situations.

Definition

The definition of violence is not limited to physical assault or injury; it also includes verbal aggression. The Practice accepts the Health & Safety Executive's working definition of violence, namely:

'Any incident in which an employee is abused, threatened or assaulted by a member of the public in circumstances arising out of the course of his or her employment.'

The following behaviours will also not be tolerated:

• Any physical violence towards any member of the Primary Health Care Team
• Excessive noise, for example, loud, intrusive conversations, shouting
• Threatening or abusive language in any form including swearing or offensive remarks
• Derogatory, racial, bigoted or sexual remarks
• Persistent or unrealistic demands that cause stress to staff. Requests will be met wherever possible and explanations given when they cannot
• Rude or aggressive behaviour which staff find intimidating even when not couched in foul or abusive language
• Malicious allegations relating to staff, other patients or visitors
• Offensive sexual gestures or behaviours
• Obtaining drugs and/or medical services fraudulently
• Substance abuse in our facilities
• Causing damage / stealing from the Practice's premises, staff or patients.

We ask patients to treat GPs and our staff courteously at all times.

Duty of the Practice

Under the Health & Safety Work Order (NI) 1978 and the Management of Health & Safety at Work Regulations (NI) 2000, the Practice has a duty to ensure so far as is reasonably practicable the health, safety and welfare of all employees. The duty of care at common law extends to taking reasonable precautions to protect employees from criminal attack. We also have a duty to our patients to provide for them a safe environment.

Removal from the Practice List

A good patient-doctor relationship, based on mutual respect and trust, is the cornerstone of good patient care. The removal of patients from our 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. An exception to this is on immediate removal on the grounds of violence, for example, when the Police are involved.

Removing other Members of the Household

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 they 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 be doctors or their staff at risk.