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Unacceptable behaviour

Violence and Abuse 
West Green Surgery aims to provide the best possible health care for their patients. However, there may be circumstances when it would be considered reasonable, or in the best interests of the patient, to remove patients from the list. The purpose of this policy, therefore, is to define the practice guidelines for when it is reasonable to remove a patient from the practice list for unacceptable behaviour and to ensure that any concerns about removing patients from the list are dealt with fairly.
 
The practice supports the Government’s Zero Tolerance Campaign in relation to violence and abuse. The staff and GPs at the surgery have the right to care for others without the fear of being attacked or abused. Violent patients can be reported to the police and offending patients will be removed from the GPs list. We ask that you treat your GP and practice staff without any violence, intimidation or verbal abuse. Situations which justify removal:

Violence
When a patient:- 
• Is physically violent or threatening towards a doctor, practice staff or other patients on the practice premises. This may include but not limited to swearing, throwing objects, spitting, threatening behaviour, being rude, raising voice, shouting or raising ones voice beyond reasonable levels, sarcasm, pointing fingers aggressively, Intimidating staff or repeatedly insisting points being made for argumentative purposes, any mention or display of any object that could be used as a weapon. This may be via any forms of communication e.g. face to face/telephone or by email
• Causes physical damage to practice premises or other patient’s property. 
• Gives verbal abuse or makes threats towards the doctor, practice staff or other patients. 
• Gives racist abuse, orally or physically. 
• Is violent or uses or condones threatening behaviour to doctors (or some other members of the primary health care team) while visiting the patient’s home. Such behaviour may involve the patient, a relative, a household member, or pets (such as unchained dogs). 


 
Irretrievable Breakdown of the Doctor-Patient Relationship
• Where a patients behaviour falls outside of that which is normally considered reasonable and leads to an irretrievable breakdown of the doctor-patient relationship. This includes where a patient:-
• Fraudulently obtains drugs for non-medical reasons. 
• Deliberately lies to the doctor or other member of the primary/secondary health care team (e.g. by giving a false name or false medical history) in order to obtain a service or benefit by deception. 
• Attempts to use the doctor to conceal or aid any criminal activity
• Steals from practice premises. 
 

Guidance on removing patients due to irretrievable breakdown of the doctor-patient relationship
Occasionally patients persistently act inconsiderately and their behaviour falls outside that which is normally considered to be reasonable. In such circumstances there may be a complete breakdown in the doctor-patient relationship. 


Warning
The patient will be warned verbally or written that they are at risk of removal from the practice within 12 months before the date of the request to the Primary Care Organisation. Should the patient not heed the verbal or written warning then they may be removed from the practice list.

However no warning is required if:
 The practice has reasonable grounds for believing that the issue of such a warning would be harmful to the physical or mental health of the patient
 The practice has reasonable grounds for believing that the issue of such a warning would put at risk the safety of members of the practice or those entitled to be on the practice premises
 It is, in the opinion of the contractor, not otherwise reasonable or practical for a warning to be given.
 If no reason is given an explanation in writing should be made and retained for potential future inspection by the PCO or NHS England. 

 
Family Members
When a decision is made to remove a patient from the practice list, the removal may well be extended to other members of the family or household i.e. if the patient is deemed violent and we worry for the staff’s safety, or the named responsible person for children is deregistered. The practice manager will write to the family / household offering an explanation for the removal. They will be allowed 4 weeks to re-register rather than being removed from the practice list immediately.