London GP leaders have urged practices to be ‘proactive’ in monitoring threats of patient abuse, including via social media and the design of their premises.
They warned that a ‘failure to pro-actively engage’ with patients on social media ‘risks damage to the practice’s local reputation’ which could lead to more frustrated patients.
In a new guide on violent patients, Londonwide LMCs has set out advice for practices to reduce the chances of abuse as well as how to react when incidents occur.
The LMCs first announced plans to produce a guide two years ago, in collaboration with the Metropolitan Police, in response to increased levels of patient abuse compared with before the pandemic.
According to the guidance, GP practices should work with their local policing team by setting up a meeting or attending ward meetings to raise any issues around patient abuse.
Medical director Dr Elliot Singer said the ‘rising abuse and violence’ practices face is ‘deeply concerning’, and it is ‘regrettable’ that this guidance is needed at all.
The section on prevention encourages practices to use their existing social media presence to ‘pick up early warning signs’ such as if an individual is ‘repeatedly posting negative opinions about the practice’.
In this case, GPs could directly contact the person in order to ‘prevent future escalation’.
For those practices who may be ‘reluctant’ to join local community online forums, LMC leaders suggest there might be a ‘missed opportunity’ to communicate directly with patients and ‘counter misinformation’.
The guide said: ‘A failure to pro-actively engage risks damage to the practice’s local reputation.
‘One potential consequence of a negative reputation through social media is that when patients attend the practice their expectation is that the practice will not meet their need. As such they are already in a mindset that they expect to become frustrated.’
GPs in London are also advised to ‘consider physical re-design of the practice environment’ to prevent instances of abuse, which could include adjusting the proximity of the front desk to the waiting areas.
The LMC guidance explored ‘common violence triggers’ for patients, such as being told that results are unavailable or being refused an instant conversation with a clinician.
‘Try to focus on what you can do rather than what you cannot do, even if what the patient is asking for may not be possible at that particular time,’ the guidance advised.
Other recommendations
- Ensure reception staff have regular customer care training and complaints about staff manner and attitude are dealt with in a timely way, ensuring there is reflection within the team and required action is taken;
- Reduce congestion at entry points; try and keep open sightlines so staff can see what is happening;
- Where this is not possible consider CCTV and/or mirrors. CCTV should cover entrances and exits, capturing good quality facial images of people entering and leaving the practice;
- Consider having monitors where people can see that they have been captured on CCTV and signs that aggression towards staff members will not be tolerated and offenders may be prosecuted;
- Ensure your staff acknowledge patients when they enter the practice and engage with them at the earliest opportunity;
- Do conflict management training, for example by using role play, scenario discussions and making sure all members of the team know their roles and responsibilities should an incident arise;
- If an incident does occur, using positive/assertive behaviours and actions will help reduce the conflict: remember open body language style, controlled breathing, tone of voice, and thought prior to speech;
- Following an incident, any service users present should be given the opportunity to provide their details both to provide a witness statement and be given the option to receive support.
Dr Singer said Londonwide LMCs hope this guide is ‘useful’ but warned that ‘there is only so much practices can do themselves’.
He added: ‘They need the support of commissioners in removing aggressive patients to properly resourced special allocation schemes and a timely response from local police at the point staff or patients feel threatened.
‘They also need political leaders to be clear with patients about what they can expect from general practice with the resources it has available.’
Pulse has reported on several recent incidents, including a stabbing at a GP practice in South East London last month and the arrest of a man for an incident involving a bow and arrow.
At the recent UK LMCs conference, GPs called for ‘more severe sanctions’ for perpetrators of threatening and violent behaviour towards practice staff.
They also demanded that the criteria for inclusion in the violent patients scheme is ‘relaxed’.
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Where to even start with this…
Completely impractical to monitor “social media” beyond comments made via NHS website. For vexatious complaints that spiral with online and potentially malicious postings, LMC NHSE and MDU didn’t offer practical advice or support. And the Police are only interested if an arrestable offence may have occurred. GP left to deal with the problem, as always.