The NHS Zero Tolerance Zone is a nation-wide campaign to tackle violence and abuse, both physical and verbal, against all members of staff working in the NHS. Its two principal aims are: · To inform the public that violence against staff working in the NHS is unacceptable and the Government is determined to stamp it out · To inform all staff that violence and intimidation is unacceptable and is being tackled. The practice fully supports this campaign and its legal requirements to provide, as far as is reasonably practicable, conditions of working that are conducive to the prevention of and safe management of violence.
In January 2000 the Department of Health (DOH) issued guidelines to Health Authorities to introduce local initiatives as part of a Zero Tolerance Campaign which addresses any incident where a General Practitioner (GP), or his/her staff are exposed to violent or abusive behaviour. As well as having a right to protect themselves, GPs have a duty, as employers, to protect their staff and as providers of a public service, those with reason to be on their premises. The DOH established the following definition for violence/abuse – “Any incident where a GP, or his or her staff, are abused, threatened or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, wellbeing or health”. The definition does not define violence just as physical assault but also includes threats that challenge the “Safety, wellbeing or health of staff”.
Here are some examples of the breaches of the Zero Tolerance Policy;
- Behaviours that target a person based on their protected characteristic or belonging to a marginalised group. These can be intentional and unintentional and are based on biases either conscious and unconscious
- Any physical violence towards any member of the Primary Health Care Team or other patients, such as pushing or shoving
- Racial abuse and sexual harassment
- Causing damage/stealing from the Practice’s premises, staff or patients
- Obtaining drugs and/or medical services fraudulently
- Refusing appointments with an appropriate clinician for the presenting care need i.e. insisting on a GP appointment when seeing a pharmacist or nurse prescriber is most appropriate or refusing to see an available GP for your presenting care need when your preferred GP is unavailable
- Refusing to access the service in the appropriate manner i.e. sending emails/texts instead of using the NHS Digital approved digital consultation service
- Demanding a same day appointment for a routine clinical need – this deprives access to urgent care services for those who genuinely need it
- Contacting individuals directly via social media or personal email instead of through the practice contact channels
- Using bad language threatening or swearing at practice staff or other service users;
- Unnecessarily persistent or unrealistic service demands that cause disruption;
- Verbal, non-verbal and environmental slights, snubs and insults which communicate hostile, derogatory or negative messages;
The practice operates a Zero Tolerance Policy towards any member of our staff or patients. Patients are expected to be considerate and act reasonably. Management cites but does not restrict, the following unacceptable behaviour within its Zero Tolerance Policy: · any display of a violent temper · shouting, raised voices, sarcasm, pointing fingers. · repeated or insistent points being made; not engaging with staff in a positive way; being pushy or trying to intimidate staff · hostile or aggressive behaviour · threats, swearing, spitting · any mention or display of any object that could be used as a weapon. Should a member of staff (or patient) feel that they have encountered behaviour that could be classed as unacceptable within the Practice Zero Tolerance Policy, a complaint should be made to the Practice Manager. Once the matter has been reviewed by the Practice Manager the person in question will be sent a formal warning letter, depending on the severity of the incident they may then be either sent a warning letter with behavioural agreement to be signed within 30 days of the warning letter been issued or be removed from the practice list. We will have no hesitation in having the patient removed from the building by the Police should his/her behaviour warrant it.
If an incident is taking place and staff feel that a Police presence is required, regardless of the circumstances, the Police will be called to deal with the incident. It is our responsibility to protect our staff and patients and therefore no hesitation will be made if a Police presence is required. If the patient has left the premises and there is no immediate danger, the Police will still be notified of the incident so it can be recorded for future reference. The GP will also keep a record of the incident.
Following an incident where a complaint has been made about a patient’s behaviour a formal warning letter will be sent with a behavioural agreement to be signed within 30 days of the date of the warning letter. The letter will notify the person that their behaviour was unacceptable and will not be tolerated, if the person is a patient at the surgery they will be warned that they run the risk of being removed from our practice list if they do not sign the behavioural agreement within the specified time period. The letter will clearly state that if there is any reoccurrence of their behaviour in any way that they will be removed from the Practice list. A permanent record of the warning, including the date and reason for the warning, will be made and retained. Although this procedure will be generally applied, there may be occasions where the Management Team feel that an episode of behaviour is so serious that a patient will removed from the Practice list with immediate effect. Where this is the case, the police will usually have been called to attend the Practice and one or more members of staff or patients will have been threatened or attacked or narrowly avoided being attacked. It is important to remember that it is not the intention of the perpetrator that is relevant, rather than the perception that is generated by the actions and behaviour of the perpetrator that will generate the Practice response.
Removal from the Practice List
Removal of patients from this Practice list is an exceptional and rare event and is a last resort. The practice must respect the safety and wellbeing of their staff and patients, and if a patient at the surgery is unable to respect the staff and treat them with courtesy then it is in the best interest of the patient in question and, more importantly, our staff that they register elsewhere. If the decision to remove a patient from the practice list is made, NHS England will be notified either immediately (in case of serious breaches where a deregistration is to be processed within 24hours with or without a police reference as necessary) or on 8 days’ notice for the protection of other NHS staff members. If a patient is removed from the Practice list, they will also be banned from entering the Practice premises or contacting Practice staff in any way.
Notifying the Patient
The Practice will take steps to contact the patient to inform them of the action being taken. After having a formal consultation with our integrated care board, we advise patients that following a breach of zero tolerance threshold, where the breach is not warranting a removal, practice is more than happy to carry on providing the service as normal provided a behavioural agreement is signed. This means that the practice will be monitoring patients behavioural after they have signed the agreement for a period of 12 months and should there be a reoccurrence of the same, a deduction will be processed as appropriate. Practice warning letter clearly specifies about the 30 days’ time period for signing the behavioural agreement and the patient will be informed in writing to their home address or through a verified email. Failing to sign the behavioural agreement within the given time period will result in the de-registration of the patient and no further notifications will be sent. Once this decision has been made the deduction will not be revoked under any circumstances, and the subject will not be entertained by any staff member and will be only considered as harassment. Practice is not obliged to send removal notifications in cases of serious breaches where it is necessary to remove patients within 24 hours’ time period, however all necessary measures will be taken by the practice to inform the NHS health authority of the event so that they can contact the patient directly to
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. 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 the 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 put Doctors or their staff at risk.