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Respect policy and Zero tolerance policy

Good relationships and mutual respect

The majority of relationships between patients and GP practices are good and this helps to improve the performance of GP practices. The core of good relationships is mutual respect and dignity.

This does not mean you do not tell us if we drop below the standards you expect of us. We will tell you when we drop below these standards. See under professional duty of candour policy which applies to all we do. We will respect you equally whatever your background, culture, or age as you can see in our statement on the NHS constitution and equality and diversity.

There are well over 1 million contacts a day in the NHS, most of them in general practice, and the demands on the NHS are likely to increase significantly over the next few decades with an ageing population.

We all know that people perform far better if they are respected and valued and that is not just in the individual interactions, they might have with you but in the whole job they do. The NHS does need to become more efficient and we hope this small contribution with our website will make it easier for you to navigate local health and social care, but remember that each person is doing their best within the present environment to provide a good service and they are disappointed themselves when that does not happen.

Importantly this relationship must extend to all who work in general practice. Receptionists are the bedrock of a good practice and are the face of our practice. They can be caught between the limitations of our internal capacity and that of the NHS as a whole and the understandable desire for support from patients. They have a multitude of tasks to complete which are a result of the complex service the NHS offers and the number of patients we look after. We understand frustrations but please continue to treat our receptionists with respect and dignity, as we ask them to do for you. The majority of our patients do this.

Respecting and supporting other patients

We completely support the principle of an NHS service free at the point of use, equally available to everybody whatever their wealth or background. At the same time when the service is not always used appropriately in any part of the NHS (including general practice) this is not free. There is a real cost that is borne by other patients as when any finite resource has to be shared around. Other patients are not an anonymous group but real people who potentially include your family and friends, local community, people going through significant mental illness or physical illness including cancer. We include on the page on “appointments and requests” found under “book an appointment” support to help you use the service appropriately.

Respect for you whatever your circumstances

We know some patients will struggle to attend a GP practice and discuss certain topics. We will always show you respect whatever your circumstances and treat you with dignity and any thing you say with confidentiality.

Poor relationships

Dysfunctional relationships are neither good for you or for us. They act as a barrier for you getting the best care, we can give you and for us we get caught up in activity which is non-productive for patient care (including for all our patients). We understand that people who have illness physical and/or mental, or social isolation have many issues to cope with and we try to take account of this in our interactions and remember our ambition is to do the best we can to help you. We always try to do our best to repair relationships. However, when trust has irretrievably broken down it can be in the patient’s interest, just as much as that of the practice, that they should find a new practice.

Zero tolerance to violent and abusive behaviour

It is a rare event for us to remove a patient from our list for behavioural reasons. There is one situation in which we will always ask you to leave the practice and that is with violent or abusive behaviour. Violent behaviour when the police are involved will likely result in immediate removal on the grounds of violence or threat of it. To keep someone on our list after such behaviour impacts on the integrity of our practice and our need to support all staff who work in our practice.

Such circumstances are a very exceptional and rare event but we provide further detail under our Zero Tolerance policy below including the situation with other family members registered with our practice even if they are not responsible for the behaviour.

Zero tolerance policy in more detail

Our responsibility to our staff is set out in the NHS Constitution and includes
“To have healthy and safe working conditions and an environment free from harassment, bullying or violence.” The NHS Constitution for England – GOV.UK

To meet this very important right for all our staff we have adopted the NHS Zero Tolerance Approach which has been commonly adopted across the whole of the NHS. Violent or abusive behaviour will not be tolerated and may result in you being removed from the practice list and, in extreme cases, the police being contacted.

The Health and Safety Executive (HSE) defines work-related violence as:
“Any incident in which a person is abused, threatened or assaulted in circumstances relating to their work” Work-related violence – HSE

Whilst it is not possible to give an exhaustive list of abusive behaviour some examples include:

  • Offensive language, verbal abuse and swearing
  • Racist comments
  • Unwanted or abusive remarks
  • Negative, malicious or stereotypical comments
  • Brandishing of objects or weapons
  • Threats or risk of injury to NHS staff
  • Intimidation
  • Stalking
  • Unreasonable behaviour

The process of removing a violent patient from a practice list

The British Medical Association (BMA) covers patient removals relating to violence or threatened violence.
Removing patients from your practice list Removing patients from your GP practice list

The potential situation with other family members not directly responsible for the violence

As the British Medical Association (BMA) suggest
“In rare cases, because of the possible need to visit patients at home, you might need to remove their family members from the list. This is particularly likely if the patient was removed for violence or threatening behaviour.” Removing patients from your GP practice list

Potential future care for a violent patient after removal from a practice list

A patient’s care is not halted because of their violence but it does change.

This is explained below in the article from the BMA.
Removing violent patients and the special allocation scheme Removing violent patients and the special allocation scheme

Other information

From NHS England
Violence prevention and reduction standard Report template – NHSI website

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