Introduction

The NHS has a zero-tolerance policy of all violence and aggression. This policy is for the protection of all NHS staff, but also for the protection of other patients, their families, visitors, etc. In order to ensure that this zero-tolerance approach is adhered to, it is essential to have robust policies and procedures in place. In General Practice, this will need to cover a variety of situations in which incidents could occur. The majority of patients behave in acceptable or manageable ways, however the incidence of excessively aggressive or violent attacks in the GP practice is increasing.

Aims and Objectives

The aims and objectives of this policy are as follows:

• To ensure adequate processes are in place for the protection of staff and patients
• To ensure staff are fully aware of their responsibilities when dealing with violent or aggressive patient

Definitions

Violence and aggression - refers to a range of behaviours or actions that can result in harm, hurt or injury to another person, regardless of whether the violence or aggression is physically or verbally expressed, physical harm is sustained, or the intention is clear.

Violence - The use of physical force that is intended to hurt or injure another person. (NICE guidelines 25, 2005)

Work related violence - an incident where an individual is abused, threatened or assaulted in circumstances related to their work, which includes an explicit or implicit challenge to their safety, well-being or health.

Dealing with an Aggressive Patient

Patients can become aggressive for a variety of reasons, and it is always advisable to try to calm down the situation as early as possible, as this may prevent an incident. Being observant of patients/relatives is often the first sign that a difficult/tense situation is imminent.

Recognising the signs of an impending aggressive incident

The use of appropriate inter-personal skills in potentially difficult situations is essential.

Observation of the patient/client can help in predicting when aggression may occur. The following are some of the signs to look for:

• Staring, unblinking, uncomfortable gaze.
• Muscles tensed; jawline tensed.
• Facial expression
• Person balanced to move quickly
• Fingers or eyelids twitching
• Pacing about, uncomfortable stance, alternate sitting/standing
• Withdrawn on approach
• Voice-change of pitch or tone, use of insults, obscenities or threats
• Sweating
• Increase in rate of breathing
• Tears (crying)
• Offensive weapon carried or visible

If a patient is violent, rude or aggressive to any member of staff at the Practice a warning letter will be sent to the patient from the Practice Manager. If there is a second occurrence of behaviour the patient will be removed from the Practice list. 

Depending on the severity of the patients behaviour, we reserve the right to remove patients from the practice list if the police have had to be contacted EG: Threats, Assault.