Unacceptable Actions

Unacceptable Actions Policy – Information for Patients 

At YourGP, we are committed to treating everyone with dignity and respect.  We ask that our patients, visitors and staff treat one another in the same way.  We understand that people may feel anxious, distressed or frustrated when seeking healthcare.  However, we operate a zero-tolerance approach to violent, threatening or abusive behaviour towards our staff, patients and visitors.  This policy explains what we consider to be unacceptable behaviour and the actions we may take to protect our people and maintain a safe environment for everyone.

This policy is not intended to discourage patients from raising concerns, making complaints or expressing dissatisfaction with our services. We welcome feedback and will always listen to concerns raised respectfully. The policy exists to protect our staff, patients and visitors from behaviour that is abusive, threatening or unreasonable.

1.0 What actions are considered to be unacceptable?
People may act out of character when they are anxious, distressed or frustrated. We recognise that seeking healthcare can be stressful. We do not view behaviour as unacceptable just because a patient is forceful or determined. In fact, we accept that being persistent may sometimes be an advantage when interaction with healthcare. However, we do consider actions that result in unreasonable demands on the practice or unreasonable behaviour towards practice staff to be unacceptable. It is these actions that we aim to manage under this policy.

2.0 Aggressive or abusive behaviour
We understand that patients may be angry about the issues they have raised with the practice. If that anger escalates into aggression towards staff, we consider that unacceptable. Any violence or abuse towards staff will not be accepted. Violence is not restricted to acts of aggression that may result in physical harm. It also includes discrimination, harassment, unwanted physical contact, inappropriate behaviour on social media, behaviour or language (whether verbal or written) that may cause staff to feel offended, afraid, threatened or abused. We will judge each situation individually and appreciate individuals who come to us may be upset. Language which is designed to insult or degrade, is derogatory, racist, sexist, transphobic, or homophobic or which makes serious allegations that individuals have committed criminal, corrupt, perverse or unprofessional conduct of any kind, without any evidence, is unacceptable.

3.0 Unreasonable demands
A demand becomes unacceptable when it starts to (or when complying with the demand would) impact substantially on the work of the practice. Examples of actions grouped under this heading include:

• Repeatedly demanding immediate responses
• Insisting on speaking to one particular staff member
• Repeatedly contacting the practice about the same issue
• Refusing to engage with reasonable requests
• Making repeated requests for treatment contrary to clinical advice
• Repeatedly failing to attend appointments without explanation

4.0 Unreasonable levels of contact
Sometimes the volume and duration of contact made to the practice by an individual causes problems. This can occur over a short period, for example, several calls in one day or one hour. This may occur over the course of repeated interactions with the practice. We consider that the level of contact has become unacceptable when the amount of time spent talking to a patient on the telephone, or responding to, reviewing and filing emails or written correspondence impacts on our ability to deal with that issue, or with other patients’ needs.

5.0 Unreasonable refusal to co-operate
Where we need to investigate or resolve an issue, we may ask the patient to work with us. This can include agreeing with us the issues we will look at; providing us with further information, evidence or comments on request; or helping us by summarising their concerns or completing a form for us. Sometimes, a patient repeatedly refuses to cooperate, and this makes it difficult for us to proceed. We will always seek to assist someone if they have a specific, genuine difficulty complying with a request. However, we consider it is unreasonable to raise a concern with us and then not respond to reasonable requests for information or cooperation.

6.0 Unreasonable use of the complaints process
Individuals with complaints about the practice have the right to pursue their concerns through a range of means. They also have the right to complain more than once about the practice, if subsequent incidents occur. This contact becomes unreasonable when the effect of the repeated complaints is to harass, or to prevent us from pursuing a legitimate aim or implementing a legitimate decision. We consider access to a complaints system to be important, and it will only be in exceptional circumstances that we would consider such repeated use is unacceptable – but we reserve the right to do so in such cases.

7.0 Examples of how we manage aggressive or abusive behaviour
Depending on the seriousness of the incident, the practice may:

•  Issue a formal written warning
• Restrict how we communicate with a patient
• Report the matter to Police Scotland where appropriate
• End the patient relationship with the practice

8.0 How we may respond
We have to take action when unreasonable behaviour impairs the functioning of the practice. We aim to do this in a way that allows a patient to progress through our process. We will try to ensure that any action we take is the minimum required to solve the problem, taking into account relevant personal circumstances including the seriousness of the issue(s) or complaint and the needs of the individual.

9.0 Other actions we may take
Where a patient repeatedly phones, visits the practice, raises repeated issues, or sends large numbers of documents where their relevance isn’t clear, we may decide to:

•  limit contact to telephone calls from the patient at set times on set days, about the issues raised
• restrict contact to a nominated member of the practice staff who will deal with future calls or correspondence from the patient about their issues
•  arrange appointments in an appropriate format where clinically suitable
• restrict contact from the patient to writing only regarding the issues raised
•  return any documents to the patient or, in extreme cases, advise the patient that further irrelevant documents will be destroyed
• take any other action that we consider appropriate

Where we consider continued correspondence on a wide range of issues to be excessive, we may tell the patient that only a certain number of issues will be considered in a given period and ask them to limit or focus their requests accordingly. In exceptional cases, we reserve the right to refuse to consider an issue, or future issues or complaints from an individual. We will take into account the impact on the individual and also whether there would be a broader public interest in considering the issue or complaint further. We will always tell the patient what action we are taking and why.

 10.0 How decisions are made
• Any member of staff who directly experiences aggressive or abusive behaviour from a patient has the authority to deal immediately with that behaviour in a manner they consider appropriate to the situation and in line with this policy
• With the exception of such immediate decisions taken at the time of an incident, decisions to issue a warning or remove patients from the practice are only taken after careful consideration of the situation by the Senior Management Team
• Wherever possible, we will give a patient the opportunity to change their behaviour or actions before a decision is taken

11.0 How we let people know we have made this decision
When an employee makes an immediate decision in response to offensive, aggressive or abusive behaviour, the patient is advised at the time of the incident. When a decision has been made by the Senior Management Team, a patient will always be given the reason in writing as to why a decision has been made to issue a warning (including the duration and terms of the warning) or discharge them from the practice. This ensures that the patient has a record of the decision.

12.0 How we record and review a decision to issue a warning
We record all incidents of unacceptable actions by patients. Where it is decided to issue a warning to a patient, an entry noting this is made in the patient record. Each quarter a report on all restrictions will be presented to our Senior Management Team so that they can ensure the policy is being applied appropriately. A decision to issue a warning to a patient as described above may be reconsidered either on request or on review.

13.0 The process for appealing a decision
Patients who wish to appeal a warning or decision should do so in writing.  The appeal will be reviewed by a senior manager who was not involved in the original decision where possible.

An appeal could include, for example, a patient saying that: their actions were wrongly identified as unacceptable; the warning was disproportionate; or that it will adversely impact on the individual because of personal circumstances.

The Practice Manager or a member of the Senior Management Team who was not involved in the original decision will consider the appeal. They have discretion to quash or vary the warning as they think best. They will make their decision based on the evidence available to them. They must advise the patient in writing that either the warning or removal still applies or a different course of action has been agreed. We may review the warning periodically or on further request after a period of time has passed. Each case is different.

Our aim is always to maintain a respectful and constructive relationship with our patients.  The vast majority of interactions at YourGP are courteous and positive.  This policy exists solely to protect our staff, patients and visitors and to ensure we can continue providing safe, high-quality care to everyone.