AMSPAR Vice President
Hands up if you or anyone in your practice has been subjected to violence or verbal abuse by patients or those accompanying patients? I'm now visualising a sea of hands being raised in the air because, as we all know, violence and abuse are nothing new in our line of work.
In 1998, the government set NHS targets for cutting acts of violence against staff: a 20% reduction by 2001; a 30% reduction by 2003. By April 2000, trusts were to have published strategies to achieve these reductions, and to have a system to record acts of violence. These targets were not met – by 2003, recorded violent incidents had risen to 116,000. Note that this is just recorded incidents. How many of those who experience violence think it's just part of the job, an everyday hazard of dealing with the public?
Well it isn't!
Violence can never be justified; all the more so when healthcare professionals like you and your teams are doing their best every day to alleviate suffering. We sometimes hear all manner of excuses – I don't need to go into detail, I expect you've heard all the excuses I have, and no doubt more.
Cry and demand
It seems to me that there is frequently a conflict between needs and wants. There is clearly a culture of heightened and very often unreasonable expectations these days. Society is being conditioned to believe that its every whim can be gratified immediately – usually with an overworked credit card – and this means that people frequently perceive a need that cannot be met within the healthcare system. There may be frustration at the length of waiting lists, or at the length of time it takes to get an appointment with a GP. Perhaps a doctor hasn't been able to make a house call? There may be a distorted opinion of the appropriate outcome-failure of treatment. Perhaps an angry person has not been given a treatment, investigation or specialist referral that they felt was necessary?
Interestingly, it's often the person accompanying the patient who becomes violent. The patient themselves generally feel too ill to do anything more than slump into a chair, leaving their companion to shout, thump the reception desk – and thump the poor receptionist doing their best to help.
Worryingly, some very bizarre assaults are being carried out. In 2004, a man was seen in a Bristol practice spiking a receptionist's coffee with a substance later found to be diazepam. The man had been banging on the reception desk. When the receptionist walked away to check on something, another patient saw him "pull pills out of his pocket and, with a smug expression, drop a number of tablets into her cup of coffee". When questioned by police, the culprit claimed he had done it because the receptionist "looked miserable". Who wouldn't when having to deal with such people?
Anarchy in the UK?
A recent survey of 1,000 GPs in five European countries has shown that GPs in Britain suffer the most abuse. Of the 200 British GPs who took part, 94% admitted that they had suffered verbal abuse, and 33% had suffered physical abuse. The European average for verbal abuse was 82%.
Dr Laurence Buckman, from the BMA said: "I've been verbally abused plenty of times and physically abused twice. Both times I was physically abused, the perpetrator was drunk." Dr Buckman sees a general culture of attacking authority in the UK. He said: "There's a sense that it's all right to beat up a teacher, that it's OK to beat up a policeman who hasn't done anything to you. There's something about assaulting people, verbally or physically, that is British."
Don't tolerate abuse
Help is at hand. Since 2003, the NHS Security Management Service (SMS) has been in place to tackle this problem. Since then, the number of prosecutions for assault has risen 15-fold. In 2002/3, there were 59 prosecutions; in 2004/5 there were 759.
The Legal Protection Unit at the NHS SMS, headed by a barrister, Gerard McEvilly, takes a firm line on prosecutions and civil injunctions of those who assault and abuse staff. There are times when the police feel that it is not in the public interest to prosecute, often in cases involving mental health issues. In such cases, the SMS often decides that it is worthwhile and does so. The protection of NHS staff is very much to the fore with the unit. All PCTs should now have a security management specialist in-post. If you have problems finding them, contact the SMS (www.cfsms.nhs. uk).
AMSPAR is very pleased to be working with the SMS in trying to tackle violence in primary care and community health services. Together with other organisations, including the Royal College of General Practitioners (RCGP), the BMA, the Royal College of Nursing (RCN) and Royal College of Midwives (RCM), we have signed up to a project aimed at ensuring that all NHS staff can work in a secure environment. Our advice to you who work on the frontline is to report all incidents of violence, both physical and verbal, which occur, and report them to the SMS. They are there to help you.
(Association of Medical Secretaries, Practice Managers, Administrators and Receptionists)
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