Following our recent webinar on statutory compliance for GP practices considering various premises related health and safety obligations, the role of leases and effective digital record keeping to show compliance, we consider another aspect: providing a safe environment for staff.

Research published by the BMJ last year shows violent incidents at GP practices has almost doubled over a five year period. This acts as a timely reminder to think about what appropriate action should be taken to ensure safe practice premises for staff and patients.

Given the thousands of patients visiting GP premises and health centres every day, the actual numbers of recorded crimes are relatively low. However, for the individual victims, of course, the effect may be life-changing. Managing difficult patients can also be challenging for a practice, but there are effective ways to help protect staff.

Legal obligations

The obligations on a practice to address such issues will arise from various sources and from its roles as employer, service provider and owner (or tenant) of practice premises.

Key relevant legal obligations include:

• ensuring as far as is reasonably practicable the health and safety of employees, patients and visitors to the premises (Health and Safety at Work etc. Act 1974)
• security arrangements to make sure that people are safe while receiving care (Care Quality Commission (CQC) Fundamental Standards Regulation 12)
• sufficiently trained staff (CQC Regulation 18).

Risk assessment

As with many health and safety obligations, the starting point in addressing required and recommended actions is to conduct an adequate risk assessment. The basic purpose of the risk assessment is to identify hazards, evaluate risks and implement, monitor and review measures to reduce the risks – in this case potential aggressive behaviour to staff and other patients. The Health and Safety Executive (HSE) even has specific guidance on assessing workplace violence in a health and social care setting.

The followings areas are likely to be of note in a risk assessment for GP premises:

• The physical environment
  
  Are access ways well-lit and visible? Are there good lines of sight? There is various guidance showing how the impact of colour palette, signage and layout can help reduce and better manage the risk of patient violence. One study reported a 50 per cent reduction in violent incidents in A&E as a result of design and signage changes.
• Lone staff or visitors
  
  Do you have lone workers or those conducting visits? What reasonably practicable measures can be put in place to address additional risks?
• Level of staff training
  
  Do staff receive appropriate training, such as basic techniques in managing challenging behaviour or de-escalation, with greater training for those in higher risk situations?
• Procedures and policies in place
  
  Are there appropriate policies and procedures in place for handling incidents, emergencies and particular high-risk patients, and dealing with threatening patients, such as warning letters and acceptable behaviour agreements?
• Equipment availability
  
  Is appropriate equipment available, such as panic buttons or alarms?

Serious consequences

Failure to have adequate systems in place can have serious consequences. For example, a staff member injured by a patient could bring a claim for financial compensation for harm, or in an employment tribunal. The employer could also face a health and safety prosecution or fine.

Dealing with serious threats

Cases of stalking of a GP by a patient are very rare, but not unknown. Some years ago a male patient was imprisoned for a campaign of harassment against a female GP which led to serious mental health consequences.

A common sense approach to dealing with violent incidents includes contacting the police as a first port of call. It is also important to keep a log of events in case the acts become repeated by a particular individual and evidence is needed to pursue formal action, or patterns emerge which can be assessed to help reduce risk.

Interestingly, the Criminal Justice and Immigration Act 2008 created an offence and power to remove those creating a nuisance from certain NHS premises. The legislation does not cover GP premises, but rather hospital and other facilities on hospital grounds. Options that GPs do have include removing an individual from the practice list if certain criteria are met. There is a careful process to follow but violent or threatening behaviour can be grounds to justify removal of a patient from the list.

Practices should have a policy on dealing with difficult behaviour, such as escalating correspondence and setting out how decisions will be taken, including clinical input. These steps often act as a pre-cursor to removing a patient and help establish a clear and reasonable process for the practice to follow.

In cases of harassment or violence, the police have a range of powers that can be used and there are various criminal offences. Liaising with the police and ICB would be the first recommendation. In certain circumstances, a practice might consider taking action itself. The Protection from Harassment Act 1997, which creates a criminal offence of harassment, also gives a civil court the power to issue an injunction (a court order) preventing someone from carrying out acts of harassment against other specified individuals.

The threshold for acts that constitute harassment is relatively high and to obtain an injunction it is necessary to show a course of conduct causing alarm or distress. In 2012, that Act was updated to include specific offences and remedies in relation to stalking. Whilst seeking an injunction from the court comes as something of a last resort, Capsticks have successfully obtained them: for example in regard to the release from a psychiatric unit of a patient known to be fixated on a former healthcare professional still living in the area.

Here are some key tips to consider for protecting practice staff and complying with legal obligations:

• Have the environment and staff procedures been risk assessed and identified actions completed?
• Can the physical environment be adapted to be safer?
• Ensure policies are up-to-date (dealing with violent patients, lone working etc).
• Make sure staff are trained in how to respond.
• Are appropriate equipment and safeguards in place?
• Keep a record of any incidents that take place, and consider ‘debriefing’ staff.
• Where appropriate, report incidents to the police.
• Seek further advice if necessary.

How Capsticks can help

Capsticks’ Primary Care team knows the workings of healthcare practices inside and out, including the safety challenges they face. Our legal experts understand the need for robust adherence to health and safety procedures. 

If you have any queries around what's discussed in this insight, and the impact on your primary care organisation, please speak to Daniel Kirk, or any of your contacts at Capsticks, to find out more about how we can help.

This page was correct at the time of publication. Any guidance is intended as general guidance only. If you need specific advice relating to your own circumstances, please contact us at Capsticks.