As GP practice staff work hard to deal with the post-pandemic backlog in care and provide an unprecedented number of appointments, many are distressed to be facing daily abuse from patients. Such abuse has risen markedly since before the pandemic, with serious consequences for the morale and mental wellbeing of primary care teams.
So what is driving this escalation in abuse and what can be done about it?
GP practice teams receive frequent abuse
Across healthcare specialties, GPs and practice staff are particularly likely to experience high levels of abuse and aggression from patients. The scale of the problem has grown dramatically during the pandemic, with three quarters of surveyed GPs reporting an increase in verbal abuse during 2021.
The abuse has included verbal insults – including racism, as well as threatening behaviour and even physical violence towards GPs, nurses and reception staff. GPs most frequently face this abuse in their consulting rooms, but it is also reported in waiting rooms and remote consultations, on phone calls, emails, texts and social media.
Chair of the Royal College of GPs, Professor Martin Marshall, said: “It’s entirely unacceptable for anyone working in general practice to be at the receiving end of abuse of any kind, let alone the threat of physical violence.”
What lies behind the worsening abuse?
The relationship between GPs and their patients has suffered as a result of COVID-19. Infection control measures reduced face-to-face consultations at the height of the pandemic and there are ongoing delays for patients because of the backlog in care. Often the patients giving abuse are frustrated with access to appointments and long waiting times for treatment and referral. Others have opposed the roll-out of vaccines. While GPs try to understand their patients’ concerns, they often have little control over the issues being raised.
The problem has been exacerbated by media claims about lack of face-to-face appointments. This is despite GP practices having worked throughout the pandemic to manage both face-to-face and remote appointments. Indeed, complaints about access to appointments are reportedly up by 82% even though the actual number of GP appointments being delivered is now higher than ever.
The impact on GP teams
Bearing the brunt of patients’ frustrations and anger is taking a toll on the wellbeing of practice staff, adding to the stress and anxiety from workload pressures and staff shortages. Primary care staff are frequently been left in tears by rude and abusive patients; many have needed to seek help from mental health services.
In a recent survey, 43% of GPs reported deteriorating mental health over the past year. With primary care already understaffed, it is vital that existing team members are supported so that patient safety is maintained. However, morale among exhausted GPs is low and the risk of burnout is high. Early retirements rose to a four-year high in 2021 and over half of GPs surveyed have said they are considering early retirement or leaving the profession.
What can be done to reduce the abuse?
Solutions suggested by doctors include education to help manage patient expectations, enhancing support services for the health and wellbeing of staff, increasing powers to prosecute people who abuse healthcare workers, and improved security.
According to a DHSC spokesperson, “The NHS has established an NHS Violence Reduction Programme which aims to support and protect the NHS workforce against deliberate violence and aggression from patients, their families and the public, and to ensure offenders are punished quickly and effectively.”
However, the British Medical Association (BMA) has called on the Government to support GPs and explain to the public why primary care is under pressure.
Professor Martin Marshall stressed that the real issue is the shortage of GPs, intensified by the pandemic. He urged the Government to deliver on its “manifesto pledge of an additional 6,000 GPs by 2024 – plus 26,000 additional practice staff” – to ensure the safe delivery of patient care “now and in the future”.
Dealing with abuse: resources for general practice
NHS England offers materials and guidance to encourage respect towards GP practice staff. These include posters with the message, ‘We are here to help you. Thank you for treating us with respect’. GP practices can also download graphics for social media and display screens, as well as wellbeing resources and support for managing patients available via FutureNHS.
The BMA provides further resources:
- Advice regarding the legal duties of employers to protect the health and safety of employees and HSE guidance on reducing the risk of violence in health and care settings.
- Guidance on removing a patient from the practice list, including in cases of violent or threatening abuse. Such cases should be reported to the police.
- Guidance on dealing with abuse on social media.
- Resources from the ‘Support your surgery’ campaign, with downloadable materials to help educate patients about the pressures in general practice.
For GPs and other primary care staff who are concerned about abuse from patients, expert medico-legal advice and support is available from Medical Defense Society.