Zero Tolerance Policy

Confidentiality notice

This document and the information contained therein is the property of the following practices:

• All Inspire Healthcare Sites

This document contains information that is priveleged, confidential or otherwise protected from disclosure. It must not be used, or its contents reproduced or otherwise copied or disclosed withoutout prior consent in writing.

Introduction

We believe that patients have a right to be heard, understood and respected. We work hard to be open and accessible to everyone. Occasionally, the behaviour or actions of individuals registered with the Church Street Group makes it very difficult for us to deal with their issue or complaint. In a small number of cases the actions of individuals become unacceptable because they involve abuse of our staff or our process. When this happens we have to take action to protect our staff, and must also consider the impact of the individual’s behaviour on our ability to do our work and provide a service to others. This policy explains how we will approach these situations.

What actions are considered ‘unacceptable’?

People may act out of character in times of trouble or distress. There may have been upsetting or distressing circumstances leading up to us being made aware of an issue or complaint. We do not view behaviour as unacceptable just because a patient is forceful or determined. However, we do consider actions that result in unreasonable demands on our practices, or unreasonable behaviour towards our staff, to be unacceptable. 

Aggressive or abusive behaviour

We understand that patients may be angry about the issues they have raised with the group. However, if that anger escalates into aggression towards our staff, that is unacceptable.

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 behaviour or language (whether verbal or written) that may cause staff to feel offended, afraid, threatened or abused. 

Language intended to insult or degrade, is derogatory, racist, sexist, transphobic, homophobic or which makes serious allegations that individuals have committed criminal, corrupt, perverse or unprofessional conduct of any kind, without any evidence, is unacceptable.  This includes language delivered verbally, in writing or posted on social media.

We may decide that comments aimed not at us, but at third parties, are unacceptable because of the effect that listening or reading them may have on our staff.

Unreasonable demands

A demand becomes unacceptable when it starts to (or when complying with the demand would) impact substantially on the work of the group. 

Examples of such actions include:

• Repeatedly demanding responses within an unreasonable timescale
• Repeatedly requesting early supplies of medication
• Repeatedly requesting further supplies of stolen medication, without the required Police Incident number
• Repeatedly ordering prescriptions outside of the set timeframe
• Insisting on seeing or speaking to a particular member of staff when that is not possible
• Repeatedly changing the substance of an issue or complaint or raising unrelated concerns
• Repeatedly insisting on a course of medical treatment for which there is no clinical evidence
• Not ensuring that a review appointment is in place, prior to ongoing medication finishing

Unreasonable levels of contact

Sometimes the volume and duration of contact made by an individual causes problems. This can occur over a short period, for example, a number of calls in one day or one hour. Alternatively, it may occur over the life-span of an issue when a patient repeatedly makes long telephone calls to us, or inundates us with letters or copies of information that have been sent already or that are irrelevant to the issue. 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 the needs of other patients.

Unreasonable refusal to co-operate

While looking into an issue or complaint, we will ask the patient to work with us. This may include providing us with further information, evidence or comments on request; or helping us by summarising their concerns or completing a form for us.

If patient repeatedly refuses to cooperate, it can be 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 unreasonable to bring an issue to us and then not respond to reasonable requests.

Unreasonable use of the complaints process

Individuals with complaints about the Church Street Group have the right to pursue their concerns through a range of means. They also have the right to complain more than once, if subsequent incidents occur. However, 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.

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.

Examples of how we manage aggressive or abusive behaviour

• The threat or use of physical violence, verbal abuse or harassment towards our staff is likely to result in a warning from the Senior Management Team. Incidents may also be reported to the Police – this will always be the case if physical violence is used or threatened.
• Staff will end telephone calls if they consider the caller aggressive, abusive or offensive. Our staff have the right to make this decision, to tell the caller that their behaviour is unacceptable and end the call if the behaviour persists.
• We will not respond to correspondence (in any format) that contains statements that are abusive to staff or contain allegations that lack substantive evidence. Where possible, we will return the correspondence explaining that we consider the language used to be offensive, unnecessary and unhelpful. We will also state that we will not respond to their correspondence if the action or behaviour continues and may consider issuing a warning.

Examples of how we deal with other categories of unreasonable behaviour

The Church Street Group will take action when unreasonable behaviour impairs the service that we are able to offer to all of our patients. 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.

Other actions that may be taken

If a patient repeatedly phones, visits, raises repeated issues, posts unhelpful or abusive messages on our social media sites or sends a large number of documents that are not relevant 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 staff who will deal with future calls or correspondence from the patient about their issues.
• 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.
• Block them from our social media platforms.
• 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.

Removal from the patient list 

The removal of patients from our list is an exceptional and rare event and is a last resort in an impaired patient-practice relationship. 

We value and respect good patient-doctor relationships based on mutual respect and trust.  However, when that trust has irretrievably broken down, the Church Street Group will consider all factors before removing a patient from our list, and communicate to them that it is in the patient’s best interest that they should find a new practice. An exception to this is in the case of immediate removal on the grounds of violence e.g. when the Police are involved. 

Removing other members of the household 

Due to the potential need to visit patients at home, it may be necessary to terminate responsibility for other members of the family or the entire household to ensure the safety of our staff. This is more likely in cases where the patient has been removed following a violent incident or display of threatening behaviour.  In such circumstances, keeping the other family members could put doctors or their staff at risk

The process we follow to make decisions about unreasonable behaviour

• 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 our patient list 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.

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 Senior Management, 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 to remove them from the patient list. This ensures that the patient has a record of the decision.

How we record and review a decision to issue a warning

All incidents of unacceptable actions by patients are recorded. Where it is decided to issue a warning to a patient, an entry noting this is made in the relevant file and on appropriate computer records. The decision to issue a warning to a patient may be reconsidered either on request or on review.

The process for appealing a decision

It is important that a decision can be reconsidered and a patient can appeal a decision about the issuance of a warning or removal from the practice list. If they do this, we will only consider arguments relating to the warning or removal, and not to the issue or complaint made to us, or our decision to close a complaint.

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.

A Practice Manager or a GP Partner who was not involved in the original decision will consider the appeal. They have discretion to quash or vary the warning as considered appropriate and their decision will be made based on the evidence available to them. The patient must be advised in writing of the outcome of the appeal. We may review the warning periodically or on further request after a period of time has passed. Each case is different.