Zero tolerance

1. Policy Statement

This GP Practice is committed to providing a safe, respectful, and supportive environment for patients, staff, contractors, and visitors. We operate a Zero Tolerance approach to violence, aggression, abuse, and unacceptable behaviour. Any behaviour that causes fear, distress, or risk to safety will not be tolerated.

This policy aligns with NHS guidance and supports the Practice’s legal duty under the Health and Safety at Work Act 1974 to protect staff and others from harm.

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• Scope

This policy applies to:

• All patients registered with the Practice
• Family members, carers, and visitors
• Any individual interacting with the Practice in person, by telephone, in writing, or electronically (including email and social media)

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• Definitions of Unacceptable Behaviour

• Inappropriate Behaviour

Behaviour that is unacceptable and disruptive but not immediately threatening, including but not limited to:

• Use of offensive, discriminatory, or derogatory language
• Excessive rudeness or sarcasm towards staff
• Inappropriate comments of a sexual, personal, or discriminatory nature
• Shouting or raised voices
• Repeated interruption of staff

• Aggressive Behaviour

Behaviour that causes intimidation, distress, or fear, including:

• Verbal abuse or swearing directed at staff
• Threatening language or gestures
• Intimidating behaviour such as invading personal space
• Persistent hostility after being asked to stop

• Violent Behaviour

Behaviour involving or threatening physical harm, including:

• Physical assault or attempted assault
• Damage to Practice property
• Throwing objects
• Threats of violence to staff, patients, or visitors
• Possession or use of weapons

3.4 Persistent Unrealistic Demands and Refusal to Follow Practice Protocol

Including but not limited to:

• Repeated demands for appointments, prescriptions, referrals, or outcomes that are clinically inappropriate or outside NHS guidance
• Refusal to follow agreed care plans, appointment systems, or triage processes
• Repeatedly ignoring Practice policies after clear explanation
• Harassing staff through repeated calls, messages, or visits
• Refusal to engage respectfully with alternative solutions offered by the Practice

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• Warning Process

• First Incident – Formal Warning

For any incident of inappropriate or unacceptable behaviour that does not warrant immediate removal:

• A formal warning will be issued verbally and/or in writing by the Practice Manager or Patient Liaison Officer

• The warning will clearly state:

• The nature of the unacceptable behaviour
  • That the Practice operates a Zero Tolerance Policy
  • That any further incident will result in removal from the Practice list

• The incident and warning will be fully documented in the patient record and/or incident log

• Second Incident – Removal from the Practice List

If there is a further incident of inappropriate, aggressive, or unacceptable behaviour following a formal warning:

• The patient will be removed from the Practice list
• Removal will be carried out in line with NHS regulations
• The patient will be informed in writing of the reason for removal
• NHS England / the Integrated Care Board (ICB) will be notified as required

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• Immediate Removal from the Practice List

The Practice reserves the right to immediately remove a patient from the Practice list without warning in cases of:

• Actual or threatened violence
• Serious aggression or intimidation
• Damage to property
• Behaviour that places staff, patients, or visitors at risk

Immediate removal will be carried out in line with NHS regulations and the patient will be informed in writing. The Practice may also:

• Contact the police
• Notify NHS England / Integrated Care Board (ICB)

Patients removed immediately will be advised by Primary Care Support England (PCSE) how to register with another GP and how to access emergency care.

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• Support for Staff

The Practice will:

• Support staff who experience abuse or aggression
• Encourage reporting of all incidents
• Record incidents and review them regularly
• Offer debriefing and access to occupational health, or counselling where appropriate

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• Equality and Reasonable Adjustments

The Practice recognises that some patients may have conditions or circumstances that affect behaviour. Where appropriate:

• Reasonable adjustments will be considered
• Support from carers or advocates may be encouraged

However, this does not justify violent, threatening, or abusive behaviour, which will still result in action under this policy.

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• Communication of the Policy

This policy will be:

• Displayed prominently within the Practice premises
• Available on the Practice website
• Included in new patient registration information

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• Review

This policy will be reviewed annually or sooner if required due to changes in legislation or NHS guidance.