Unacceptable Behaviours Policy

At Newhills Medical Practice, we are commitment to offering a high-quality service and we believe that all our 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 using our Practice makes it very difficult for us to deal with their issue or complaint. In some circumstances, we need to take action to protect our staff or service from types of unacceptable engagement.

Any issues that arise that are not specified below, but are subsequently deemed unacceptable by the practice, will also be treated in accordance with our unacceptable behaviours policy.

This policy sets out how we identify and respond to unacceptable behaviours or actions.

Section 1 – Aggressive or abusive behaviour

We understand that patients may act differently or out-with their usual character in times of distress. Additionally, patients may feel angry about an issue that they have raised with the practice.

Any 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.

We will judge each situation individually, and appreciate individuals who come to us may be upset.

Language which is designed to insult or degrade, is derogatory, racist, sexist, transphobic, or homophobic or which makes serious allegations that individuals have committed criminal, corrupt, perverse or unprofessional conduct of any kind, without any evidence, is unacceptable.

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

The threat or use of physical violence, verbal abuse or harassment towards the Practice staff will result in immediate removal from the Practice list. We may report any incidents to the Police.

Practice staff will end telephone calls if they consider the caller aggressive, abusive or offensive.  Practice 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. We may consider issuing a warning to the Patient.

Section 2 – Unreasonable demands

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

Examples include, but are not limited to:

  • Repeatedly demanding responses within an unreasonable timescale
  • Repeatedly requesting early supplies of medication
  • Repeatedly requesting further supplies of stolen or lost/missing medication, without the required Police Incident number
  • Repeatedly ordering prescriptions out-with 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
  • Any other repeated demand that inappropriately takes up an excessive amount of staff time, and in so doing disadvantages other patients

Section 3 – Unreasonable levels of contact

Sometimes, the volume and duration of contact made to our Practice by an individual causes problems. This can occur over a short period, for example, a number of calls in one day. It may occur over the life-span of an issue, when a patient repeatedly makes appointments or sends communications regarding the same or a similar 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 with other Patients’ needs.

Where a patient repeatedly phones, visits the Practice, raises repeated issues, or sends large numbers of documents where their relevance isn’t clear, 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 the  Practice staff who will deal with future calls or correspondence from the patient about their issues
  • Assess the patient by in-person or telephone appointment only
  • 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.

Section 4 – Excessive requests for medical records

Under Part 3 of the Data Protection Act 2018, patients have rights of access to their personal data. This includes medical records.

The Information Commissioner’s Office advises that a request could be deemed as ‘excessive’ if an individual was to receive information via a subject access request (SAR), and then request a copy of the same information within a short period of time.

We are entitled to refuse to respond to a request if it is manifestly unfounded or excessive. Alternatively, we may charge a reasonable fee for dealing with the request. A list of non-NHS service changes can be obtained from the Practice.

Section 5 – Unreasonable refusal to co-operate

When we are looking at an issue or complaint, we will ask the patient to work with us. This can include: agreeing the defined issued; providing us with further information or provision of evidence or comments on request.

If a patient repeatedly refuses to co-operate, this makes it difficult for us to proceed. We will always seek to assist someone if they have a specific or genuine difficulty complying with a request. We consider it is unreasonable to bring an issue to us and then not respond to or co-operate with reasonable requests.

Section 6 – Unreasonable use of the complaints process

At Newhills, we strongly believe in a transparent complaints procedure and that patients have the right to pursue their concerns. They also have the right to complain more than once, if subsequent incidents occur.

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.

We consider 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. We reserve the right to do so in such cases.

Section 7 – How we manage unreasonable behaviour

Any member of the Practice 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 Practice List are only taken after consideration of the situation by Practice Partners.

We may decide to provide the patient with the opportunity to modify their behaviour or actions before a decision is taken.

We reserve the right to remove patients from the Practice list

Section 8 – Removal from practice list without warning

Removal without warning can only occur if:

  • A patient has moved outside the practice boundary, which is agreed by NHS Scotland. Patients should be given 30 days in which to make alternative arrangements. After this, the practice is no-longer responsible for treating the patient.
  • The Practice has reasonable grounds to believe that issuing a warning would be harmful to the patient’s mental or physical health, or put practice staff at risk.
  • It is, in the opinion of the Practice Partners, not otherwise reasonable nor practical for a warning to be given

If a warning is given, the practice is required to produce a written record of the date on which it was issued, including the reason(s) for the warning as explained to the patient, or the reason why no warning was given. 

Section 9 – Documentation & communication of warnings or notification of removal from the practice list

When a Partner or Practice employee makes an immediate decision in response to offensive, aggressive or abusive behaviour, the patient may be advised at the time of the incident.

We record all incidents of unacceptable actions by patients. When a decision has been made by the Practice Partners, communicated will be issued to the patient in writing regarding a decision that has been made to issue a warning (including the duration and terms of the warning) or removal from the Practice list.

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.

Section 10 – Appealing decisions

A patient may appeal a decision about the issuance of a warning or removal from the Practice list.

We will only consider appeals that relate to the warning or removal, and not to either the issue or complaint made to us, or to our decision to close a complaint.

The Practice Manager or a GP Partner who was not involved in the original decision will consider the appeal. They will advise the patient in writing that either the warning or removal still applies or a different course of action has been agreed.

We may review a warning periodically or on further request after a period of time has passed.

This policy is subject to review