Introduction

BrisDoc recognises that staff deal directly with members of the public at a time when they are anxious and vulnerable which might manifest in them behaving in ways that could be taken as being aggressive or violent. Staff may be sworn at, threatened or even attacked. BrisDoc has zero tolerance of violent and aggressive behaviours towards staff. This policy sets out how BrisDoc will endeavour to prevent violence and aggression to staff and support staff to manage violent and aggressive behaviours. This policy applies to all BrisDoc staff and supports BrisDoc deliver its core value to care for its workforce and resources. All staff have an interest in ensuring there is no or little violence and aggression at work in order to maintain the morale of the workforce and BrisDoc’s reputation as a good place to work; reduce absence, and retain the workforce.

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Definitions

Work related violence is:

“any incident in which a person is abused, threatened or assaulted in circumstances relating to the work.” (Health & Safety Executive)

This covers the serious or persistent use of verbal abuse which the HSE recognises can add to stress or anxiety, thereby damaging a member of staff’s health. It also covers staff who are assaulted or abused outside their place of work for example, while going home, while working in the community, or while travelling as long as the incident relates to their work.

Physical assault is:

“the intentional application of force against the person of another without lawful justification, resulting in physical injury or personal discomfort.”

Legal Requirements

The Health and Safety at Work Act 1974 (HSW Act) stipulates that employers have a legal duty under this Act to ensure, so far as is reasonably practicable, the health, safety and welfare at work of their employees.

The Management of Health and Safety at Work Regulations 1999 stipulate that employers must assess the risks to employees and make arrangements for their health and safety by effective:

• planning;
• organisation;
• control;
• monitoring and review.

The risks covered should, where appropriate, include the need to protect employees from exposure to reasonably foreseeable violence.

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) stipulate that employers must notify their enforcing authority in the event of an accident at work to any employee resulting in death, major injury or incapacity for normal work for three or more consecutive days. This includes any act of non-consensual physical violence done to a person at work.

Safety Representatives and Safety Committees Regulations 1977 (a) and The Health and Safety (Consultation with Employees) Regulations 1996 (b) stipulate that employers must inform, and consult with, employees in good time on matters relating to their health and safety. Employee representatives, either appointed by recognised trade unions under (a) or elected under (b) may make representations to their employer on matters affecting the health and safety of those they represent.

Effective Management of Violence and Aggression

Risk Assessment

Service Managers are responsible for undertaking and routinely reviewing risk assessments for harm from violence and aggression, in accordance with BrisDoc’s risk management policy, of the work areas and staff within BrisDoc they are responsible for.  Risks will be recorded in the risk register. Baseline security risk assessments and data against which change may be determined exist. This includes staff survey results.

Identification of risks may be aided with the use of the checklist produced below.

Checklist for Managers (in consultation with staff)

• Do staff in your area of responsibility have contact with the public during which violence may occur?
• Do you know whether a violence problem exists?
• If you are unsure, are you finding out more by taking soundings from managers and staff?
• If there is known to be a problem, do you have a reliable process for reporting incidents in accordance with the Incident Management Policy?
• Do you regularly analyse the data as a basis for deciding what measures may be needed – e.g. staff survey results for service/location?
• Have suitable preventive measures been adopted?
• Is the problem and your general approach to dealing with it referred to in your written safety policy?
• Have previous measures proved effective and how is their effectiveness monitored?

Risk factors for violent behaviour may be both staff and patient related:

• Patient Related Factors:

• • impatience
  • frustration
  • anxiety
  • resentment
  • drink, drugs and inherent aggression/mental health problems
  • the environment.

• Staff Related Factors:

• • Rising activity levels and workload
  • Working alone
  • Working in a situation about which little is known
  • level of training and information provided
  • design of the job
  • the environment.

Reducing Risk

Having identified vulnerable locations and activities steps should be taken to eliminate the risk of harm.  Where a risk cannot be eliminated and vulnerable locations/activities remain the manager must ensure the risk is reduced by changing the environment, redesigning the job, and/or providing staff with appropriate knowledge and skills.

Training and Information

It is recognised that physical violence of one form or another is a more common expression of a patient’s frustration, or that certain conditions tend to bring about such frustrations.  These frustrations of patients may be expressed in the form of verbal abuse and aggression. Conflict resolution training is provided by BrisDoc and will be undertaken by staff 3yearly who are considered to work in an environment where violence and aggression from the public is a risk. This will typically include:

• use of non-aggressive physical techniques to include breakaway moves and use of escape routes,
• interpersonal skill techniques to identify and diffuse that type of situation,
• knowledge on the rights of the individual to take action to protect themselves from physical abuse.

Staff will be provided with information and notices of “zero tolerance to violence and aggression” will be displayed where relevant.

Environment

The consulting and waiting room environment may present risk factors for violence and aggression including for example:

• waiting times,
• availability of reading material,
• seating arrangements,
• decor,
• availability of information,
• availability of entertainment, e.g. television,
• furnishings which may be used as missiles or weapons.

Every effort will be made to ensure that the environment is conducive to the prevention of injury and reducing the risk of violence and aggression. BrisDoc will liaise with its landlords to ensure the environment it provides clinical care from is as conducive as possible to providing a calm and stress free experience for patients. This could include the provision of better seating, decor, and lighting in public waiting rooms. Measures to improve staff safety include video cameras or alarm systems, coded security locks on doors to keep the public out of staff areas, wider counters and raised floors on the staff side of the counter to give staff more protection.

BrisDoc will ensure patients are provided with regular information about delays and are supported with their refreshment needs as measures to reduce anxiety. Staff will treat patients in a timely and respectful manner.

Clinicians can reduce their risk by improving the consulting environment to ensure they cannot be trapped in the room by an aggressive patient, have quick access to the panic alarm and/or personal alarms made available to them.

Job Design

BrisDoc managers and staff will take appropriate measures to ensure jobs and tasks minimise the risk of violence and aggression in the workplace. For example:

• Make theft less attractive by keeping valuable items out of sight (e.g. equipment, prescriptions), limiting the amount of petty cash held on site.
• Check the credentials of clients, and the place and arrangements for any meetings away from the workplace.
• Arrange for staff to be accompanied by a colleague if they have to meet a suspected aggressor at their home or at a base.
• Ensure visiting staff can summon help quickly.
• Make arrangements for staff who work away from their base to keep in touch.
• Maintain numbers of staff at the workplace to avoid a lone worker situation developing.
• The threat of violence does not stop when the work period has ended. It is good practice to make sure that employees can get to their vehicles/transport safely.

Successful solutions are achieved where staff are involved in helping to design and put them into practice. A mix of measures provides the best solution to reduce risk.

Police Intervention

It is the right of an individual to call the police to their assistance, or the assistance of a colleague, by using the emergency services number.  It is not the intention of this policy to encourage this practice; however it must be recognised that staff have a legal right to be protected by the police in such circumstances.

The training programme should include guidance on recognition of situations where it is unlikely that an individual staff member is able to contain the situation and needs the assistance of the police.

BrisDoc will support staff who may wish to prosecute the client, patient, employees or member of the general public who have assaulted them in the course of their duty with advice.  Such prosecutions would come under the auspices of the Offences against the Persons Act.  BrisDoc should also be mindful of their obligation to sanction staff who inflict violence on colleagues.  The disciplinary procedure will be invoked if the circumstances require it.

Support and Care for Staff

BrisDoc recognises that exposure to violence and aggression, be it physical or verbal, may cause staff psychological trauma and will support staff to ensure the effect is minimised.  To this end BrisDoc has a five point plan for supporting staff following an incident of violence or aggression. Staff will be supported by their Line Manager as soon as possible after the incident through de-briefing, discussion and the offer of counselling where appropriate. BrisDoc will be committed to provide and pay for staff to access a counsellor where appropriate to support the affected staff member (up to 6 sessions).

Managers will identify staff who are particularly exposed to violence and aggression.  The support that an individual, or individuals, may receive from within their immediate peer group is a valuable asset and, as such, techniques for using group support should be developed.  Managers are responsible for ensuring that time is allocated for group discussion and may provide an external facilitator as appropriate.

Co-consulting one to one allows each individual space to express their concerns.  This technique can be used to great effect.  Its use should be encouraged and training should be provided so that its value can be maximised.

Five Point Plan

The five point plan outlines a framework of actions to be taken and documented, for members of staff who have reported an incident of violence and/or aggression.  Whilst it may not be appropriate or possible to complete all steps, line managers should use and complete the plan to ensure they have considered all points, to ensure assurance is provided.

The plan’s key principles are as follows:

• There is no set criteria for incidents that may be classed as “violence or aggression”. All incidents where staff members have raised concerns or have felt vulnerable will be taken seriously.
• Although there are inherent risks with working with the general public, dealing with incidents of violence and aggression are not considered to be an acceptable part of the job.
• The five point plan should be used in conjunction with the BrisDoc policy on managing violence and aggression. The framework is not prescriptive and should be responsive to the member of staff’s needs and the individual incident.

Reporting and Monitoring

Every incident where a member of staff considers that they have been exposed to violence must be recorded using the BrisDoc incident form in accordance with the Incident Management Policy. This should be completed by the end of the shift. Where circumstances allow, the individuals themselves should complete the form.  If this is not appropriate due to the physical and mental state of the member of staff, then their immediate manager should complete the form using the information they have available.  There may also be a requirement to report incidents under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995.

The HSE provides a simple classification of incidents of violence and aggression as follows:

• Fatal injury
• Major injury – requiring medical assistance e.g. fractured bone; internal injury; unconsciousness; cut requiring stitches; deep puncture wound; hospital treatment or admission for observation
• Injury or emotional shock – requiring First Aid (minor injuries) e.g. cuts, bruises, grazes; any other injury requiring only ‘first aid’ type treatment such as dressing on pain killers.
• Feeling of being at risk or distressed – involving verbal abuse, resulting in an employee feeling intimidated.

 

Incidents are recorded in BrisDoc’s IRIS/ClarityTeamNet systems, reported monthly on the Corporate Dashboard to the senior management team and reviewed quarterly at the urgent care and practice services governance meetings.

Related Policies and Procedures

• Risk Management Policy
• Incident Management Policy
• Health & Safety Policy
• Lone Working and Personal Safety Policy
• Five Point Plan for Supporting Staff Following an Incident of Violence and Aggression

 

Appendix 1 – Zero tolerance

 

 

ZERO TOLERANCE

BrisDoc takes it very seriously if any member of staff is treated in an abusive, violent or aggressive way.

Brisdoc supports the government’s ‘Zero Tolerance’ campaign for Health Service Staff. This states that GPs and their staff have a right to care for others without fear of being attacked or abused. To successfully provide these services a mutual respect between all the staff and patients has to be in place. All BrisDoc staff aim to be polite, helpful, and sensitive to all patients’ individual needs and circumstances. Staff understand that ill patients do not always act in a reasonable manner and will take this into consideration when trying to deal with a misunderstanding or complaint.

However, aggressive behaviour, be it violent or abusive, will not be tolerated and may result in a patient being asked to leave the premises or in the case of a telephone call, replacing the handset and, in extreme cases, the Police being contacted.

In order for BrisDoc staff to maintain good patient relationships the following unacceptable forms of behaviour will be displayed throughout BrisDoc services and in patient facing communications:

• Using bad language or swearing at our staff or other patients
• Any physical violence towards any member of staff or other patients, such as pushing or shoving
• Verbal abuse towards the staff in any form including verbally insulting the staff
• Racial abuse and sexual harassment will not be tolerated within this service
• Persistent or unrealistic demands that cause stress to staff will not be accepted. Requests will be met wherever possible and explanations given when they cannot
• Causing damage/stealing from our premises, staff or patients
• Obtaining drugs and/or medical services fraudulently

Staff will be supported through Customer Service and Conflict Resolution training to manage a situation where they experience verbal or physical violence, abuse or aggression. Staff are expected to remain polite, calm and use clear communication in such situations, and will be fully supported in the action taken to manage them in accordance with BrisDoc’s expected standards. Staff experiencing violence, aggression or abuse will be supported through the Five Point Plan (section 4.4.1).

 

 

Change Register

 

Date	Version	Author	Change Details
August 2019		CL Nicholls	Map to new policy template. Update in line with new governance framework, include 5 point plan.
June 2021	3.3	T Clutterbuck	Zero Tolerance appendix 1 added
27th February 2024	3.4	M Duncan	Changed owner