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Reducing the Risk of Violence and Aggression in your Practice

Nobody wants to think about getting attacked at work, especially from a patient, but 1 in 7 healthcare workers experience physical violence in the workplace.

I know from my own experience as a PM that the last thing you expect in this job is to be squaring off against a VERY big fella with a bat in his hand, or defending your staff from a patient screaming in their face.

Violence in a GP Practice (or any other healthcare setting) is different from other workplaces since it means interacting closely with their patients and their families, usually under difficult circumstances. Patients may act aggressively due to a medical condition or medication, or there may be a history of violent behaviour or a feeling of frustration or anger as a result of their circumstances.

Figures from last year’s NHS Staff Survey showed that 14.9% had been subjected to physical violence while in work, even with the NHS having a Zero Tolerance policy since 1999, GP Practices will still have to deal with a minority of people who are abusive or violent towards staff. A Pulse survey in 2017 showed that 6% of primary care staff were attacked, with practice managers most likely to have experienced all forms of abuse - physical (9%), verbal (44%) and written(87%).


Employers have a duty of care for their staff and people using the service. The Practice is responsible for identifying and managing the risk of violence against staff while in work. Workers who are assaulted, threatened or abused at work also have legal pathways available to them which can result in damages against the Practice or individuals, the most common being a personal injury claim.

A Practice’s responsibilities are covered under law  by the following;

Assessing the risks in the workplace

The Health & Safety laws mentioned above focus on employers' assessing the “foreseeable risk” of their staff being subjected to violence (Section 2 of the HASAW). The Management of Health & Safety at Work Regulations says that an employer must consider the risk of foreseeable violence, so you should decide how significant those risks are and under Regulation 3 you must complete a Risk Assessment.

Bottom line – treat violence at work as a serious issue. Here’s a few things to consider;

Have you done a Risk Assessment?

Carry out a risk assessment of your practice;

  • assess the risk to your staff
  • how significant these risks are to staff safety
  • What to do to prevent/control them

This helps to identify hazards, evaluate any hidden risks to staff safety and what you can do to make it a safe place to work. It might not feel as straightforward as other types of risk assessments, but we have a template in our Policies & Procedures Library for FPM members that can help.

Risk assessment are an ongoing process to ensure that recommendations from your last assessment(s) have been implemented.

Have Policies in place that protect your staff

The first step is to have policies for employees that outline what is acceptable behaviour and how to deal with any potential incidents. Clear policies should be in place which explain the practice and staff responsibilities to set standards for workplace behaviour.

These policies can include the most common types of workplace violence, non-discrimination, racial or sexual harassment, drug and alcohol use, and safety procedures. Distribute the policies to all levels of the workplace including employees, managers, leadership, and contract workers. In addition, make sure you carefully establish a complaint process and communicate this process in your policies.

Staff Input is vital

Even with a Zero Tolerance Policy in the NHS, experts still believe it is significantly under-reported. A record of violence against staff should always be logged as incidents reports. Clinicians and non-clinical staff will have valuable – and usually first-hand – information so ask for their views on the existing measures in place and their own perception of the risk of violence. Surveys, questionnaires or interviews/discussions will help you get these details, but the key element is engaging with the team and getting their feedback on what to do to protect them as part of the practice.

Anticipate challenging behaviour

I’m sure there will be some patients who have a history of challenging behaviour that you are aware of, and there may be measures that you can put in place if they are due to attend an appointment at the practice. Have a process for preparing staff and that they are aware of what needs to be done when you know these patients are due to attend the practice.


When people don’t feel safe, they don’t perform at their best. Being prepared and actively involving your teams in the preparation will give them the confidence that action will be taken when you have a plan in place.

FPM subscribers can access the new ‘Violent and Aggressive Patients Risk Assessment Template’ and the ‘Violence in the Workplace Staff Survey Template’ from the FPM Policies and Procedures Library.

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Salary: £50,000-£65,000 p/a depending on experience

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Closing Date: 7 August 2020

Salary: £35-£40k

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