Violent incidents at GP surgeries double in five years, BMJ investigation findsBMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1333 (Published 31 May 2022) Cite this as: BMJ 2022;377:o1333
The number of violent incidents at UK general practices recorded by police forces has almost doubled in the past five years, an investigation by The BMJ has found.
Crime figures obtained from police forces around the UK show that violent incidents at GP surgeries and health centres have increased every year since 2017. Worryingly, the figures also show a near doubling of assaults that cause physical harm.
The rise in violent incidents and abuse aimed at GPs and their staff is causing some to leave their jobs, GPs have warned (boxes 1-3). “We have to try to address this because it leads to burnout of our staff, demoralisation, and staff leaving the service altogether,” said Richard Vautrey, a GP in Leeds and former chair of the BMA’s General Practitioners Committee.
“He said was going to hurt somebody”
Alan Stout, a GP in east Belfast and chair of the Northern Ireland General Practitioners Committee, told The BMJ how a recent incident of violence at the hands of a patient in March had affected GPs and staff:
“It began with a phone consultation—a patient was looking for additional medication. He got progressively more aggressive throughout the course of the conversation, and it culminated in him saying that he was coming down to the practice there and then and he was going to hurt somebody. So we locked the front door. The staff were in the reception and office area; there was only one doctor on [duty] at the time, and he was in his consulting room.
“The individual then appeared, kicked the locked front door down and stormed in, and then started attacking the door and the window to the reception where the reception staff were. At this point the doctor then had to lock themselves in their room. The police were contacted and subsequently arrived, and he was then arrested.
“We are getting increasing aggression and abuse on phones and then also on occasion in person at the practice as well. It absolutely has an effect on our practice and staff. We now keep the door to reception locked at all times. Also, quite frustratingly, we’ve ended up closing for an hour over lunchtime, predominantly to protect our staff. We had tried very hard to remain open at all times throughout the day, but by doing that we were reducing the number who were there [at lunchtime], and they were in a very exposed position.”RETURN TO TEXT
“Targeted abuse of individuals on social media”
Richard Fairclough, a GP partner at Riverside Medical Practice in East Lothian, said that his practice frequently experienced various types of abuse:
“This might be our call handlers being verbally abused over the phone or at the front desk, but also, increasingly, targeted abuse of individuals on social media. We recently needed to take the hard decision to remove the names and photos of our staff from our website, because some of them had been targeted by an anonymous Twitter user. We didn’t like doing that, but we need to protect our team.
“Thankfully, we haven’t seen the extreme, horrifying abuse that some staff at some other surgeries have experienced, but nonetheless there has been a very real impact on our team, which does then have a knock-on impact on the care we can give to our other patients. On a day-to-day basis we’ve seen members of our call team being very upset, and we think that abuse by patients—tied with unprecedented demand as we exited the first lockdown—did contribute to us losing a substantial number of team members from our call team back in late 2020.
“There’s a very real mismatch between patient demand and capacity in health services right across the country, and that’s what this is about, ultimately. If patients could get the healthcare they needed quickly and easily, every time, I’ve no doubt that abuse would decrease.”RETURN TO TEXT
“I’ve had a person threaten to come down and stab me”
Adam Janjua, a GP in Fleetwood, Lancashire, said, “In the past 2-3 years we’ve seen a huge rise in incidents. I’ve never seen it like this. The most recent time that we had to call the police was in a row over a person not wearing a mask. They shoved me in the chest. I’m quite a big guy, but if it had been someone else he could have done some real damage.
“I’ve had a person threaten to come down and stab me when I least expect it. We’ve had to update our zero tolerance signs to add ‘intimidation.’ Staff feel very mentally drained each day. We have a lot of abuse over the phone, people saying things like, ‘You don’t actually do anything.’ Most GPs don’t report these types of incidents to the police, as they don’t want to get tied up in red tape and it can take a long time.”RETURN TO TEXT
GP leaders said that the “appalling” figures showed how assaults, harassment, and other forms of abuse aimed at doctors and their staff had worsened during the pandemic, as services came under increased pressure and some sections of the media perpetuated the idea that GP services were “closed.”
A recent survey by the medical defence organisation MDDUS found that three quarters of GPs had faced an increase in verbal abuse or aggression from patients, leading to a big rise in work related stress.1 The UK annual conference of local medical committees recently proposed that practices be given greater powers to remove patients immediately from their list of registered patients if they abused GPs and staff, including verbally.2
Richard Van Mellaerts, a GP in Kingston upon Thames and an executive officer for the BMA’s GP Committee, said that the figures obtained by The BMJ matched the experiences of doctors in primary care clinics, including his own. He said, “I regularly hear abuse directed at reception staff in my practice. We’ve had to call the police several times over the last year.
“I know GPs who have been attacked, their reception area has been damaged, and their consultation room has been wrecked. It is absolutely appalling. Any single instance of abuse or violence or harassment towards any GP or practice staff or any NHS staff is one too many, and it should never be tolerated. It is tremendously sad that we’re seeing this.”
Surge in violent crime
The BMJ sent freedom of information requests to the 45 police forces in the UK, asking for the number of recorded crimes committed at general practices and how each crime was categorised. A total of 42 forces (93%) had sent responses by the time of publication, 32 of which (71%) were able to provide complete and comparable data for the past five years.
The figures show a near doubling of violent incidents over the past five years. In total the 32 police forces recorded 1068 incidents of violence at health centres and GP surgeries in 2021-22, up from 791 in 2020-21 and from 586 in 2017-18 (fig 1). These figures include all incidents defined in the category of “violence against the person,” which includes all forms of assault and harassment.
Within this number were 182 assaults resulting in injury last year—the highest for five years and almost double the 98 recorded in 2017-18.
Also within this number, recorded incidents of stalking and harassment at GP surgeries have almost tripled over the past five years, with 223 instances last year, up from 85 in 2017-18. This was largely driven by a surge in malicious communications, which can include sending letters or emails and which increased from 25 in 2017-18 to 92 last year.
As well as a rise in incidents of violence, public order offences such as threatening behaviour rose by 24% last year, from 438 in 2020-21 to 541, and were up 40% on five years ago (387) (fig 2).
The most recent NHS staff survey figures show that 14% of NHS staff experienced at least one incident of physical violence from patients, service users, relatives, or other members of the public in the past 12 months, while 28% experienced at least one incident of harassment, bullying, or abuse.3
But the survey figures cover only NHS trusts and do not give a clear picture of incidents at GP surgeries.
Vautrey said that the police crime figures represented only a fraction of incidents in general practice. “It’s often daily abuse that staff are having to deal with,” he told The BMJ. “It can sometimes generate much more significant incidents that are reported to the police. But the figures from the police are just the tip of a much, much bigger iceberg, and many staff have almost become accepting of the fact that this is part and parcel of that role, which is simply not acceptable in itself.”
Why is it happening?
Van Mellaerts said that, as well as the police and courts taking action against perpetrators of violent crime, to tackle the problem it was important to understand why the increase in abuse and violence was happening.
“Some sections of the media have driven a view that general practice was closed during the pandemic, which is of course the opposite of the truth,” he said. “Unfortunately, that opinion has been adopted by some people, and that’s been a driver for some of the aggression. That’s not been adequately quashed by the government, which could have taken the opportunity to be more supportive of general practice.
“In addition, the number of remote and telephone consultations has gone up dramatically, and some patients are finding that difficult to comprehend, which can then feed into the narrative of general practice being closed. Plus there are simply fewer GPs doing more and more, so it’s no surprise that some patients are finding it difficult to access the care they need. This never excuses any kind of violence . . . but it is vital that the government grasps hold of some of these issues and solves them in order to nip this in the bud.”
As well as being deeply distressing for the people involved, the rise in violent incidents and abuse aimed at GPs and staff will only exacerbate the staff shortages that are contributing to difficulties in accessing care, leaders warned.
Vautrey has recently been working with NHS officials in West Yorkshire on a patient facing campaign called Leaving a Gap,4 which aims to explain the consequences of abusing GPs and their staff. He said, “The risk is that this constant and repeated abuse leaves people unwilling to do the job, and we’re not then able to recruit people to replace them. That makes the problem worse because we’ve got fewer staff to be able to respond to the needs of patients, and their concerns increase, so this becomes a real vicious circle.
“The intent of the campaign is to highlight these things to patients, to try to encourage them to be much more kind and considerate and understanding of our hard pressed workforce and to understand the consequences of repeated abuse.”
Van Mellaerts said that his own practice had lost reception staff because of the way they had been treated. “We had two reception staff who both left within a fortnight because they could not stand how they were spoken to every day on the telephone and face to face by patients,” he said. “These are people who had come to work in general practice and had been genuinely interested in the work, and they found themselves ground down in such a short period of time that they couldn’t tolerate it.
“We appreciate patients’ frustrations and upset with delays in their care, but those frustrations need to be channelled into holding governments to account—[so] that they invest appropriately in general practice and solve these systemic issues—not taken out on their GPs and practice staff.”
In 2020 the NHS joined forces with the Metropolitan Police Service and the Crown Prosecution Service to launch Operation Cavell,5 a pilot scheme that aimed to increase the number of convictions for attacks on healthcare staff by assigning a senior officer to review all reports of assaults and hate crimes against NHS staff. It has now been rolled out more widely.
Data from the Ministry of Justice show that in 2021 there were 17 043 prosecutions on the charge of assault of an emergency worker, of which 13 422 cases were convicted.6 This compares with 13 392 prosecutions and 10 626 convictions in 2020, and 11 257 prosecutions and 9350 convictions in 2019.
In response to The BMJ’s findings a spokesperson for the Department of Health and Care for England said, “Deliberate violence or abuse directed at NHS staff, who continue to work tirelessly to provide care, is unacceptable. All staff, including GPs and their teams, deserve to work in a safe and secure environment.
“The NHS violence reduction programme [box 4] aims to protect the workforce and ensure offenders are punished quickly and effectively, and the government has taken action to support this—including by passing legislation to double the maximum sentence for assaults on emergency workers, including those in the NHS.
What is the NHS violence reduction programme?
The programme was set up to deliver a coordinated response to reducing violence in England’s health services. Its aims include:
Running training to improve the safety and wellbeing of staff working in primary care
Delivering a new risk based framework that supports a safe and secure working environment for NHS staff
Legislating to double the maximum sentence for an assault on emergency or NHS workers to two years
Working with the Crown Prosecution Service to ensure more effective investigation and prosecution of cases
Supporting a national process of collecting data on incidents of violence against staff across the NHS
Improving training for staff to deal with violence, including circumstances involving patients with dementia or mental illness
Ensuring prompt mental health support for staff who have been victims of violence, and
Investing £8.4m in a trial of body worn cameras for ambulance service staff in England.
“Security measures including CCTV, panic buttons, and screens at reception have also been rolled out across GP surgeries.”
NHS England recently updated its Primary Medical Care Policy and Guidance Manual for service commissioners to add a chapter on managing inappropriate and unacceptable patient behaviour, including protecting against discrimination, harassment, and victimisation.7
An NHS spokesperson said, “It is unacceptable that NHS staff, including GPs, who work around the clock to protect patients and went above and beyond to care for millions of people during the pandemic, are experiencing abusive, intimidating, and violent behaviour at work.
“The NHS will not tolerate abuse or violence towards its staff and, despite the despicable actions of a minority, is grateful for the overwhelming sense of national support NHS workers have received from the wider public over the last two years as it stepped up to fight covid.”