Abuse towards general practice staff ‘widespread’

Violence and abuse in general practices are common in many countries including Australia, according to a recent study.
 
A scoping review, ‘Violence and abuse towards general practice staff by patients and the public’, was published this week in the British Journal of General Practice.
 
It looked at 50 studies from 24 countries including nine studies from the UK and six from Australia, with rates for violence and abuse by patients and the public towards staff ranging from 13.8% to 90.3% for the past year.
 
Career-long estimates varied from 18.3% to 91.0%.
 
According to the researchers, long waiting times and unmet patient demands were the most common reasons for the abuse or violence.
 
‘It had an impact on staff mental health, turnover intention, and service capacity,’ they wrote.
 
They also state that their review is the first to their knowledge to focus exclusively on patient violence within general practice, noting there is less awareness of the issue here than in other healthcare settings.
 
‘Violence and abuse by patients and the public in secondary care receives more attention than that in primary care, including general practice,’ the study’s authors wrote.
 
‘The negative impact of violence/abuse on staff mental health, turnover intention, and service capacity has been reported in the literature, but existing research on its prevention, management, and support interventions is limited.’
 
For RACGP Victoria Chair Dr Anita Muñoz, the pattern revealed in the study is a predictable one.
 
‘I don’t find it surprising at all, and I think many GPs around the country would have similar experiences of a rising trend in both verbal aggression and physical aggression in general practice,’ she told newsGP.
 
‘Certainly I think this is an issue that needs to be raised, particularly with governments.
 
‘We know that there are certain protections and laws about aggression that occurs in hospital settings, but not so much for that kind of behaviour in the private practice setting in Australia.
 
‘It is deeply concerning to me that if a person feels their expectations have not been met that it feels like it is a reasonable course of action is to become abusive or to become physically violent.
 
‘That is totally unacceptable.’
 
Dr Muñoz said it was important that incidents are taken seriously.
 
‘If we are talking about it being a society where we do not accept violence as a means of resolving issues, we really need to demonstrate that we’re serious about that and not turn a blind eye to what is happening increasingly commonly in general practice,’ she said.
 
‘People who are going about their jobs need to be able to do so without fear of abuse and physical assault.’
 
The researchers found that violence and abuse most affected female staff, as well as younger and less experienced employees.
 
According to the study, where figures were available 61.2% were female, and where staff roles were identified, most were doctors, followed by nurses, allied health professionals, administrative staff and receptionists.
 
Previous studies have suggested medical receptionists are the most frequent targets of abuse and patient aggression.
 
The authors of this most recent work said their research uncovered a ‘substantial body of literature’ that would enable a further review of prevalence and risk factors for violence and abuse towards general practice staff.
 
They recommended that such a review include exploring definitions of violence and abuse, as well as prominent risk factors and details on staff and perpetrator characteristics.
 
They also said more studies are needed to ‘explore violence and abuse towards general practice staff post-COVID and as the use of digital technology to access GP services increases’.
 
‘In addition, the intersection between violence and abuse and wider societal factors (for example, deprivation) requires further study,’ they wrote.
 
‘Owing to the nature and fundamental purpose of scoping reviews, policy and practice implications can only be discussed tentatively.
 
‘Nevertheless, the high prevalence of violence and abuse and its negative impact on individuals and services indicate the need for effective preventive strategies, staff support, and addressing organisational factors contributing to violence and abuse.’
 
For Dr Muñoz, more needs to be done at a government level.
 
‘At the moment, the management of this kind of behaviour is left to individual practices and individual GPs being trained on how to deescalate when somebody is angry, to manage the risk of things escalating or the risk of somebody being injured or harmed,’ she said.

‘That’s insufficient.
 
‘We need to look at what policies and what our governments can do to put in layers of protection and also consequences for essentially attacking people as they go about their work.

‘We know that there's been attention on sectors like police and ambulance and in hospitals there have been some dreadful events but there certainly are those same kind of dreadful events happening in general practice.

‘It’s just not getting the kind of attention that it needs.’
 
In a newsGP poll earlier this month, almost four in five respondents said that patient aggression is a factor at their workplace, with only 21% saying they 'hardly ever' experienced it.

Resources for managing patient aggression and violence are available on the RACGP website.

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