Unacceptable Behavior Policy




At Penrhyn Surgery, we believe that patients have a right to be heard, understood, and respected. We work hard to be open and accessible to everyone.

As an employer, the practice also has a duty to care for the health and safety of its staff and a legal responsibility to provide a safe and secure working environment for staff.

image depicting zero tolerance


As an employer, the practice also has a duty to care for the health and safety of its staff and a legal responsibility to provide a safe and secure working environment for staff.

All patients are expected to behave in an acceptable manner which overall most patients do. However unfortunately we have experienced situations where a patient may engage in unacceptable, unreasonable and or abusive behaviour towards staff or other patients.

When this happens, within our responsibilities as employers, we must consider the impact of this behaviour on our ability to work and provide a service to other patients.

In certain situations, unacceptable behaviour may result in removal from our practice list or even criminal proceedings.

We understand that people may act out of character in times of trouble or distress however, we do not expect that these actions will become unacceptable.

Unacceptable behaviours include abusive behaviour, unreasonable demands, and violent behaviour, all of which are outlined in more details in the sections below.

This policy aims to set out what behaviours/actions the practice deems as unacceptable and how we deal with them.


Unacceptable Behaviours

Aggressive, abusive, or violent behaviour

We understand that patients may be angry about the issues they have raised with the Practice. If that anger escalates into aggression towards Practice staff, we consider that unacceptable.

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 decide that comments aimed not at us, but at third parties, are unacceptable because of the effect that listening or reading them may have on our staff.

The following list is not exhaustive but is provided to explain the actions and behaviours that the practice considers to be unacceptable:

  • Violence (towards members of staff and/or other patients)
  • Excessive noise e.g., recurrent loud or intrusive conversation or shouting
  • Threatening or abusive language involving swearing or offensive remarks
  • Derogatory remarks regarding protected characteristics (e.g., racist, sexist, or homophobic behaviour)
  • Making inflammatory statements e.g. “You are incompetent and should be sacked”
  • Derogatory, abusive, or insulting comments made about staff online or in the media
  • Harassing, abusing, or threatening staff on their personal social networks
  • Malicious allegations relating to members of staff, other patients, or visitors
  • Offensive sexual gestures or behaviours
  • Abusing alcohol or drugs on practice premises
  • Drug dealing on practice premises
  • Willful damage to practice property or threats to damage practice property
  • Threats, threatening behaviour or intimidation
  • Theft
  • Abuse of practice processes/policy

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 of actions grouped under this heading include:

  • Repeatedly demanding responses within an unreasonable timescale
  • Repeatedly requesting early supplies of medication
  • Repeatedly requesting further supplies of stolen medication, without the required Police Incident number
  • Repeatedly ordering prescriptions outside the set timeframe( 48hours for Penrhyn Surgery)
  • 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
  • An example of such impact would be that the demand takes up an excessive amount of staff time and in so doing disadvantages other patients

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, excessive number of calls in one day or one hour.

  • Repeated appointments for an ongoing issue that is being dealt with, within a very short time span.
  • It may occur over the life-span of an issue when a patient repeatedly makes long telephone calls to us, or inundates us with letters or copies of information that have been sent already or that are irrelevant to the issue.
  • We consider that the level of contact has become unacceptable when the amount of time spent talking to a patient on the telephone, consulting with the patient on the issue or responding to, reviewing and filing emails or written correspondence impacts on our ability to deal with that issue, or with other Patients’ needs.

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 with us the issues or complaint we will look at; providing us with further information, evidence, or comments on request; or helping us by summarising their concerns or completing a form for us.

Sometimes, a patient repeatedly refuses to cooperate and this makes it difficult for us to proceed.

We will always seek to assist someone if they have a specific, genuine difficulty complying with a request. However, we consider it is unreasonable to bring an issue to us and then not respond to reasonable requests.

We work closely with our patients to ensure they get the best health outcomes. In situations where a patient refuses to co-operate with efforts to ensure their clinical safety e.g. monitoring of vital signs such as blood pressure or doing blood tests, taking into consideration all their prevailing circumstances we may ask such patients to register with another practice, if they repeatedly refuse to cooperate with us on monitoring their health.

Unreasonable use of the complaints process

Individuals with complaints about the Practice have the right to pursue their concerns through a range of means. They also have the right to complain more than once about the Practice, 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 – but we reserve the right to do so in such cases.


How the practice deals with aggressive/abusive/violent behaviour

There are two processes in place for dealing with unacceptable or abusive behaviour.

These are the

  • Unacceptable behaviour process and
  • Removing violent patient process

The unacceptable behaviour process will be followed if the practice feels a patient’s behaviour is unacceptable but does not warrant immediate removal from the practice register. The removing violent patient process will be followed if a patient is violent or exhibiting behaviour that makes staff or other patients fear for their safety. This will result in the police being contacted and immediate removal of the patient from the practice register.

Unacceptable behaviour process

This process will be followed when the actions/behaviour of a patient are unacceptable but do not warrant immediate removal from the practice list. The process consists of an internal review to investigate the circumstances of the behaviour/actions to decide on further action

The process

  • A member of staff identifies unacceptable incident from a patient and reports this to the management team.
  • The situation is reviewed by senior team within 5 working days.
    • The situation review agrees that the behaviour did not meet the threshold for further action. The reasons for this decision will be explained to the member of staff who raised the concerns. No action to be taken against patient. The reasons for the decision will be explained to the member of staff who raised the concerns.
    • The situation review agrees that the behaviour was unacceptable. 

If the the behaviour was unacceptable

1. Patient’s first offence within the last 12 months
  • Patient is sent a warning letter, explaining the reasons.
  • Further repeat instances of unacceptable behaviour within 12 months of the first letter will result in removal from the practice register.
Example: Content of first letter to patient - Warning

Dear Patient

I am writing to you following an incident in the practice on [Date].

While we appreciate that the events leading to the incident may have caused you to feel some upset and anger we feel the actions you took/behaviour that was displayed *delete as appropriate* was unacceptable.

We have a strict policy on unacceptable behaviour and this will NOT be tolerated.

[Description of actions and reasons why unacceptable]

If there are any further instances of unacceptable behaviour within 12 months from this letter the practice will remove you from our practice register and you will be required to register with an alternative practice.

2. Patient’s second offence within the last 12 months
  • Patient is sent a second letter explaining the reasons and that they are being removed from the practice list.
  • The Practice will send a written notice to the PCO or NHS England, giving the patient’s name, address, date of birth and NHS number, requesting removal of the patient.
  • The removal will take effect on the eighth day after the request is received.
Example: Content of second letter to patient – removal from practice list

Dear Patient

I am writing to you following an incident in the practice on [Date].

While we appreciate that the events leading to the incident may have caused you to feel some upset and anger we feel the actions you took/behaviour that was displayed *delete as appropriate* was unacceptable.

We have a strict policy on unacceptable behaviour and this will NOT be tolerated.

[Description of actions and reasons why unacceptable]

Our records show that you have previously been warned about such behaviour on *insert date here*. The letter sent on this date explained that repeat instances would result in your removal from the practice register. We have now requested that you are removed from our patient register. This will take place eight days after NHS England receive our request. You willnow have to register at an alternative practice.

Removal of Violent Patients including verbally abusive patients

This process will be followed if a patient commits an act of violence or behaves in such a way that makes staff or other patients fear for their safety.

Such behaviours include, but are not limited to:

  • Assault
  • Threatening behaviour
  • Behaviour resulting in damage to property
  • Verbal aggression including use of swear words/derogatory language
  • Racially motivated abuse

All such instances will be reported into the police.

This process has been designed to adhere to the requirements of removing patients under the NHS Special Allocation Scheme.

Any individual who receives injury, no matter how small, should be the subject of an entry in the Accident Book and should always be strongly advised to be examined by a doctor before they leave the premises

The process

Should a patient commit an act of violence or behave in such a way that makes staff or other patients fear for their safety is as outlined below

  • Where possible, such actions should be reported to the duty doctor, management team or other supervisor. This individual will contact the police to report the incident and if necessary, request police attendance.
  • If one of the above individuals is unavailable or reporting to them will delay contacting police and/or may result in harm coming to any individual present the police should be contact immediately.
  • As soon as possible after the incident notify NHS England about the incident and provide them with the patient details for the removal. The removal takes effect at the time at which the practice contacts PCSE.


Notifying patients of our decision (to issue a warning letter or remove a patient from the list)

  • When a Practice employee makes an immediate decision in response to offensive, aggressive, or abusive behaviour, the patient is advised at the time of the incident.
  • When a decision has been made by Senior Management, a patient will always be given the reason in writing as to why a decision has been made to issue a warning (including the duration and terms of the warning) or remove them from the Practice list.
  • This ensures that the patient has a record of the decision.


How we record and review a decision to issue a warning

  • We record all incidents of unacceptable actions by patients.
  • 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.
  • Each quarter a report on all restrictions will be presented to our Senior Management Team so that they can ensure the policy is being applied appropriately.
  • A decision to issue a warning to a patient as described above may be reconsidered either on request or on review.


Management of aggressive/abusive telephone calls/correspondence

  • 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. Where we can, we will return the correspondence. We will explain why and say that we consider the language used to be offensive, unnecessary, and unhelpful and ask the sender to stop using such language.
  • We will state that we will not respond to their correspondence if the action or behaviour continues and may consider issuing a warning to the Patient


How the Practice deals with unreasonable demand

We have to take action when unreasonable behaviour impairs the functioning of our Practice.

We aim to do this in a way that allows a Patient to progress through our process.

We will try to ensure that any action we take is the minimum required to solve the problem, considering relevant personal circumstances including the seriousness of the issue(s) or complaint and the needs of the individual.

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
  • see the patient by appointment only
  • restrict contact from the patient to writing only regarding the issues raised
  • return any documents to the patient or, in extreme cases, advise the patient that further irrelevant documents will be destroyed
  • 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


Related Policies


Further Guidance

This policy and the embedded processes have been developed in line with the NHS Constitution and advice and guidance from the Citizens Advice Bureau and the British Medical Association (BMA).