Violence and Abuse towards Staff by Patients and the Public in General Practice since COVID-19 in England

Problem

In 2021, 37% of UK doctors reported experiencing direct verbal abuse from patients and/or the public in the preceding month. Of these 37%, 51% were general practitioners (GPs) and 30% were hospital doctors. Two-thirds of GPs said their experience of abuse, threatening behaviour or violence had become worse after the COVID lockdown. 67% of GPs reported witnessing abuse by patients towards colleagues, especially reception staff. However, there is limited research on the experiences of violence and abuse staff in general practice. Furthermore, there is no data suitable for direct comparisons between staff groups in general practice.

Objectives

To explore

- the extent of experiences of violence and abuse by patients and/or the public towards general practice staff since the start of the COVID19 pandemic;

- the impacts of such experience on staff wellbeing and

- staff views on current and future practice or strategies to prevent and manage violence and abuse by patients and the public.

Approach

A mixed methods study was conducted. Data were collected between 11/7/23 and 20/12/23. Part 1 was an online survey of general practice staff in England. It was distributed through clinical research networks, professional newsletters and distribution lists, employing snowball sampling. The survey asked about the level of physical abuse, threats, verbal abuse, harassment, and inappropriate sexual behaviours directly experienced and/or witnessed in the preceding three years. At the end of the survey, eligible participants were invited to an individual interview online (Part 2).

Findings

Overall, 1,226 complete survey responses were received, of which, 74 did not meet eligibility criteria and were excluded. The 1,152 participants (44% clinical, 56% non-clinical) were from all regions of England. 83.8% self-identified as a woman, 15.4% as a man, 0.2% as other and 0.6% preferred not to say. Overall, 48.7% of participants reported experiencing physical violence or threats of physical violence; 92.3% reported experiencing verbal abuse; 23.7% reported experiencing inappropriate sexual behaviours or remarks; 61.5% reported feeling harassed. It is worth noting that 4% of participants might be experiencing serious mental health symptoms at the time of survey completion.

Twenty-three members of general practice staff shared their experiences and views in detail in interviews. Staff appeared to view violence and abuse as ‘part of the job’ and discussed its impacts on staff, the practice, and the wider patient population. Current practices in prevention and management appeared to vary across areas. Suggestions on future directions also emerged from the interview.

Consequences

The extent of violence and abuse experienced by staff in general practice appears to be prevalent among the respondents. A multi-level systemic approach to understanding and responding to this issue is recommended.