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General Practice - a safe place: tips and tools

It is clear that general practices need to work both collectively and at the individual practice level to ensure that people in general practice remain safe and secure. General practice – a safe place focuses on the prevention and management of patient initiated threats to the personal safety of general practice staff. The evidence demonstrates the multidimensional nature of patient initiated violence and the need for a preventive, multifaceted response to this issue.

A number of studies have reported that about two out of three general practitioners experience some form of occupational violence in a 12 month period. At the most severe end of the spectrum of violence, four Australian GPs have been murdered in the past 12 years. Although it is important not to overreact to these rare instances of major physical assault, a preventive approach is essential as the negative consequences of any potentially violent situation can be severe. As one GP said of such an experience: ‘I aged 10 years in 2 seconds’.

Because different types of violence require different responses, a balanced and comprehensive approach to violence in general practice is required. Any form of patient initiated violence should be considered as a ‘sentinel event’. Some events need to trigger a ‘root cause analysis’ of all contributing factors, so as to try and prevent a future incident. This well accepted approach to quality improvement in health care can readily become part of a routine response to aggressive behaviour, threats, or assault in general practice.

Increasing health workplace violence is a symptom of increasing violence in Australian communities. General practitioners have an obligation to protect themselves, their team and the community as a whole if patients display criminal behaviours that pose a risk to the safety of others.

As employers, general practices also have responsibilities under occupational health and safety legislation to protect colleagues, the violent/aggressive patient, other patients, carers and staff by identifying and controlling risks associated with occupational violence. While some practitioners have been resistant to such measures, it must be accepted that security strategies are now part of modern life and routinely implemented by mental health services, drug and alcohol services, locum agencies, hospitals and other businesses.

This booklet outlines a range of practical strategies to assist general practices to appropriately minimise risks of violence, including means to:

• create a safe physical environment
• flag the files of patients with a history of violent behaviour within a practice
• assertively clinically manage patients at risk of violent behaviour
• work with other services to reduce the future risk of violence, and
• support the general practice team after experiences of violence.

In developing this resource, the authors have consulted with many experts in the field, and with practice teams working at the coalface. We recognise the topic is complex and requires different approaches in different situations.

We anticipate that this booklet will be used as a tool to encourage discussion within general practice teams about appropriate responses to manage the risk of occupational violence.

The RACGP is keen to have feedback about patient initiated violence, the ways general practice has worked to reduce the incidence of such violence, and about this booklet specifically. Feedback can be provided at advocacy@racgp.org.au or 03 8699 0596.

Hard copy versions of the General Practice - a safe place: tips and tools can be ordered at no charge.

Adjunct Associate Professor Leanne Rowe AM
Deputy Chancellor
Monash University, Victoria

Last Modified: 7 June 2011
Authorised By: General Practice Advocacy and Support