The Pharmaceutical Journal Vol 266 No 7153 p847
June 23, 2001

Cracking down on violence in the NHS — will pharmacy benefit?

The Government wants to get tough with patients who are violent or abusive towards front-line National Health Service staff. A new scheme of yellow and red cards is to be introduced in hospitals. Will the scheme ever be extended to primary care and to community pharmacies and what can pharmacists do to protect themselves? Jonathan Buisson investigates

Tough new action will see patients who are violent or abusive towards National Health Service staff being shown football-style “yellow cards” or “red cards”, Health Secretary Alan Milburn announced on June 18. Anyone shown a red card could be banned from receiving treatment for up to a year.

“I am sickened by the tide of violence against NHS staff. There are 65,000 assaults reported on NHS staff every year,” Mr Milburn said.

Difficult dilemas

Mr Milburn praised the scheme, saying “where it has been used as a deterrent there is evidence that it is working”.

“These policies and procedures clearly raise difficult dilemmas. Withholding treatment should only ever be a last resort and must be subject to stringent safeguards. But where a patient is persistently violent or abusive and where no other course of action proves possible I will stand full square behind trusts which take tough action to protect staff,” the Health Secretary said.

The scheme has the backing of Prime Minister Tony Blair who visited the Royal London Hospital where a red and yellow card scheme has been on trial since last year.

Under the Royal London red card scheme, abusive or violent patients, or their relatives, are first given a verbal warning. Further incidents lead to a written yellow card being issued. This warns of the hospital’s willingness to withdraw treatment. Patients given a red card would be denied treatment at that hospital if their condition was not held to be life-threatening. However, the rules do not apply to those suffering from mental illness. It is reported that four yellow cards have been issued but, so far, no red cards.

Guidance is to be issued to NHS trusts by the end of the year on developing policies for withdrawing or withholding NHS treatment. The Government has pledged to reduce the level of violent incidents against NHS staff by 20 per cent from its 1998 level by this year and by 30 per cent by 2003.

Helen Remington, president of the Guild of Healthcare Pharmacists, says that hospital pharmacists suffer mainly from verbal abuse, although she had heard of one pharmacist who was badly assaulted in a London hospital in 1996.

“Pharmacists on the frontline, especially those working in outpatient departments, are subject to verbal abuse if, for instance, waiting times are extended. Most staff are used to this and probably would not think of reporting it.”

Mrs Remington said that the guild had not formally discussed the issue of violence against pharmacists.

At present the red card scheme is only aimed at hospitals but violence is also a concern in primary care where health staff are face-to-face with patients and members of the public everyday. The Department of Health told The Journal that the new scheme was just for hospitals at present. A “zero tolerance” scheme for general practitioners allowed them to work in conjunction with local police forces to deal with patients who were violent or abusive.

Mrs Remington’s comments are echoed by Bob Rihal, chairman of Lambeth, Southwark and Lewisham local pharmaceutical committee: “Verbal abuse is part of the daily routine for community pharmacy staff,” he says. He believes that pharmacy staff should be offered training. The LPC has run some courses but funding for them is limited. Lambeth, Southwark and Lewisham Health Authority has made grants to four pharmacies to help them install security equipment and closed circuit television cameras.

Difficult customers

John D’Arcy, chief executive of the National Pharmaceutical Association, says that the NPA has not detected any specific increase in violence against pharmacists or their staff but adds “dealing with customers has become more difficult — decorum is disappearing from society”. The association receives regular enquiries from its members asking how they can deal with difficult customers and their rights in relation to banning people from pharmacies.

“We generally tell them that they can have who they like in their pharmacies, customers come in by invitation,” he says. “There is a problem with pharmacists’ terms of service which say that prescriptions must be dispensed on demand. It has been suggested to some that they dispense the prescriptions but do not allow the person to enter the pharmacy. They have to hand it to a member of staff or a representative.”

The NPA produces a leaflet on violence at work. It advises pharmacy owners to evaluate the risks and train staff to spot early signs of aggression and how to avoid or cope with it. Physical security measures such as CCTV cameras, alarms, security coded door locks and the design of counter areas to give staff more protection through wider counters and raised floors can all help, it says. Copies are available from the NPA sales office on 01727 858687 ext 469.

More information is available from the Government’s crime reduction website (www.crimereduction.gov.uk). A guide for employers can be downloaded from the site.

Staff training

Staff training courses are available. Bradford Health Authority is one of a number of authorities in the north of England to have made use of SecuriCare Ltd, a conflict management training company based in York (tel 01904 567327), for training pharmacists and their staff.

SecuriCare’s training covers health and safety law, understanding and coping with stress and inappropriate behaviour, communications skills and incident reporting. Training is also given in responding to physical provocation during which an emphasis is placed on reducing the risk of escalation in the early stages of an incident and allowing staff to escape or contain situations in order to preserve their own safety.

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Jonathan Buisson is on the staff of The Pharmaceutical Journal