Feeling unsafe at work - what would you do?

[onyxtulip]

Hi all, would love some advice from anyone who has been through similar or has better knowledge of employment law than I do!

I'm a GP. I often work evening clinics where there are just 2 staff in the building - myself (female) and one (also female) receptionist.

I have a patient who has recently been released from prison. He has a history of violence against men, women and medical personnel. He has addiction issues (crack, cocaine, speed, alcohol). I recently saw him during an evening clinic and, whilst he was entirely appropriate throughout, I did feel in hindsight that perhaps he should have been booked to see me during the day as there would be more people around should anything untoward occur. I raised this with the partners and management at my surgery and was informed that to restrict this patient to appointments M-F 9-6 would be discriminatory and therefore not possible.

During the appointment, this patient described ongoing impulses to hurt others, often strangers and impulsively. He also told me the police suspect him of an attempted murder by stabbing but currently don't have enough evidence to arrest/charge him. My managers and the partners are aware of these details.

Surely they have a duty of care to me and our receptionists, in terms of reducing our risk of harm?

I don't know what steps to take next to be honest. I don't feel comfortable with it but don't want to rock the boat too much/risk my job!

Have you spoken with your union for advice?

Not quite sure this level of detail on Mumsnet is professionally appropriate, but yes I agree you should be protected and safeguarded. As a midwife we would be visiting in pairs if it was a home visit.

On what basis are they saying it’s “discriminatory”? Being a criminal isn’t a protected characteristic

I agree it could potentially be discriminatory if he had a disability but as long as he could get other appointments it should be justifiable, as you say they have a duty to protect staff

Is there a lone worker policy? I realise you aren't alone in the building, but you are in the room. When I've worked in very similar circumstances, also in a medical field, we each had a silent alarm we could press. Not the emergency call bell on the wall which rings out for a resus, but a tag clipped on near my pocket which I could press to alert reception.

What nonsense!

How could it be discrimination against him to say he has to have a daytime appointment? What is his protected characteristic? He hasn't one!
Speak to the BMA.

Concerning that you have posted here rather than go to the BMA to be honest OP, really inappropriate.

I can't see that confidentiality is breached in any way?

Again, not helpful - there is no breach in confidentiality here. I am genuinely seeking the views/experience of others. Not to say I wouldn't approach organisations such as the BMA (though not all GPs are signed up to a union, I'm not a member of the BMA as I have no faith in them)

I'm not sure but I will find out about lone worker policy. We have panic buttons on our computer software but it would only alert the single receptionist and I can't imagine that'd be too helpful in a genuine emergency

Don't have a union - lots of doctors don't as BMA hasn't always represented us well and generally a waste of money (in my mind)

We have indemnity providers; wondering if they may be able to advise

Ask them to do a risk assessment ... absolutely ridiculous.

Dear lovely GP.. honestly thank you for all you do… if this guy “ described ongoing impulses to hurt others, often strangers and impulsively” does he not need to be sectioned under the mental health act? As for lone working with such clients, you are right in your assertions that you shouldn’t have to see him alone in the evening with skeleton staff… I wonder can you call the police if he’s booked in again to be on standby? In Cork, a man actually brought a gun to his GP Surgery and shot himself. The trauma that must have caused staff.. https://www.irishexaminer.com/news/munster/arid-40579637.html Don’t back down here, you matter and people want you safe and protected doing your job..

Very strange to say its discriminatory. That sounds wrong to me as they do have a duty of care and should put appropriate safeguards in place.
I'm not a health care worker but had a similar situation present itself - and I would definitely want to minimise risks. We would add that as a risk awareness on the persons record

A member of staff (a receptionist) was attacked recently at my gp practice. The man has been arrested.

As others have said it is not discrimination if other appointments are offered to the patient - unless the patient works full time?

If you are a salaried GP your employers owe you a duty of care. That same duty applies to your receptionist!

Your GP practice should have a practice manager and a safe working policy. It needs to be checked to see if the appointment practice with this patient is compliant and if it is then it sounds as if the policy needs to be reviewed.

I suspect your issue is that you don't want to rock the boat. I was in a similar position once - seeing clients that other professionals would only meet in pairs or with a police presence. I was lucky but it was a worry.

If you want to raise it further, and it is a GP partnership, flag up whether their insurance for public liability and for employees would cover them if the insurer thought they engaged in dangerous working practices. If the insurer said the claim was not covered by their insurance then any damages claim from you could be claimed from the assets of the GP partners - so they could lose their homes and other assets.

It is really frustrating as clearly the GPs are not investing in proper HR and legal advice.

Thank you - this is really helpful. I'm a bit of a people pleaser and just want to be helpful by nature but the situation is clearly unacceptable and its good to have an objective sense-check!

This definitely needs a risk assessment. I would not be happy with the situation.

can he be assigned to only see a male GP?

They offered to reassign him to a male GP but I didn't think this really resolved the issue - what if he brought in a knife/other weapon. I'd feel terrible if a colleague was hurt in my place if you see what I mean!

Just seen you post about indemnity providers. If you mean insurer then you should not approach them as that would probably lead to disciplinary action against you as it would be a breach of your employment terms ( or should be) .

If you raised this with the indemnity provider or insurer they should refuse insurance or increase the premium because of the increased risk.

The way forward is to raise it formally with the practice manager or CEO of the practice.

Sorry didn't answer your question - the patient doesn't work currently so daytime appointments shouldn't be an issue for him

I can’t see how this would be classed as discrimination. You wouldn’t be insisting on him coming at a different time of day because of a protected characteristic! It’s because of risk.

I work in community health and we usually do domiciliary visits but occasionally we have someone who we will only see in our clinic due to risk either by them or someone in their household.

NHS lone worker training is all focussed on risk assessment and you are absolutely allowed to make adjustments to how/where you see the person in order to keep yourself and colleagues safe. I’d take advice from your local Management of violence and aggression team

Can he be assigned to ‘police surgeries’?
In my force there are monthly GP surgeries held in a police station with police supervising, for violent patients. I’m not sure if they are patients that have already been violent, but why should you have to wait?

Having worked in MH for many years, there are lots of people that we would have a patient alert and plan for - might be male / female only staff, might be visit in 2s, might be clinic rather than home visit etc. - reasons could be previous threats to staff, could be related to forensic history, inappropriate behaviour, accusations against staff.

It would be appropriate to do a risk assessment for this man given risk history and currently expressed thoughts and as part of the management plan to have some sort of restrictions in place.

I don't know what risk assessment documentation GPs use but I'm sure you must have some? If you completed it and then took it to whoever you needed to - practice manager?

Even if unrelated to appointments, you should probably have a risk assessment in place for him anyway. If he did go on to attack someone questions would be asked about why health were aware of his thoughts prior to the incident and hadn't assessed the risk and done some sort of management plan....

They offered to reassign him to a male GP. That would fix the problem of you being alone with him in the evening clinic.
Accept that solution.

I mean the MDDUS. They are an indemnity provider but I've never needed to have any dealings with them in the past. I'm aware that they sort things like legal representation if a doctor is being sued by a patient but beyond that I'm not sure of their role and whether or not I should be making contact with them

Sadly I have discussed this with our practice manager on several occasions now and not got any further than described

Pass him on to another gp who thinks it's OK? Ask the police if they think you are safe alone with this man? Only agree to phone appointments? Get a male hopefully burly character to be waiting for you if you have to see this person. It seems ridiculous that you have to put yourself in a frightening and possibly dangerous position like that.