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!

We used to have this service locally but not for a few years now unfortunately. This gentleman has assaulted several medical professionals (albeit not at our surgery as he wasnt registered with us at the time) in the past so I think he would have qualified.

Not quite the same but I used to teach adults in a deprived community with lots of addiction ect. One of the students was an ex offender and unpredictable. We used to only work with him in pairs and had a walker talkie to get help. I do agree this seems very unsafe and I am sorry they are not taking the concerns seriously. Could you contact ACAS or similar? I don’t think it’s discriminatory to give him an appointment where the staff are safeguarded. I’m actually surprised this doesn’t come up more often.

You and the other female should say you do not feel sufficiently safe working there alone with him as it stands.
Explain he speaks about violent and even murderous ideation and there needs further security measures.

Fellow doctor here.

Firstly, there is too much detail in your post and it is breaching patient confidentiality due to the level of detail - it wouldn’t take a lot for someone to identify who the person is.

Secondly, BMA are actually VERY helpful in these situations. I have been in a similar position. They did all the leg work and took away all the stress. You don’t need to be a member forever, the membership can be cancelled with minimal notice whenever.

if you’re a GP registrar you should be approaching your supervisor and deanery about this. I would also speak to GP colleagues in other practices to see what they do to manage risk.

I work for the NHS and any patient that is deemed to be dangerous it is clearly marked on their record they must be seen in pairs or a visit is arranged in a building with more staff present. They are putting you in a very vulnerable position, you need to take further advice.

I had a Quick Look at their website and yes you are right - they are the place to go to if you are a member.

In one article they mention the risk of the GP practice facing down grading and even prosecution for failing to protect staff in similar circumstances to the risk you describe.

They have offered the male doctor solution. Like you, I think that is a cop out as you say the patient is a risk to males and , in my experience, females are often better at defusing situations. However, if you have run up to a brick wall with the practice manager and don't want to risk having to get another job or being bad named with other local GP surgeries then maybe you should accept the offer ? Or print out the MDDUS case study and leave it on the practice manager's desk!

This whole scenario has a 'lesson's learned' feel to it. I work in an adjacent healthcare environment and as lone workers, our management are very good at listening to concerns, probably because they don't want to be standing in a Coroners court saying 'Oh yes, Dymaxion raised concerns several times ( as per email coresspondence dated X ) , but we didn't do anything to address them and we purposefully chose to gaslight her instead !

This is wrong on every level, you and your receptionist are in danger of serious (if not fatal) attack from a convicted psychopath. I'd fear for the safety of a man in that situation ket alone lone women.
There has to be some duty of care considerations here. You might like the BMA but surely they'd support your position - rejoin, or an alternative representative body right now

Also a doctor and agree with this OP. I think I would ask to get this taken down. You've included far too much detail.

Contact the BMA - you have a right to a safe working place (so does the receptionist). Theoretically any patient booking in could be a danger (you just happen to know this patient's background). There should be an SOP in place to lower risk.

Out of interest - how does the evening clinic work regarding intimate examinations? Is the receptionist able to step away from the desk to chaperone? Also seems like something that would put doctors working this shift at risk.

On that basis , none of you should be lone working with him. Your practice manager and the GPs neeed to come to some agreement on this and other similar cases.

Thank you everyone - I feel really validated and energised to not just roll over on this issue now. I'm going to rejoin the BMA and also speak to MDDUS.

Deleting the thread now due to others concern about confidentiality though I do not personally see that the gentleman can be identified given you don't know my indentity/location!

Good grief, don’t tell me you’re not in a union.
You’re a gp why on earth are you worried about rocking the boat? Or have you blurred the details for anonymity (we’ve all done it).
Whatever, check the loan worker policy. Get advice/ support from wherever (depending on your profession).
And definitely arrange to see him in the daytime, if ‘management’ have a problem escalate.

In future keep it much vaguer - we don't need to know what substances your patient has problems with, gender, recent release from prison.

'I'm being asked to see a patient with a history of violence towards health care professionals OOH' would have sufficed.

I’m a community nurse and we absolutely have policies in place regarding dangerous patients.
if your practice doesn’t, you need to write one!
perfectly reasonable to only see him during standard hours, I would even recommend him only being seen my a male dr if he has been violent towards women.
Risk of offending anyone is smaller than the risk of him harming you

Remember it's not just this thread people can see. Think what else you may/may not have posted or commented on under the same username (I've not searched for you, but I could) - it's easier to piece together information than you think it is. Just something to be mindful of when posting about professional situations online.

People talk such nonsense about discrimination. You have to have suffered a detriment in order to be discriminated against and this man won't have done so if he can easily be seen during the day.

I’m a GP. We’ve had violent patients in the past and we have an alert on their records that they’re only to be seen with a GP and another member of staff. Some can only be seen by male staff, if they have a history of assaulting women. If they're already known to be aggressive, they have to sign a zero tolerance agreement when they join our list, and if they ever behave in a threatening way then they’re removed from the list.

Agree with this. Patient confidentiality doesn’t only refer to their names/DOB/addresses and hospital/NHS numbers. It also refers to disclosing their medical histories or any level of detail that can identify them.
The GMC guidelines/ standards on confidentiality explain this in more detail (especially the media section).

What would I do?

say no and not do it. 🤷‍♀️ email practice manager and say I will not see him after 6pm under any circumstances.

what they going to do? FUCK ALL

As a former health professional, my gut response is: yeah fuck that.

Discrimination is valid, but overidden by threat or history of harm and violence.

you are a GP, call welfare on him

That is a completely unacceptable response from your surgery. As you're not part of BMA it wouldn't do any harm to try ACAS. I'm sure this comes up in plenty of employment places.

Regardless of the threat of violence, I’m appalled that you are lone working with a receptionist. That doesn’t seem right from a medical emergency perspective. Your receptionist will have some minimal training but that’s it.
Working in OOH services, albeit as a dentist, in a stand alone clinic, there always has to be 3 staff on site for the medical-emergency legalities. One of whom can be the receptionist. In a large clinic, like a walk in centre, where other clinical staff are working (albeit in their own clinics), 2 dental staff-dental nurse and dentist -are ok to continue to see patients ( if the receptionist for eg fails to arrive) because there are other properly trained HCPs in the building.
Why don’t you phone your indemnifier and get some clarity on the legal side of things here?

Also, where is the risk assessment about seeing this patient after hours? Who’s written that ? Ask the practice manger ! They won’t have one….
Just refuse, push back. It’s a stupid ask. Far better to pre-empt problems with a bit of common sense, that be reactive.

I'd ask what steps are being taken to ensure your safety with this patient, who is a known risk, and also more generally to see the risk assessment for evening work and to know what has or will be put in place to ensure your safety more generally if another patient became threatening.