Zero Tolerance Policy

This Practice considers aggressive behaviour to be:

  • any personal comments directed at staff
  • abusive and/or aggressive comments or attitude to staff
  • using bad language, cursing and/or swearing at practice staff or other service users
  • raised voices
  • verbal, non-verbal, slights, snubs and insults which communicate hostile, derogatory or negative messages
  • physical contact and aggressive gestures.
  • In summary, any behaviour, verbal or physical that make the staff or patients uncomfortable, embarrassed, or threatened

No abuse of the staff is acceptable in all forms of communication – i.e., face to face, social media, or any other form of electronic communication with the surgery.

All abuse will be reported to the Practice Operations Manager who will keep a log of all incidents.

All physical abuse of any of our staff is reported to the police.

  • The patient will then be removed immediately from our patient list.
  • The health authority will inform the patient of the need to register with a new doctor.

Any incident of verbal abuse whether in person or on the telephone will be

  • reported immediately to the Practice Operations Manager and
  • Recorded in the logbook kept in the zero-tolerance folder on the computer system shared drive.
  • If appropriate, the Practice Operations Manager will discuss the incident with one of the Partners and a formal letter will be sent to the patient.
  • A copy will be kept with the medical records.
  • Any response to the letter will be recorded in the logbook and the letter will be kept on file.
  • The logbook will be reviewed weekly and discussed, if necessary, at the staff meeting.

Common themes resulting in a breakdown in relationship between the practice and the patient include:

  • Multiple DNA’s
  • Unrealistic expectations
  • Unreasonable demands
  • Unnecessarily persistent or unrealistic service demands that cause disruption
  • Behavioural issues – the Practice will not tolerate any form of discrimination, harassment, or victimisation
  • Use of racist or other offensive language
  • Social media – abusive or derogatory posts about staff or the surgery – see Social Media Zero Tolerance Policy.

All break-down in relationship issues are viewed as serious matters and will be reported to the Practice Operations Manager, who will keep a log of all incidents, and this may result in you being removed from our patient list.

Reporting of Patients

  • If the patient’s name appears once in the logbook, a letter will be written warning him/her that any further abusive behaviour will result in removal from the list, (the yellow card).
  • On the second occasion, the patient will be removed immediately from the list and a letter will be sent to the patient confirming this, (the red card).
  • Where a patient has been asked to leave the premises because of unacceptable behaviour and refuses to do so the Police will be called to remove the patient. Where the Surgery must call the Police, this incident will warrant a (red card) response from the Surgery immediately. The patient will be informed in writing that they have breached the Zero Tolerance Policy and have been removed from our list.
  • From this point on,
    • the patient will not be welcome at this practice and
    • will be removed from the premises by the police if they present here.
    • We will refuse to treat them


The possibility of leaving a patient without any access to healthcare, despite his or her behaviour is not ethically acceptable even where there have been repeated violent incidents.

This policy envisages that no patient will be removed formally from a GP’s list until a red card is issued.

In the interests of staff safety, patients will be removed after a red card warning. They will then be referred to Primary Care Support England (PCSE) and may be seen in a secure place in accordance with PCSE procedures.


It is not acceptable for the innocent relatives of a violent person to be removed from a list or refused treatment because of the behaviour of a relative.

A home visit to such a family to treat a relative of the offender may require the supervision of the police.


  • A poster outlining the Practice’s Zero Tolerance to Violence will be displayed on the premises.
  • A copy of this “Zero Tolerance to Violence Policy” will be available to patients at no charge.