Has abuse become the norm for NHS staff?

NHS leaders need to act on the increasing levels of abuse which are unsustainable, damaging to morale, and exacerbating staff shortages

When supporting a member of the receptionist staff at the surgery recently after they had endured horrendous abuse from a patient, their response was “it’s ok, this is just a part of the job.” 

Is abuse now so commonplace that it is a “part of the job” we all have to learn to accept? How can this ever be acceptable? 

There is no doubt that the covid-19 pandemic has been a very stressful time for everyone working in public facing jobs, but possibly greatest for those working in health and social care. The general public have been anxious, and often frustrated by the pace of change enforced by the pandemic. New ways of interacting with the NHS are often poorly communicated centrally and poorly understood. 

The findings of a recent survey carried out by the BMA looking into levels of abuse against NHS staff are extremely worrying. The survey from July 2021 included more than 2,400 doctors in England, Wales, and Northern Ireland across primary and secondary care sectors. Results showed that more than a third (37%) of all respondents had experienced verbal abuse first-hand in the most recent month. 51% of GPs and 30% of hospital doctors, and one in five GPs reported being threatened. 

Hospital doctors were most likely to report abuse of nurses (87%) or other doctors (65%). In general practice, 96% of those who had seen colleagues face abuse said this was directed at reception staff. 

Two-thirds of GPs (67%) said their experience of abuse, threatening behaviour, or violence had got worse in the last year, and the most common place for abuse experienced by GPs was in their consulting rooms (53%). This is very worrying as GPs are usually working alone.

A survey of 1250 doctors by the Medical Protection Society in October 2020 also reported high levels of abuse towards staff, with over a third saying they had experienced verbal or physical abuse from patients or relatives.

While these results are very concerning, they may not come as a surprise. The global effects of covid have caused divisive opinions on many topics, in particular the need for lockdowns and vaccines. The pandemic has affected us all in some way, but some people have felt far less at risk, or even sceptical, and therefore, perhaps more likely to want to go about their lives as usual. The changes imposed by covid on the NHS meant a rapid move to a “digital first” approach, with far less face to face appointments offered in all settings. However, while patients seemed to largely accept cancelled hospital clinics and remote reviews, there has been a lot of public frustration and anger lodged towards GP teams who were perceived as being “closed” because of new ways of working. Perhaps this is because GP surgeries are normally at the heart of their communities, and act as a social hub for many. And of course because of the sheer volume of patients seen in GP, who deal with 90% of NHS care (over 300 million contacts per annum) compared with 23 million in Emergency Departments).

This perception of “GP being closed” was fuelled by false rhetoric from some media outlets, many social media anecdotes, comments from politicians and most surprisingly from several letters from NHS England itself telling GPs to offer face to face appointments. The BMA and NHS England remain at loggerheads due to these letters. The chief executive of Boots Sebastian James was forced to apologise after making misinformed comments that primary care had “more or less disappeared” during the coronavirus crisis. Journalists actively seeking examples of poor practice to denigrate the entire profession might be doing more harm than good.

Throughout the pandemic we have seen regular reports of NHS staff being abused verbally by crowds of covid deniers and vaccine-skeptics who have collected at hospital doors. Ironically this abuse often occurs for staff when leaving work after gruelling shifts caring for critically ill patients. Many staff in uniform have been abused on their journeys to and from work, such that they have decided to travel in plain clothes and hide any NHS logos. A senior midwife was sent death threats after urging pregnant women to get vaccinated. Thousands of anti-vaccine protesters gathered in Trafalgar Square on 24 July calling for the names of healthcare professionals so they could be tried in “Nuremberg style trials” for “genocide.” 

GP teams have received hate mail and abusive messages, and have been experiencing unforeseen levels of abuse including graffiti, hoax bomb threats, and blood soaked items thrown at reception staff. To be subjected to this type of regular abuse while working ever harder is demoralising and disheartening for staff, and at times traumatising. Many feel that the increased levels of abuse are exacerbating staff vacancies, which are already at critical levels in many areas. There is a well recognised GP crisis that predated the pandemic and we cannot afford to lose any more staff.

The recent BMA survey shows that abuse against NHS staff is rapidly escalating in frequency and severity. The impact of this on the workforce cannot be underestimated in terms of morale and wellbeing. NHS staff have a right to be treated with the safe courtesy and respect with which they treat their patients. Acts of abuse, violence, and threats are totally unacceptable and should not be tolerated.

Urgent action is needed to ensure that all staff feel supported and safe in their roles; particularly those in reception and those clinicians working alone with patients. With over five million patients now on waiting lists, and increasing demands on the NHS which are likely to surge again as schools return and over the winter—the strain on the NHS is only likely to worsen.

It is clear that NHS leaders need to act on the increasing levels of abuse which are unsustainable, damaging to morale, and exacerbating staff shortages. There must be a consultation process with medical leaders and patient groups facilitated by the Government to understand the reasons behind the rise in abuse, and to address the problems faced by patients. The public need to have realistic expectations of what can be provided by an exhausted workforce 18 months into a pandemic, with record staff vacancies, entering a very uncertain winter ahead. 

Above all we must continue to remind the public that we are all human beings, we are trying to do our best—so please try to be kind and considerate when contacting your GP surgery or dealing with any medical staff. A smile and kind words go a long way. Action must be taken to protect all NHS staff, and to try and prevent front line staff bearing the brunt of frustration and anger caused by years of underinvestment, and now exposed by a global crisis.

Simon Hodes is a GP partner in Watford, a GP trainer, appraiser and LMC rep. Twitter: @DrSimonHodes

Neena Jha is a salaried GP in Hertfordshire with an interest in emergency care and global child health. Twitter: @DrNeenaJha

Competing interests: none declared. 

All views expressed are the authors own.