The Violent Society: Doctors at the mercy of violent patients: Workers in the professions are taking action to combat increases in physical assaults and abuse

FAMILY DOCTORS and their surgery staff are increasingly at the mercy of violent patients who abuse them verbally and physically, according to a new survey.

More than one-fifth of the 500 GPs who took part said that they had been assaulted in the last year in incidents ranging from punching and spitting to attacks with knives, bricks, and, in one case, a used syringe. Three-quarters of GPs said they had suffered verbal abuse.

Overall, 12 per cent reported physical attacks in their surgeries; 10 per cent said that the assault had occurred during daytime home visits, and 10 per cent during night calls. Fifteen per cent of GPs reported physical assaults on practice staff, while in inner cities the figure was 29 per cent.

More than 40 per cent of GPs said that fear of assault had forced them into unnecessary treatment. They had written prescriptions or carried out diagnostics tests that were not needed because they feared reprisals from patients.

GPs in inner cities are at the highest risk, with a quarter claiming they had been physically attacked in their surgeries, and a similar number during daytime home visits. Night-time visits appeared to be slightly less problematic (21 per cent in inner cities) although one GP needed 13 stitches after being hit on the head with a brick during a night visit.

However, GPs in rural areas are not escaping the increase in violent behaviour: 8 per cent said that they been assaulted at least once during surgery or home visits, and that verbal abuse was common.

The survey, carried out by Pulse, a magazine for GPs, was to mark the introduction of new rules on 1 April, which allowed a GP to remove a violent patient from his or her list immediately. Previously they had to wait seven days.

The General Medical Services Committee had campaigned for the new ruling believing that the threat of removal from a GP's list would be a deterrent to violence.

However, critics say the ruling means that violent patients will just be 'passed on' for other GPs to cope with. Delisted patients are referred to the local family health services authority, which must find them another GP.

Some of the GPs in the survey said that violent patients should forfeit their right to medical treatment from a GP and be sent to casualty departments. Others wanted a complaints system for doctors to use against patients.

Other suggestions to reduce the danger to GPs included; treating drug abusers in special clinics rather than at surgeries; adequate community care for psychiatric patients; and removing 'contentious services', such as welfare-related medicals, from the responsibility of a GP.

Better training for GPs in how to recognise and deal with violent patients is called for, and more investment by health authorities in protecting surgery staff with alarms and escorts.