Running out of patience

WHEN Xavier Nalletamby started working as a GP 15 years ago he was able to go on home visits at night by himself.

He did not carry a personal alarm and the idea of having a two-way radio so staff could keep in contact had not been considered.

But now the Brighton-based GP makes sure there is someone waiting in his car when he goes out to see a patient in the early hours.

All his staff wear personal alarms and have been trained in how to cope with potentially violent patients.

The vast majority of Dr Nalletamby's patients do not cause any problems but there is a small core who can become violent or aggressive.

He said: "On one occasion a patient came off the street and registered as a temporary resident.

"He came in and sat down but after a while he got up, went over to a cabinet and started helping himself to drugs.

"When I picked up the phone to call for help he grabbed it from me and threw it across the room.

"He then ran out but another patient and myself were able to stop him."

In other incidents Dr Nalletamby has been threatened with a knife and locked in a house with a patient with no way of calling for help.

He said: "Concern about violence or abuse has been something we have always lived with so I don't think things have got particularly worse in the past few years.

"What is happening is that doctors are no longer just accepting these incidents but are doing something about it.

"The extra security measures are to protect ourselves and other patients.

"Nobody likes being shouted at, threatened or abused and so we try to avoid those situations.

"Most patients are perfectly fine and do not cause problems but there are those who create difficulties, particularly when they are drunk because they are more volatile and aggressive."

East Sussex GP Martin Heath was attacked by a patient while working as a hospital doctor.

He was punched and kicked by an angry father following a dispute about the treatment of his baby.

The man had to be restrained by staff to stop Dr Heath from being seriously injured.

There were about 28 recorded attacks on GPs in the East Sussex area between April 2001 and May 2002 with 17 taking place in Brighton and Hove.

This is a slight rise on the same period the year before and unions say the real figure is much higher because not all incidents are reported.

Cases have ranged from a minor assault, such as a slap around the face, to being hit with a hammer.

John Chisholm, chairman of the British Medical Association general practitioner's committee, called for more protection for GPs, adding: "It is intolerable that GPs devoting themselves to the NHS do so in fear for their own safety and their staff's safety."

Brighton and Hove City Primary Care Trust (PCT) is the only one in East Sussex where a surgery has agreed to take part in a scheme to treat patients who have been struck off a GP's list for violent or abusive behaviour.

Ordinary patients and visitors at the Preston Park Surgery in Brighton are not affected as the struck-off patients are seen outside normal surgery hours.

Security staff are on hand to help and CCTV cameras and panic buttons have been installed.

GPs and staff have been given extra training on how to deal with incidents.

The surgery can have up to 15 such patients on its books but there are only six at the moment.

If a patient has caused an incident where the police had to be involved and a crime reference number allocated, then they are immediately struck off.

They may then be referred to Preston Park after an assessment.

They are asked to sign a contract agreeing to certain conditions before they can receive any medical care.

PCT primary care manager Chris Naylor said the system was working very well.

She said: "Those that have been referred to the surgery have been better behaved and there have not been any major problems.

"Being struck off can give them a jolt and make them realise what they have been doing.

"Most of the patients on the scheme had been abusive and threatening with their previous practice, rather than physically violent.

"We are pleased with how things have gone so far and will be keeping a close watch on developments.

"These types of patients are in a minority but we have an obligation to ensure the safety of GPs and other patients."

The PCT is encouraging other surgeries in the city to consider bringing in extra security measures to try to reduce the number of incidents.

Information packs on how to deal with potential problems have been sent out.

The PCT is planning to work more closely with other NHS organisations such as the Royal Sussex County Hospital in Brighton.

Mrs Naylor said: "For example, if a patient behaves violently in accident and emergency then that information may not be given to their GP.

"It is difficult because of patient confidentiality but we are trying to work on ways in which communications can be improved.

"There does seem to be an increase in incidents.

"I think people seem to be more aggressive and impatient, which can lead to problems.

"It is a pity we have to go through all this but we do need to protect others from violence or abuse."

The work by the PCT reflects a growing insistence from health bosses that more should be done to protect NHS staff.

Similar secure surgery schemes have been set up in Worthing and Crawley and PCTs are considering setting up schemes in Eastbourne and Hastings.

Health Secretary Alan Milburn has spoken about a new system where hospital patients who are persistently violent or abusive towards staff could have their right to treatment withdrawn as a last resort.

The zero tolerance policy will include a yellow and red card scheme and will be introduced later this year.