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Independents' Day

Disparaging social media comments - is a ‘zero-tolerance’ policy acceptable?

Experts advise on whether a practice should apply zero tolerance to online criticism

MPS medicolegal adviser Richard Stacey

Dr Richard Stacey: Ensure your policy is applied fairly

Patients have always spoken out about the service they receive from their GP practice, however, the proliferation of social media has meant that such discussions are now played out in a more public forum.

Communication on social media is often in emotive and confrontational language that is not so usual in spoken dialogue. This, plus the fact that there are limited safeguards to prevent patients making unpleasant and upsetting posts, makes practices understandably concerned.

However, adopting a zero-tolerance policy towards patients who criticise the practice on social media by taking action against them, such as removing them from your list, could come with multiple challenges.

You might ask yourself:

• How will you apply a uniform approach as some posts may not come to the practice’s attention?

• How do you establish the threshold at which a post warrants action?

• How will you maintain a consistent approach to feedback? For example, a social media post may represent an expression of dissatisfaction that could be addressed by the practice complaints procedure.

• How will you distinguish between rants and legitimate concerns that have been raised in an intemperate way?

• How will you deal with the fall-out if the policy attracts adverse publicity?

Regardless of the approach taken, practices should ensure they act within relevant professional and contractual requirements and consider the possibility that patients may raise concerns that warrant action – especially if several other patients have also raised similar concerns.

Dr Richard Stacey is a medicolegal adviser at the Medical Protection Society


Dr Anne-Marie Cunningham: There is no reason to punish patients

It makes sense for a practice to consider how to respond to comments in social media.

However the GMC is clear that criticism or complaint is not a reason to end a professional relationship with a patient, so the practice would need to consider what zero tolerance would mean.

Policies of zero tolerance were adopted in the late 1990s to curb violent and aggressive behaviour to NHS staff. Of course, if threats of violence appear on Facebook or Twitter, they need to be dealt with appropriately – which might involve the criminal justice system. But most of the commentary will not be of this nature.

While primary care staff must respect a patient’s right to confidentiality, if a patient places a comment about their experience of healthcare – whether negative or positive – in the public domain, this is their choice.

So if a practice does come across a negative comment in social media, it might be appropriate to contact the patient privately to see how the issue can be resolved in a supportive way. It may raise important issues that, if dealt with, may improve care.

Dr Anne-Marie Cunningham is a GP in Cardiff and academic lead for eLearning at the School of Medicine, Cardiff University


John Fitzpatrick: You must act in good faith

A zero-tolerance policy is intended to prevent abusive and violent behaviour towards staff, but is not a means to prevent negative feedback or criticism of a practice.

The NHS Constitution invites patients to provide feedback, both positive and negative about their experience, treatment and care.

Such feedback can be given anonymously. It expressly states that giving feedback will not adversely affect the patient’s care and how they are treated.

Equally it reminds patients that NHS staff should be treated with respect and that abusive and violent behaviour can result in withdrawal of services.

Practices are contractually required to act in good faith in performing their obligations.

They must set out in a practice leaflet the rights and responsibilities of patients and how they can make a complaint or comment on services.

They also must explain the action that may be taken if a patient is violent or abusive. 

Removing patients from the list is contractually permitted only in specific circumstances, and on reasonable grounds – for example, where there has been an irretrievable breakdown in the relationship, and usually only after a warning.

Violent patients may be removed instantly, but again there is a specific process to follow.

Contractors who fail to act reasonably, and in good faith, risk further complaints and contract sanctions.

John Fitzpatrick is an associate for health and social care law at Hempsons, specialising in regulation and contracts 

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Readers' comments (7)

  • Can those who post offensive comments on Pulse please take a lesson from this message...most of those who are insulted here by medics will have no idea .and it is a form of social media

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  • Come off it, ya stuck-up sticky beak! Social media are all about openness. If it's false and damaging, you can take action. If you just don't like what's being said about you: tough toodles.

    PS I'm not a military GP (not since 2007 anyway) - Pulse has got me all wrong.

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  • Instigating a ‘zero-tolerance’ policy against complaints on social media - isn't that what King Canute is famed for doing?

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  • 'However the GMC is clear that criticism or complaint is not a reason to end a professional relationship with a patient'

    Yet another reason why the GMC is a useless body of politically correct pen pushers.

    Libel type negative comments deserve far worse than simply removing from your list, as it is tarnishing your professional name and will undermine relationships with other patients as the old adage mud sticks, and no smoke without fire come into play, even when the comments are completely false.

    Once put out in the web they are there to stay almost permanently.

    Many who have ranted in an official complaint eventually are apologetic themselves once the situation is discussed and clarified, and they understand what has actually taken place.

    Patients who abuse their doctors need to be made aware this is not acceptable, and not to use social media as an open forum, and to use the complaints systems open for them to vent their issues in a safe and appropriate manner.

    Removal from the list will send the required message and is the best way as they will either stop doing it, or have no access to care.

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  • Azeem Majeed

    In my own practice, we do respond to any comments we receive by email and we try to respond to comments on NHS Choices (whether negative or positive). We don't respond to comments on other social media sites such as Facebook, Twitter or blogs.


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  • How about the rant on NHS choices? Clear for all to see but obviously unfair / unbalanced.

    Can this be redacted?

    We have contacted NHS choices about such comments and been told that it had passed their inclusion criteria and nothing can be done

    Seems a very odd and one sided situation

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  • Those who are not happy with the NHS can bugger off to America where they are charged the proper market rates:

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