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

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