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We need zero tolerance of bullying of GPs

Dr Kailash Chand

Bullying is a persistent problem within the NHS, which has significant negative outcomes for both the individuals and organisations affected.

In a recent survey of NHS staff, one in four reported experiencing bullying and harassment in the previous 12 months from patients, or their relatives, and 15% reported a similar experience from other staff. 

Research also shows that workplace bullying and harassment of doctors occurs across the medical workforce, from medical students and junior doctors in training to consultants and GPs. One in 10 callers to the UK National Bullying Advice line are healthcare professionals, including nurses and GPs.

A recent BMA survey on violence in the workplace revealed that more than one third of members had experienced some form of violence or abuse in the workplace in the past year, including verbal abuse, threatening behaviour and physical assaults.

GPs need to know they are entitled to a safe space to voice concerns

Doctors in both hospital and general practice settings reported such behaviour, largely from patients and their friends or family, but also from managers, medical directors, nurses and colleagues.

It is important to recognise that although much of the literature focuses on the bullying of junior doctors and medical students, the problem is also evident among GPs and hospital consultants, while anecdotal evidence suggests that consultants may be bullied by other consultants or senior managers.

GPs in Wales recently complained of being bullied and harassed by health boards.

And doctors and other staff at Alder Hey Children’s Hospital in Liverpool recently reported unprecedented levels of harrassment from the wider public, by telephone, email and social media channels – a barrage of highly abusive and threatening language and behaviour that has shocked the NHS community.

Doctors who experience bullying in the NHS are often unsure how to access help and when they attempt to do so, they often find the results are unsatisfactory. Anger, stress and powerlessness are the most common reactions to being persistently bullied and harassed, in turn adversely affecting patient care.

Following the Bawa-Garba case, several flaws in existing GMC investigations and complaints procedures have been identified, including that doctors have felt bullied during the complaints process.

It is vital that doctors receive pastoral care and support during an investigation. In some cases, the fall-out does not only affect the individual doctor, but their partners and family as well.

GPs are also inundated by demanding patients and fear dealing with complaints, financial issues, appraisals, inspections and the demands of revalidation.

Yet while GPs are expected to provide the space, opportunity and permission for their patients to voice their worries and concerns, these same rights are not always offered to them.

GPs need to be trained on how to respond to patients’ needs without getting overwhelmed, but also to know they are entitled to a ‘safe space’ to voice their concerns. It is imperative we provide such a safe space for GPs to process the emotional and clinical content of their work and the potential stressors related to the organisational culture, including bullying, as well as relationships at work, such as collegial conflict.

Any initiative to combat bullying and harassment and develop a healthy workplace culture requires more than policy statements and agreed procedures. I believe until we view bullying in the same light as we view sexual impropriety or racism, and look for evidence to support the victim rather than discredit them, it will persist.

The grievance mechanism employed by most organisations to address accusations of bullying is generally not effective, and often counterproductive. With each failed grievance the bully’s status, and confirmation of their position, is only enhanced.

Increasing awareness of the problems faced by GPs may help to alleviate the problems faced. We must move away from a culture that accepts and expects that stress and bullying is inevitable, and work towards improving working conditions for the profession.

A zero tolerance approach to bullying and harassment has to be implemented from the top of our NHS organisations.

Dr Kailash Chand is a retired GP from Tameside