Brief encounters of aggression and violence in primary care: a team approach to coping strategies

Our aim was to investigate the extended primary care team's experience of aggression and violence from patients, in order to promote the formulation of multiprofessional team procedures for critical incident management and organizational development.

A qualitative study based on in-depth interviews and focus groups with primary health care teams and community staff was carried out in one inner London and one outer London health authority area. Key issues and themes were derived from transcripts of 30 individual interviews and five focus group discussions.

Key issues identified during interviews informed focus group discussions. The focus groups identified existing and proposed responses to the problem of aggressive encounters. No practice had a protocol for dealing with incidents, and few kept records, but the incidence of violence and aggression was perceived to be increasing. Receptionists were most at risk, and relied on experience to cope with incidents. Due to being usually excluded from team meetings, they were not able to benefit from peer support and advice. Negative management tactics, such as patient appeasement or exclusion, were the norm. Recommendations include formal record keeping, communication skills training and team responsibility for incident management and for the development of practice protocols to ensure the consistency of response. Improvements to the working environment need to balance staff security with patient-friendliness, and constitute only one aspect of a measured response to the problem.

The success of the focus group format in this context suggests that entire primary care teams could be led in workshops to review their experiences and formulate responses on an inclusive, multidisciplinary basis. These findings fit in with the concept of systems analysis in risk management protocols. We recommend that the team collectively formulate protocols for managing threatening encounters, with agreed mechanisms and thresholds for recording and reporting. Together with improved support systems within the extended teams and post-incident analysis of adverse events, this would allow a formal approach to identifying systematic weaknesses and solutions that benefit the staff involved.