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  6. Case type 3 violent or abusive behaviour
Guidance introduction

Case type 3: violent or abusive behaviour

  1. Violent or abusive behaviour describes behaviour that may be aggressive, coercive, controlling, destructive, harassing, intimidating, isolating, or threatening. It can be demonstrated through physical acts or omissions, or verbally.

  2. Physical abuse often occurs when physical force is used in a way that injures or endangers another person. Emotional abuse may include verbal abuse such as yelling, name-calling, blaming and shaming. Isolation, intimidation, and controlling behaviour – such as rigidly controlling finances, withholding necessities (food, clothes, medication, shelter), preventing someone from working or seeing friends or family – are also forms of emotional abuse.

  3. Violent or abusive behaviour may include aggressive or physically threatening behaviour to colleagues or patients, or more specific incidents of violence outside the workplace. It may also include stalking and harassment.

  4. When violent or abusive behaviour arises in a PA or AA’s working life, the PA or AA’s behaviour may be directed towards patients, former patients, relatives of patients, or colleagues.32 In addition to the direct impact it will have on the recipient, violent or abusive behaviour can impact other individuals, such as those who witness the behaviour, and on the working environment.

  5. Outside a PA or AA’s working life, violent or abusive behaviour may be directed at any person, including the PA or AA’s partner or a family member.

The professional standards PA and AAs are expected to meet

  1. PA and AAs must protect and promote the health and safety of patients and the public and make sure their conduct justifies their patients’ trust in them and the public’s trust in the profession.33 They must treat colleagues and patients with kindness, courtesy and respect.34

  2. PA and AAs must be aware of how their behaviour may influence others.35 They should help to create a culture that is respectful, fair, supportive and compassionate by role modelling behaviours consistent with these values.36

  3. PA and AAs must not abuse, discriminate against, bully or harass anyone.37 PA and AAs are expected to act, or support others to act, if they witness, or are made aware of, such behaviours.38 

Seriousness

  1. Whilst a range of behaviour can be seen, the nature of the departure from the standards expected may mean that a concern or allegation of violence or abusive behaviour falls at the high end of the spectrum of seriousness. Even a single incident of violent or abusive behaviour can have a significant harmful impact and pose a risk to public protection.

Impact on public protection

In cases of violent or abusive behaviour, the different parts of public protection might be engaged as follows:

Protecting, promoting and maintaining the health, safety and well-being of the public (patient safety)

It is necessary to protect patients and members of the public from physical, emotional and / or psychological harm resulting from violent or abusive behaviour. The impact of harm arising from this behaviour can be long lasting and may affect how a person accesses health services in the future. 

Violent or abusive behaviour directed towards colleagues may pose a risk to patients who may be distressed by witnessing these acts. In addition to any harm to them, there may be patient safety implications as violent and abusive behaviour will have a negative impact on effective communication, and collaborative working, between colleagues.   

Violent or abusive behaviour outside a clinical setting may still present an indirect risk to patients or the wider public if this behaviour could be repeated within a clinical setting or elsewhere.     

The nature of the behaviour means it can give rise to a risk of repetition.

Promoting and maintaining public confidence in the profession (public confidence)

Violent or abusive behaviour by a PA or AA may have the effect of undermining public confidence in the profession and professional standards, especially if the act results in a criminal conviction.  

As PA and AAs have respected positions in society, members of the public will expect them to uphold professional standards and where they do not, this will impact on public confidence. 

The public having confidence in the profession is more important than the interests of an individual PA or AA. 

Promoting and maintaining professional standards and conduct (upholding professional standards) 

Good medical practice requires that PA and AAs treat others fairly and with respect, and act with integrity and within the law. 

Violent or abusive behaviour will usually amount to a significant breach of the standards expected.

Decision on interim measure

  1. Where the concern or allegation involves violent or abusive behaviour towards patients or colleagues, or the PA or AA is under police investigation for a violent criminal offence, the interim measure tribunal (IMT) should carefully consider the public interest, and the impact on public confidence if the PA or AA were to continue working unrestricted pending resolution of the fitness to practise process.

  2. More detail about when an interim measure is likely to be appropriate in a violent or abusive behaviour case can be found in the specific case types section in Section 2: IMT hearings. 

Decision on impairment

  1. Many allegations relating to violent or abusive behaviour fall at the higher end of the spectrum of seriousness. Where they do, the starting point for assessing current and ongoing risk to public protection will be high.

  2. In these cases, evidence of relevant context known about the PA or AA and/or their working environment and evidence of insight and remediation that decrease risk may have less impact because proven allegations falling at the higher end of the spectrum of seriousness can be more difficult to remediate. In such cases the associates tribunals (AT’s) decision on risk should reflect this and a conclusion the PA or AA poses a current and ongoing risk to public protection may be needed even in cases where the PA or AA has shown insight and taken steps to try and remediate. Where the AT concludes that the PA or AA poses a current and ongoing risk, this will result in them finding that the PA or AA’s fitness to practise is impaired.

  3. The level of risk associated with an allegation of violent or abusive behaviour will often be medium or high. However, where there is a single incident of violent or abusive behaviour which falls at the lower end of the spectrum of seriousness, the level of risk may be lower.

  4. Where an allegation of violent or abusive behaviour leads to a finding of impairment, it may engage one or more of the three parts of public protection. Whilst the AT must consider the individual circumstances of the case, it will be unusual for a proven allegation of violent or abusive behaviour not to undermine public confidence in the profession.

Decision on whether a warning is required

  1. Where the PA or AA’s violent or abusive behaviour falls at the higher end of the spectrum of seriousness, a conclusion that the PA or AA poses a current and ongoing risk to public protection will often have been made. However, where the specific type of behaviour amounting to violence or abuse is found to have just fallen short of a finding that the PA or AA’s fitness to practise is impaired, and there are no other proven allegations that require restrictive action to be taken, a warning will usually be appropriate to maintain public confidence in the profession and uphold professional standards.

Decision on final measure

  1. The proportionate final measure in response to an allegation of violent or abusive behaviour will depend on the extent of the PA or AA’s behaviour and the impact it’s assessed to have on each of the three parts of public protection. 

  2. Where the level of current and ongoing risk to public protection is medium or high, this will require consideration of suspension or removal. 

  3. When deciding on final measure, the AT should consider the final measures banding for cases of violent or abusive behaviour in Part C of Section 3: AT hearings.
Lower level of risk to public protection Medium level of risk to public protection Higher level of risk to public protection
Suspension up to 3 months Suspension 3 to 12 months Suspension 12 months to Removal
  1. In these cases, evidence about the impact of a specific type of restrictive action and references and testimonials will have limited, if any, relevance to the AT’s decision about what final measure is appropriate. 

  2. For cases involving a criminal conviction or caution, the AT should also refer to the specific case type section Criminal convictions, cautions, court sanctions and determinations. Where there is more than one type of proven allegation, the AT should impose the final measure that addresses the most serious findings.

32 Colleagues include anyone a PA or AA works with, whether or not they are PA or AAs.

33 Good medical practice, ‘The duties of medical professionals registered with the GMC’ and paragraph 81.

34 Good medical practice, paragraphs 23 and 48.

35 Good medical practice, paragraph 53.

36 Good medical practice, paragraph 52.

37 Good medical practice, paragraph 56.

38 Good medical practice, paragraph 58.