Dealing with racism from patients

We live in a multicultural society but racist attitudes persist - and even now, some patients are not inhibited about expressing them.

Racism is not something healthcare staff should have to tolerate, but unfortunately the evidence suggests ethnic minority doctors and practice staff continue to experience racism from some of the patients they care for.

The NHS Staff Survey (published in February 2020), revealed that 7.2% of NHS staff reported personally experiencing discrimination at work in the previous 12 months from patients and other members of the public, mostly due to their ethnic background.

Furthermore, an investigation by ITV revealed that the number of racist incidents recorded in the NHS rose by 145% from 589 in 2013 to 1,448 in 2018. More cases of abuse may have been unreported.

The Black Lives Matter movement has brought much needed attention to the wider issues involved in racism. It is important that practice staff respond appropriately when they encounter racism from patients and support affected ethnic minority colleagues.

Zero tolerance approach to racism

Ill health should not be an excuse for racist behaviour. Nor should patients be able to rely on the doctor-patient relationship to shield them should they racially abuse NHS staff. Since October 1999, the NHS has had a zero-tolerance campaign in place against all violence and intimidation of staff and notices are already within GP premises or on websites.

In November 2019, the then health and social care secretary, Matt Hancock, wrote to all NHS staff in response to concerns about racism against healthcare professionals: "If you face abuse, do not accept it. If you see a colleague being abused, do not ignore it. If you know of an employee facing this, do not stand for it. The government takes a zero-tolerance policy approach to dealing with racist abuse whenever it arises. Things should be no different in our NHS."

What you can do

If you are the victim or witness racism in your practice, there are several steps you can take.

  • Make a written note of what was said or done, with verbatim quotes if possible, so there is a contemporaneous record of the incident.
  • If other people were present and witnessed the incident, make a note of their names and job titles so they can be asked for statements during any subsequent investigation.
  • Report the behaviour so it can be investigated according to your practice policy.
  • Racist abuse may arise in the context of an already angry patient who is complaining about other aspects of care. If the patient shows signs of agitation or anger, be prepared to end the consultation if you feel there is an imminent risk of physical aggression and use the panic button if you feel unsafe.
  • Don't ignore racism because it is directed at a colleague rather than you personally. The GMC's guidance on Leadership and Management for all doctors says you "must tackle discrimination where it arises and encourage your colleagues to do the same".

Warning patients

Racial abuse must not be tolerated and patients should be challenged about their behaviour.

If you decide to warn the patient that their behaviour is unacceptable, be clear you will end your professional relationship if they don't change behaviour. Keep a record of your discussion and follow up your warning in writing. If you do need to remove the patient, you would normally be expected to have issued a written warning during the 12 months before removal.

If there are further racist incidents, you can inform the patient that they are being removed and explain the reasons and be clear they will not be left without medical care. Make a record of your decision, which should be factual and objective.

Notify your local NHS England Area Team or Health Board in writing of your decision and the reasons, in line with your NHS contract. They will notify you and the patient in writing. The removal will usually take effect when the patient is registered with another provider or the eighth day after the notice has been received, whichever is sooner.

Involving the police

Where racist abuse of staff requires police involvement, the patient can be removed straight away. Only give the police the minimum information needed to allow for proper investigation (the patient's medical details should not usually be required) and obtain an incident number.

Notify the relevant Primary Care Organisation (PCO) and confirm in writing, either immediately or within seven days. The removal will take effect when the notification has been received. If it would be unsafe or impracticable to notify the patient, speak to the PCO who will in any case notify the patient in writing and arrange for their ongoing care, in a secure setting if necessary.

Keep relevant witness statements and records of the decision for removal in a file separate from the clinical records.

It is important to keep the staff member concerned informed of developments and ensure they are fully supported throughout the process.

If you are considering removing a patient from your list, get advice from the MDU or your own medical defence organisation before taking action.

This page was correct at publication on 14/07/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.