The Challenging Behaviour General Practice (CBGP) is the enhanced service to provide Primary Medical Care for patients who have behaved in an abusive, threatening, aggressive or violent manner whilst in General Practice staff.
Referral is only accepted from GPs through SCI Gateway. Every referral is considered by the CBGP Reference Committee. The Reference Committee may suggest alternative strategies to manage behaviour if the patient does not fit the referral criteria and is not accepted for care under the Challenging Behaviour General Practice.
The practice offers restricted clinic times, by appointment only, to ensure that patients are seen by a GP and Nurse when a security officer is present. Out with clinic times, patients are directed to attend their local A&E for urgent medical problems; there are no facilities for home visits – house bound patients are not accepted.
When the patient’s Primary Care needs can be met in mainstream General Practice, (unless there has been an extremely serious event leading to referral, in which case an alternative practice is approached) the referring practice is approached with an expectation that they accept the patient back to their list.
Patients who do not attend for 6 months and for whom there are no reports of challenging behaviour elsewhere in the health service are discharged from the Practice.
Patients who have been removed from a practice list prior to the referral being considered by the reference committee will not be accepted.
The CBGP is based at:
The Andrew Duncan Clinic
Royal Edinburgh Hospital
Morningside Place
Edinburgh, EH10 5HF
Tel 0131 373 8000
Who to refer:
Patients who repeatedly behave in an abusive, threatening, aggressive or violent fashion towards Primary Care Staff and who:
- Do not respond to measures to contain this behaviour– these should generally include requests to stop / leave
- Are sent a warning letter advising him/her that their behaviour is inappropriate
- Who have been placed on a behavioural contract advising what behaviour will not be acceptable with no effect
Who not to refer:
- Patients who are acutely mentally unwell and whose behaviour, is on this occasion, uncharacteristic.
- Patients who behave on only one occasion in a disturbing manner – suggest letter of warning, behavioural contract and opportunity to discuss problem possibly with Practice Manager present.
- Patients under the age of 18
- House bound patients
- Patients whose main care needs would be better met in specialist mental health or addiction services
- Patients who require to be seen a secure setting.
- We would advise that any incident of aggressive or violent behaviour against healthcare workers should be reported to the police. If police have not been involved with the current incident, we may consider the referral inappropriate.
How to refer:
- Referral is made through SCI Gateway (psychiatry / mental health; Challenging Behaviour General Practice).
- The staff will be in touch generally within 1 week, but a decision regarding acceptance is discussed with members of the reference committee, so may take up to 2-3 weeks if complicated.
- Practices are requested not to remove the patient from their list whilst this referral is processed. Please advise patient of referral to CBGP and that they should attend A&E until informed of further GP care arrangements.
- Practices are requested to notify any patient of referral to CBGP detailing what behaviour has lead to their referral
Gateway Dictation Check List
Protocol Text
Police notified Yes/ No
We would advise that any incident of aggressive or violent behaviour against healthcare workers should be reported to the police. If police have not been involved with the current incident, we may consider the referral inappropriate.
Does the patient have any children / vulnerable adults under their care? Yes No
Have you alerted the Health Visiting Team? Yes/ No
Does the patient have a partner living with them? Yes /No
Significant Event Analysis completed Yes/ No
Has this patient’s behaviour caused concern in the past? Yes/ No
If yes please give a short description of previous behaviour and management Text
