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. This service is to offset risks to healthcare workers and associated administrative teams – it is not for people who are known to engage in violent or threatening acts with other members of society.
Referrals are discussed at our virtual Reference Group with representation from the practice, the Edinburgh HSCP (host HSCP) and NHS Lothian Primary Care directorate. Please include any incident reference number provided by Police Scotland. If accepted the patient will be contacted and will be registered via our Practitioner Services Directorate. If a referral is not accepted, the referring clinician will be contacted and a rationale for the decision will be offered.
In the first instance, a patient will be accepted for a six-month period; at the end of this, their conduct will be reviewed by our Reference Group and a decision on repatriation will be made. We would ordinarily expect the originating practice to take the patient back once this period is complete. If the act resulting in referral is egregious, then this will be managed on a case-by-case basis.
We are unable to accept patients after a low grade or situational response to distress. Patients will sometimes respond in an exaggerated way and where this is unusual for the patient or may be related to a medical cause (early/undiagnosed cognitive impairment, only when intoxicated, hypoglycaemic, etc.), referral to CBP would be inappropriate. It may be reasonable in the first instance, to instigate a behavioural contract with the patient. Sometimes if the relationship between practice and patient has broken down, it may be appropriate to have the patient register at another practice. This doesn’t necessarily mean an automatic referral to CBP should be made.
Who can refer:
We accept referrals via SCI Gateway, from the patient’s current practice. We also accept referrals from other CBPs if a patient is moving area.
Who to refer:
Any patient who has:
- made a threat to a member of staff which seems credible and violent in nature.
- acted in a violent manner.
- been found to significantly cross personal boundaries with staff members (eg. stalking).
Passing comments that offer non-specific threats are unacceptable behaviour but are unlikely to meet the criteria for accepting on to CBP list.
Who not to refer:
Any patient that has behaviours associated with a health condition. We cannot offer support for behaviourally challenged older adults with cognitive impairment. Please consider a referral to locality Rapid Response Teams within the Mental Health service.
How to refer:
Referrals are made via SCI Gateway: Mental Health > Challenging Behaviour Practice.
