Family Practice Vol. 21, No. 2, 137-139
Family Practice Vol. 21, No. 2 © Oxford University Press 2004, all rights reserved.
Article |
Abusive behaviour experienced by primary care receptionists: a cross-sectional survey
Stockwell Road Surgery, Knaresborough, a NFA Health Centre for Homeless People and b Centre for Research in Primary Care, Leeds, UK
Correspondence to CNE Tompkins, NFA Health Centre for Homeless People, Leeds, UK; E-mail: c.tompkins{at}leeds.ac.uk
Received 7 May 2003; Revised 22 October 2003; Accepted 3 November 2003.
Dixon CAJ, Tompkins CNE, Allgar VL and Wright NMJ. Abusive behaviour experienced by primary care receptionists: a cross-sectional survey. Family Practice 2004; 21: 137–139.
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Abstract |
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Background. Receptionists act as gatekeepers to GPs, and thus are often placed in situations of conflict. However, there is a lack of research in this area.
Objective. The purpose of this study was to identify the incidence and associations of verbal and physical abuse against primary care receptionists, both pre- and post-‘zero tolerance’.
Methods. A postal questionnaire was designed, piloted and sent to all reception staff in 50 randomly selected general practices in Leeds. The primary purpose was to identify any verbal or physical abuse experienced in the 12 months prior to the survey and assess the association between abuse experienced and deprivation.
Results. Seventy percent of receptionists completed and returned the questionnaire. Over two-thirds of receptionists had experienced verbal abuse in the last year. During the same time period, 60% reported telephone abuse and 55% reported face to face abuse. The incidence of abuse was higher in the year prior to the study than in the preceding period. Practice deprivation was identified as a significant factor for verbal abuse (P = 0.003).
Conclusion. Verbal abuse against receptionists is significantly associated with the level of deprivation of the practice area. There is no evidence that ‘zero tolerance’ led to a reduction in abuse experienced by primary care receptionists. All primary care receptionists should receive adequate training on managing abuse.
Keywords. Abuse, deprivation, medical receptionists, primary care, zero tolerance.
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Introduction |
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Abuse and violence within the workplace can lead to poor performance and resignation. To address this issue and reduce intimidation and violence against staff working in the NHS, the Government published its nationwide ‘zero tolerance’ campaign in 2000.1 As gatekeepers to GPs, receptionists are often placed in situations of conflict. However, such conflict and abuse have not been studied previously. This study aimed to identify the incidence of abuse against primary care receptionists in randomly selected practices in Leeds.
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Methods |
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Three focus groups were conducted with primary care receptionists. Important themes and issues raised in the discussions were identified and a questionnaire was devised and piloted. The focus group discussions included male and female primary care receptionists and were conducted in practices in varying areas of deprivation.
A random selection of 50 practices in Leeds were selected using Microsoft Excel. Each practice was contacted by phone and the survey explained. Two practices requested not to be involved. None of the receptionists from the focus group discussions were involved in the final sample. The questionnaire was kept short with 11 questions, the majority of which required the receptionists to tick or circle boxes. One week before the questionnaire closing date, non-responding practices were contacted again and sent repeat questionnaires with a further 3 weeks to respond. Demographic data was collected alongside the experiences of, and triggers for, abuse pre- and post-zero tolerance. Deprivation score was assigned using the practice postcode.
McNemar tests were used to compare the incidence of abuse between the two time periods. Logistic regression was used to determine which factors were associated with incidence of abuse. A P-value of <0.05 was considered to indicate statistical significance. Bonferroni adjustments to allow for multiple significance tests were not made due to the increased likelihood of performing a type II error.2 Analysis was undertaken on SPSS (version 11).
The questionnaire is available at Family Practice Online.
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Results |
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Seventy percent of receptionists returned the questionnaire. The practice questionnaire response rate was 78%. The average age was 45 ± 9.6 years, ranging from 19 to 63 years. Ninety-eight percent of respondents were female. Seventy-four percent (90/122) described them-selves as British or English; the remainder described themselves as white [27/122 (22%)], or by country of origin other than the UK [5/122 (4%)]. Most respondents had been in service for >12 months [134/152 (88%)]. The median practice deprivation score was 30.3 (interquartile range 16.4–52.5). A higher deprivation score correlated with increased level of deprivation.
In the last year, the majority had suffered verbal abuse [116 (68%)], with 94 (55%) reporting face to face abuse and 102 (60%) reporting telephone abuse. In the 12 months prior to zero tolerance, 93 (61%) had experienced verbal abuse, with 77 (51%) reporting face to face abuse, and 83 (55%) reporting telephone abuse. There were no significance differences in the proportion that had suffered any verbal abuse between the 2 years (McNemar test, P = 0.089). In the last year, 24 (14%) reported a threat of physical abuse, compared with 17 (10%) in the year prior to zero tolerance. There was no significance difference between the 2 years (McNemar test, P = 0.248). In the last year, seven (4%) reported actual physical action against themselves, compared with four (1%) in the year prior to zero tolerance. There was no significance difference between the 2 years (McNemar test, P = 0.549). Figure 1 shows the prevalence of different types of abuse.
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Logistic regression determined which variables were associated with the incidence of verbal, physical and actual physical abuse in the last year (Table 1). The factors included were age, number of years service, ethnicity and the practice deprivation score. The only significant factor was for verbal abuse and deprivation (P = 0.003); with each increase in deprivation score of 1, the odds of verbal abuse increased by 1.04 (95% confidence interval 1.01–1.07).
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Discussion |
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This study is the first to identify the incidence of abuse, both verbal and physical, of primary care receptionists. The results indicate that 68% of receptionists have been verbally abused; almost half within the previous 2 months. Reported abuse increased in the 12 months prior to the study compared with the preceding period. Verbal abuse is widespread, but the threat of physical abuse is more common in practices in areas of higher deprivation. There is no evidence that zero tolerance has led to a reduction in verbal or physical abuse against receptionists. A limitation of the study was that information was collected retrospectively over a 12 month time frame. As such, recall bias, such as misplacing an event in time or overlooking a particular event, may affect the results and their subsequent interpretation. A further limitation is that the questionnaire did not use pre-defined categories to collect information regarding the respondents' ethnicity. As a result, there data were difficult to interpret as some respondents confused ethnicity with nationality.
Whilst there is an absence of research into abuse against GP receptionists, our work goes some way to agree with previous work into abuse against GPs.3,4 Ness et al. identified a positive association between violence and deprivation,4 and Hobbs found that 63% of GPs had suffered abuse or violence in the previous year, with inner city GPs being more vulnerable.3 As receptionists receive training around managing violence, further research is needed to evaluate the effectiveness of the training intervention. Current strategies for managing violence also need to be evaluated, including a formal evaluation of safe havens. There is not yet evidence for which primary care staff are most vulnerable to abuse; thus, a multicentre study of all practice staff would address this, help target training and improve the smooth running of primary care.
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References |
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1 NHS. Zero Tolerance. London: HMSO; 2000.
2 Perneger TV. What's wrong with Bonferroni adjustments. Br Med J 1998; 316: 1236–1238.
3 Hobbs FD. Violence in general practice: a survey of general practitioners’ views. Br Med J 1991; 302: 329–332.
4 Ness GJ, House A, Ness AR. Aggression and violent behaviour in general practice: population based survey in the north of England. Br Med J 2000; 320: 1447–1448.
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