Patients or family members who attack doctors will be more likely to be prosecuted in future.

Guidance issued by the Crown Prosecution Service has been broadened to include violence against “a health or social welfare professional” as a trigger for prosecution.

The code gives guidance to prosecutors on the principles to be applied when making decisions about prosecutions. Previously it gave limited specific examples of victims of offences who “served the public”, citing only nurses, police and prison officers.

Richard Hampton, head of NHS Security Management Service, said: “This effectively signals to prosecutors across England and Wales that an offence against anybody providing NHS services, including ambulance workers, is to be viewed with particular concern.

“This will in time lead to more prosecutions of offences against NHS staff and, in turn, more convictions.”

Read more about the full code.

Doctors are vulnerable to violent behaviour and feel ill-equipped to manage such situations, a survey by the MDU reveals.

Fifty eight percent of doctors said they had been physically or verbally assaulted in the last five years. While some of the respondents accepted this as ‘part of the job’, six out of ten said they had not received training in dealing with such situations and would like to feel more confident.

Of the doctors who were assaulted, a quarter suffered anxiety or depression after the event and four doctors needed medical treatment, for injuries such as cuts or lacerations.

The vast majority of the 172 respondents said they had encountered a patient making unreasonable demands, such as insisting on a referral or prescription which they felt was not clinically indicated. 

Examples of incidents include a consultant whose patient brandished a knife during a consultation and another who had a hot drink thrown at her.

Strategies being employed include patients being sent warning letters, banned from seeing certain doctors, or only being seen if accompanied by another healthcare professional.

Dr James Armstrong, an MDU medico-legal adviser, said: “Many of the respondents to our survey reported that they had not received training in dealing with such distressing situations. There are steps doctors can take to try to prevent difficult situations escalating into violence or abuse, such as anticipating where flash points might arise.”

To minimise difficult encounters the MDU advises doctors to consider: identifying potential assailants or groups, such as patients with a history of previous violence, mental health difficulties or alcohol/drug abuse; anticipating activities that might present a high risk of aggression, such as delivering bad news; looking at the layout of the consulting room or reception so the doctor can easily exit; and, arranging training in handling verbally or physically aggressive people.

NHS figures reveal there were 54,758 physical assaults reported by NHS staff in 2008-9.