Viewpoint: Bullying is a silent epidemic within the NHS

There is a lack of training in general practice around understanding bullying, says London GP Dr Kamilla Kamaruddin. She looks at how bullying can occur and offers advice on what GPs can do if they are being bullied.

Dr Kamilla Kamaruddin
Dr Kamilla Kamaruddin

It’s a topic we hardly talk about - bullying. But it’s about time that we started exploring what it means and how it affects individuals, staff, practice performance and patient care at large.

From my own experiences I can relate to the consequences of bullying, but I’m hardly alone. The 2017 NHS staff survey shows that a quarter of all employees reported having experienced bullying.

Another survey showed that almost 30% of all NHS staff have experienced psychological distress from bullying. These statistics suggest that bullying is more prevalent than many of us may think. A silent epidemic in the NHS.

I’ve been a GP for around 20 years and I have never attended a lecture or training about bullying awareness. Nor have I been taught how to speak up about bullying or listen to someone who wants to discuss the fact that they are being bullied. And I’m sure this lack of awareness is common in other parts of the country as well.

However, this lack of awareness means that general practice has failed to protect its staff. Awareness of bullying is often so poor that many people do not realise that they are bullying or being bullied.

Forms of bullying

Bullying does not have to involve verbal or physical aggression; it can often be more subtle - sharing similarities to emotional or psychological abuse where there is an attempt to control a people. Commonly, the perpetrator uses emotion, intimidation, and the undermining of achievements as a weapon of choice. They are often unaware they are being abusive.

Whilst this is common, it is unfortunately difficult to identify as the boundaries and definitions are often unclear. What can be a distinguishing factor is that the abuse and bullying is often repeated behavior.

According to the NHS website, workplace bullying can involve arguments and rudeness but it can also cover: excluding and ignoring people and their contribution, giving unacceptable criticism and overloading people with work.

Regardless of the cause, the consequences can make the victim depressed, miserable and suffer from stress-related illness. It can also make them feel undermined, anxious and they often find it hard to motivate themselves to work. It is therefore a health-harming mistreatment of the victim, and the perpetrator’s conduct is clearly abusive.

Whilst it is a serious offence, bullying is unfortunately not against the law whereas harassment is; this is when bullying is related to your age, gender, sexual orientation, or race, among other 'protected characteristics' defined in law.

What to do if you are being bullied

What can you do if you feel that you are being bullied? Be calm and strong. Put your emotions to one side and behave in a professional manner. Do not be dragged into a heated discussion which can make the situation worse.

Be confident in your abilities. Recognise that it’s not your fault. The perpetrator’s action reflect only their weakness and it is intended to intimidate, undermine and control you. There is no need to explain or justify your behaviour, the onus lies on the perpetrator.

Ask the perpetrator to explain their behaviour and, if needed, take someone with you and ask your perpetrator(s) to document their reasons. Confide in someone you trust and share your experience. Often you will find out that the bullying incident is not isolated and happens to others too.

Get plenty of advice, if you’re an employee you can speak to the practice manager, a trade union official or your practice human resources services. Doctors can get further advice from the BMA, their LMC or CCG. Peninsula also has free, 24-hour access to human resources advice.

Keep a diary and document it as much as possible. If it has affected your health, see your GP and get some counselling from your GP or BMA services.

GP partners

If you are a GP partner things might be more complicated. A GP partner is self-employed, bound by partnership deed and therefore not covered by employment laws in the same way as an employee. Your partnership deed may not mention anything about bullying and intimidation. You might need advice from a lawyer if you feel the relationship between partners has completely broken down.

During this COVID pandemic, bullying and intimidation can happen in many other ways. There is less face to face interaction and we communicate more via emails and virtually. So be mindful of your tone and language in emails - a harsh email that is dismissive can be construed as intimidation.

There is no place for bullying in the NHS, while harsh and punitive leadership conveys the wrong message to practice teams. Bullying leads to low morale among staff and it is divisive - affecting your surgery’s performance and ultimately your salaries. The fallout can be costly for both sides.

  • Dr Kamilla Kamaruddin is a GP in Tower Hamlets, London, a trustee for 'Live Through This' and a board member of Spectra-London. She is passionate about improving healthcare for trans people, inclusivity and anti-bullying in the NHS.

For bullying and harassment support resources visit the BMA's website here.

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