The MDU receives around 400 calls a year to the advisory helpline from members asking how to manage difficult patients. The vast majority came from general practice.

Removing a challenging patient from the practice list isn't always warranted or viable. An alternative strategy is the use of behaviour contracts between the practice and the patient.

Sometimes called doctor-patient contracts or acceptable behaviour contracts, their objectives are broadly the same:

  • to outline to the patient what aspects of their behaviour are inappropriate
  • the impact this has on others
  • how it can interfere with the effective delivery of healthcare
  • the potential outcomes if their behaviour does not change.

NHS Protect, in its 2012 publication Unacceptable Behaviour - guidance on warning letters and other written communications, outlines strategies for addressing this type of behaviour. The guidance describes the types of behaviour that may be regarded as unacceptable and various ways in which these can be addressed, including Acceptable Behaviour Agreements (ABAs).