I want to bring to light the disturbing issue of Vertical Abuse that can occur in NHS GP surgeries, which refers to the 'hierarchical mistreatment and intimidation' of patients, staff (such as nurses and administrative personnel), by their Doctors and senior counterparts. This silent issue within healthcare not only affects the morale and mental health of the employees but also compromises the quality of care provided to patients.

I've unfortunately been on the receiving end of vertical abuse/verbal abuse in a GP surgery as a patient, during consult (which was unusual and scary to witness) - it's insidious in nature; this particular form of abuse.  It's why I have started this petition - to raise awareness.  Just so we are clear on what it is...

'Vertical abuse, describes abusive or bullying behavior between people at different levels of a hierarchical power structure'.

So, you as a vulnerable patient, go to a Doctor for advice/care - you rely on their expertise.  You hope to have a good working, egalitarian relationship.  You expect to be treated nicely and vice versa but 1 day, something tips in the Doctor - they don't treat you as an equal but as an inferior.  In an environment designed to heal and nurture, such toxic interactions have NO place between Doctors and Patients.  Nor does it have any place between Doctors and their staff.  Vertical abuse often leads to a high turnover of valuable NHS staff, increased sickness leave due to stress-related conditions, and, most critically, risks in patient safety as staff become too stressed to perform at their best. For instance, a 2019 study by the British Medical Journal highlighted that stress and bullying are significant factors contributing to medical errors in the UK.

Vertical abuse is particularly prevalent in the healthcare sector, where gender and professional hierarchies can often exacerbate its impact.  Both male and female healthcare professionals may experience vertical violence, but the experiences and consequences can vary significantly based on gender.  The most common types of vertical abuse in the healthcare sector include:

• belittling;
• unfair criticism;
• shouting;
• micro-management;
• excessive demands;
• bullying;
• physical abuse. 

It is heavily documented in nursing and medical training, where senior nurses, doctors, or instructors target students, interns, or newly hired staff.

I don't feel anyone should be a target.

The perpetrators in practice, have seen this before, somewhere in their early lives perhaps (usually in authoritarian parenting) or in poor training; which is why they act it out as adults - however this is unacceptable within a GP surgery and in general.  

Through organisational staff meetings, following patient complaints/staff complaints, vertical violence behaviours should be identified, producing staff awareness of this phenomenon.  As recognition occurs with staff, this could invite open discussions on the issue.  For the perpetrator, counselling should occur with a collaborative action plan developed to eliminate this.  A zero tolerance policy should be adopted to prevent violent behaviors towards patients/staff.

Just so we are clear on what Authoritarianism is and how it can play out in healthcare: it is 'regimes that control medical systems, and interpersonal/institutional paternalism where fundamentally Doctors strip patients and staff of autonomy and agency.

The frequency and severity of this can vary widely, depending on various factors such as the workplace culture and the individual personalities involved.

If you are under the care of an Authoritarian Doctor you will know -

• They do not like being challenged/questionned (even though you have a right to);
• They will likely engage in belittling/criticism;
• Vertical abuse can occur;
• They will be dismissive;
• Their posture/facial expressions will tense up during communications;
• They try to stifle your autonomy/agency;
• They always think they are right - their view is 'final and absolute';
• They try to control through fear and intimidation;
• They will more than likely view you as inferior (you're not);
• They could label you as 'difficult' (you are not) 

Let me remind you, as vulnerable patients and staff who deserve respect, autonomy and agency (and let this serve as a reminder to such perpretators), the NHS is an institution built on the principles of compassion and care, not fear and intimidation.

To address this pressing issue, it is crucial for:

• Any patient who has experienced this, you must report it;
• A patient to terminate consults with the GP immediately;
• A Doctor must step back and look at their own behaviour;
• The NHS should implement mandatory anti-bullying training and establish a clear, anonymous system for reporting abuse without fear of retribution;
• All incidences reported by patients/staff should be reported to Practice Management, senior staff;
• The Perpretator needs counselling and an action plan put in to place by the practice to eliminate this behaviour;
• Regular audits/inspections should be carried out to assess workplace culture, and there needs to be accountability at every level, ensuring that perpetrators are held responsible for their actions.
• Freedom to Speak Up (FTSU) Guardians are independent, impartial staff members appointed within NHS and healthcare organizations in England to support workers in raising concerns safely. Created following Sir Robert Francis’s 2015 inquiry, they help staff voice issues regarding patient safety, bullying, or workplace barriers without fear of reprisal.

The wellbeing of healthcare professionals directly correlates with patient outcomes, and by ensuring a supportive environment, the NHS can improve operational efficiency and patient satisfaction.

I implore the Department of Health and Social Care, as well as NHS leadership, to take decisive action against vertical abuse/verbal abuse towards patients/staff and reinforce a culture of respect and professionalism in all GP surgeries.

Please sign and share this petition to urge NHS leaders to address vertical abuse/verbal in GP surgeries and protect not only patients but the essential workers who tirelessly care for us all.