The Special Allocation Scheme (SAS), previously known as the Violent Patient Scheme, exists to protect healthcare staff and patients by providing GP services in a secure environment for individuals who have exhibited violent or aggressive behaviour. It ensures that:

• Practices can maintain a safe environment.
• Patients removed from a practice list still have access to essential primary care services.

When to Use the Scheme

A patient may be referred to the SAS if:

• They commit an act of violence or behave in a way that causes staff or other patients to fear for their safety.
• The incident occurs on practice premises or during a home visit.
• The behaviour includes assault, threats, or property damage.

Important:

• Referral should not be used for minor incidents (e.g., swearing or frustration linked to health conditions) unless risk assessment shows no alternative. 

Immediate Actions

• Call 999 if there is an immediate threat.
• Report the incident to the police (a crime number is not mandatory for removal).
• Document the incident thoroughly, including staff statements and any evidence.

Removal Process

• Practices can immediately remove the patient from their list under GMS/PMS regulations after reporting the incident.
• Submit a violent patient reporting form to NHS England or the ICB with delegated authority.
• NHS England will notify the patient in writing that they have been placed on the SAS.

Service Provision Under SAS

• Patients are allocated to a designated GP practice that provides care in a secure setting.
• Appointments are usually at specific times and locations with enhanced safety measures.
• Patients remain on the scheme until they demonstrate rehabilitation and can return to mainstream general practice.

Local Doncaster Context

• Doncaster LMC supports practices in managing violent patients and liaising with NHS South Yorkshire ICB.
• Practices should:
  • Issue warning letters where appropriate.
  • Consider behaviour agreements before removal if risk allows.
  • Contact Doncaster LMC for advice on complex cases.

Key Principles

• Zero Tolerance: Violence and abuse against staff will not be tolerated.
• Fairness: Ensure decisions are proportionate and documented.
• Safety First: Staff protection is paramount; risk assessments should guide actions.

Practical Tips for Practices

• Train staff in de-escalation and conflict management.
• Maintain clear policies on unacceptable behaviour.
• Use warning letters and behaviour agreements where possible before removal.
• Keep communication open with social care and mental health teams for vulnerable patients.