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Managing abusive patients – legal and regulatory considerations for pharmacists

A C+D investigation has revealed that pharmacy teams are increasingly facing abuse and even violence from patients. What should pharmacy professionals consider when handling these situations?

According to C+D’s recent investigation, in 2021 alone, violent crime – which includes violence against a person, public order offences, arson and criminal damage – accounted for 13.4% of all crimes in pharmacies reported in Northern Ireland, 18.1% of all crimes in England and a staggering 20.5% of all crimes in pharmacies reported in Wales.


Read more: Pharmacies hit by violent crime, as police record over 1k incidents in 2021


Unfortunately, the increase of abuse seems to be a familiar story across the NHS, but while GPs have been awarded funds to help increase their security measures, and GP receptionists have the option to stop offering face-to-face care, it isn’t quite the same story for community pharmacy teams.

So, where do pharmacists stand from a regulatory and a legal point of view when it comes to managing abusive and violent people in the pharmacy? C+D asked the General Pharmaceutical Council (GPhC) and pharmacy law expert Susan Hunneyball for the lowdown.


GPhC: “Pharmacy owners should have clear procedures”


The GPhC stresses that: “Any abuse of pharmacy staff is completely unacceptable and robust action should be quickly taken in response to any incidents, including by law enforcement.


Read more: Why are pharmacy teams reporting fewer crimes to the police?


“We would expect pharmacy owners to have clear procedures in place on how to deal with abusive or violent patients and members of the public, to protect staff and other pharmacy users,” the regulator adds, flagging the example of “guidance on when it is appropriate to refuse to serve or remove a patient”.

“How the patient will receive any medicines that they need and their best interests should also be considered and taken into account,” the GPhC says.

“Our inspections consider the systems and processes that are in place in a pharmacy, including how risks are managed, to ensure services are delivered safely. We have also provided advice that pharmacy staff should not be asked to work alone because of potential risks to their safety.”


Read more: Broken bottles rocks blades: The weapons wielded against pharmacy teams


Pharmacists can refuse supply in certain situations


Considering the GP practice refusing face-to-face reception contact, Ms Hunneyball, a partner at Gordons Partnership law firm, advises that this is essentially already provided for by the distance-selling pharmacy provisions set out in regulations 25 and 65 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013.

“However, it is a problem for traditional bricks-and-mortar pharmacies, and it must be reassuring for pharmacists that the GPhC has made [the above] express statement on abuse,” Ms Hunneyball says.

“A pharmacist can refuse to supply an NHS prescription if the pharmacist or other persons on the premises are threatened with violence,” she advises.

“An NHS Pharmacist (P) may refuse to provide drugs…where …P or other persons on the premises are subjected to or threatened with violence by the person presenting the prescription form or repeatable prescription or requesting the provision of drugs or appliances in accordance with an electronic prescription form or a repeatable prescription, or by any person accompanying that person.”

Source: Terms of Service schedule 4 paragraph 9


Read more: Here’s where pharmacy teams can turn for support when dealing with a crime


Considering P meds


However, the issue is not always clear cut. “There may be issues in relation to the sale of pharmacy (P) medication; where the sale has to be supervised and may well have to be refused; for example, in the case of codeine linctus,” Ms Hunneyball warns.

“In those circumstances, there is an obligation to engage with the patient in order to determine whether to make a supply, but the risk of some abuse may be reasonably high.

“It would depend on the specific circumstances and clinical judgement whether to continue to engage. The pharmacies’ procedures would also be important here.”


Don’t forget your professional obligations


“Professional standards are clear,” Ms Hunneyball stresses. “Pharmacists have a professional obligation to be polite and considerate and treat people with respect, so pharmacy professionals have to bear this in mind at all times.”

Ms Hunneyball has dealt with “a number” of fitness-to-practise cases where the “pharmacist’s response to a patient came under scrutiny”, she says.

“The pharmacist may even face criminal sanctions: a pharmacist was cautioned when his response to a perceived threat was spraying a can of a prohibited substance.”


Read more: 'One incident of violence in pharmacy is too many - that's why we're calling for dedicated funding' 



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