The prevalence and impact of violence in primary care settings establishes its position as a key public health concern. Where patients are violent in primary care, and the Police informed, contractors are entitled to immediately remove them from their practice list. These patients then receive care in designated Challenging Behaviour Services (CBSs).
Across Scotland there is significant inter-service variation in CBS delivery. Through questionnaire responses from each CBS, this review provides a detailed comparative overview of current services to inform future discussions and facilitate individual service improvement. Areas of good practice, key challenges and possible solutions are highlighted.
Crucially, current Scottish CBSs not only ensure the ongoing provision of General Medical Services for those subject to immediate removal, they also provide services for other difficult patients and often engage in an active process of rehabilitation, suggesting a need to re-define their role to recognise their valuable contribution to violence prevention. At present, central data collection, evaluation and mechanisms to share ideas are lacking and this remains an important area for future CBS improvement. CBSs also face significant challenges around accessibility, safety, support and training; these must be addressed to ensure the ongoing availability and quality of these valuable services.