As the Emergency Workers Act is extended to cover GPs, doctors and nurses working in the community, the Minister for Public Health warns that the new zero-tolerance approach will lead to increased prosecutions.

HEADING out alone to a young mum's home to check how she is coping with her baby, public health nurse Frances Grant thought she understood what she was walking into. The mother was known to have mental health issues but, after several house visits, Mrs Grant believed she had established a rapport with her.

However, that day without warning, the woman suddenly turned on the community nurse, screaming abuse and making threatening gestures. "She just snapped and became really aggressive," she said. "I thought she was going to attack me. I tried to calm her down but it didn't work and I was so scared, so eventually I left," Mrs Grant recalls, as she sits in St Brycedale Surgery in Kirkcaldy.

While Mrs Grant reported the incident to staff back at the Fife practice, and took a colleague with her for support on several later visits, that was as far as the matter went. Nor was there any question of calling in the police when a GP at St Brycedale was punched in his consulting room by another irate patient who had not received the treatment he believed he was due.

Dealing with such acts of abuse is seen by many health workers as a necessary part of their job. But from today, legislation to protect doctors and nurses working in the community comes into force to reduce such attacks and make it clear that abuse is unacceptable.

The move by the Scottish Government extends the Emergency Workers Act, which already covers workers in hospital and on emergency calls, to routine appointments in surgeries, clinics and patients' homes. From now on, it will be an offence to abuse or assault nurses, midwives and doctors whenever and wherever they are working.

Mrs Grant, 61, who has worked as a public health nurse for around 25 years, hopes the improved legislation will make a difference to a worsening problem. "I make house visits every day on my own," she says. "A lot of them are fine, but some are not. There are people who shout at you sometimes and you can feel very vulnerable. You do just accept it, but there are more and more problems like this for public health nurses. I think it will help if people know that now the act has been extended they will be prosecuted for that kind of behaviour."

Under the act, patients who are found guilty of abusive behaviour, including verbal aggression, face a maximum 12-month jail sentence and/or a £10,000 fine.

Since it was introduced in 2005 for other emergency staff in Scotland, there have been 1200 charges against patients, of which more than 1000 have led to prosecutions, with 600 convictions to date.

However, over roughly the same period, there were 1344 physical assaults and 305 incidents of verbal assault in the Fife NHS area alone, suggesting a large number of potential cases across the country.

Nationwide surveys of nurses' views back Mrs Grant's belief that matters are getting worse, with 34% saying they had experienced violence at work in 2000, rising to 40% by 2005.

With many incidents going unreported because staff still feel they have to put up with it, or the abuse is not serious enough to warrant action, many more convictions will be needed for the act to be seen as a success. Public Health Minister Shona Robison believes the law has been "very effective" already and will be increasingly so, but concedes a change in attitude is needed. Highlighting the changes yesterday at the Kirkcaldy surgery, the minister said: "I still think we have a culture of under-reporting and I don't think anyone should feel they have to accept abuse as part of their job. I think with staff in some parts of the NHS there is a bit of an acceptance of it being part of their job. However, among patients a minority - perhaps larger than it once was - think they are within their rights, if they have been waiting longer than they wanted to, to be abusive. With the extension of the act we expect numbers of prosecutions to rise, with people who might not have been prosecuted before now facing prosecution. We are talking about things like spitting and lashing out."

She added: "The government has a zero tolerance approach to this kind of behaviour and there is an ongoing campaign to get that message across to people, for example through posters."

Nursing union RCN Scotland welcomes the extension, but warns that with three out of every four work injuries suffered by nurses being linked to violence, more action is needed.

Norman Provan, associate director for employment relations at RCN Scotland, says: "All healthcare staff have the right to go about their work without fear of abuse. We will be continuing to work in partnership with politicians and NHS boards to help reduce violence and aggression, wherever it takes place.

"The impact of violence and aggression in the workplace is huge. Nurses who are attacked are often left traumatised, and those who remain have to deal with staff shortages while the person who has been attacked is receiving treatment or is off work."

Practical measures the union would like to see to protect staff include mobile devices to help nurses call discreetly for help, and more on-site police or security protection.

Back at St Brycedale, Dr Graham Duncan, one of five GPs at the 6700-patient surgery, says attacks on site are rare, and staff are increasingly less likely to accept abuse. He says: "We have people slamming doors and kicking furniture occasionally but in my experience here over about 26 years we have only had two episodes involving violence against staff, both involving patients with borderline personality disorders, one of whom assaulted a young doctor, leaving him with bruising. That patient was taken off the list so is no longer treated here. The second incident involved a patient threatening to hit a doctor at reception.

"I think this kind of behaviour is becoming more of an issue with increasing drug-taking and alcohol consumption. But staff are less tolerant and if someone mouths off' to them they will tell a doctor and sometimes all it takes is for us to have a quiet word with the patient about it."

But with the government's recent and controversial move to see doctors and their staff offering more out-of-hours appointments, Dr Duncan fears the risk of abuse could rise further.

"I hope the extension to the act will be a deterrent but the extended hours will mean we will be operating with a skeleton staff later in the evenings, which might well increase our vulnerability."