Patient Conduct and Zero-Tolerance Policy

Respect works both ways. Everyone using or working with MYTRT is entitled to safety, dignity and respectful communication. We will listen to firmly expressed concerns and will consider illness, disability, distress, neurodivergence, capacity and safeguarding needs. We do not tolerate violence, credible threats, discriminatory abuse, sexual harassment, deliberate exposure to harmful material, fraud or sustained personal abuse.

This policy applies to patients, customers, representatives, visitors, staff, clinicians, contractors and partners communicating with Elevate Healthcare Group Limited, company number 16231959, or another MYTRT pathway provider through telephone, email, secure message, video, social media, forms, reviews, post or any other MYTRT-related channel.

1. Our mutual commitments

MYTRT and the organisations providing care through our platform will aim to:

• communicate politely, clearly and without discrimination;
• listen to concerns and explain decisions, delays, limitations and options;
• protect confidentiality and dignity;
• make reasonable adjustments for disability and communication needs;
• de-escalate conflict where safe and practicable;
• avoid labelling a person because they complained, disagreed or asked repeated relevant questions;
• take proportionate action based on risk, context and evidence; and
• protect staff, patients and the public from harm.

Users and representatives are expected to:

• communicate without threats, harassment, discrimination or personal abuse;
• provide truthful identity and clinical information;
• respect professional boundaries and a clinician’s independent decision;
• use the appropriate contact route and allow a reasonable time for response;
• follow safety, medicine, account and appointment instructions; and
• raise dissatisfaction through the Complaints Policy rather than target an individual.

Employers have duties to protect workers’ health, safety and welfare so far as reasonably practicable. [1] Those duties sit alongside our responsibilities to patients, including equality, safe care, confidentiality, continuity and fair complaint handling.

2. What is not treated as misconduct

The following do not, by themselves, justify a restriction:

• making a complaint or saying that you are dissatisfied;
• asking for an explanation, correction, refund review or second opinion;
• disagreeing with a clinical or administrative decision;
• expressing distress, frustration, fear or anger without abuse or threat;
• contacting us again because a promised response is overdue or a material issue remains unanswered;
• requesting a reasonable adjustment, advocate or accessible format;
• reporting a safety, safeguarding, discrimination, privacy or regulatory concern; or
• using a legal, regulatory, chargeback or review process in good faith.

A complaint may be strongly worded and still be legitimate. We assess the behaviour, impact and risk—not whether the message is favourable to MYTRT.

3. Unacceptable conduct

Unacceptable conduct may be a single serious incident or a pattern. Context matters, but examples include:

Violence, threats and intimidation

• physical violence or attempted violence;
• a credible threat to harm a person, family member, property or service;
• stalking, doxxing, coercion, blackmail or intimidation;
• displaying a weapon or encouraging another person to cause harm; and
• threatening self-harm or harm to others as a means of coercing a prescription or commercial outcome, while recognising that any genuine risk also requires a safeguarding response.

Abuse, harassment and discrimination

• repeated personal insults, humiliating language, shouting or targeted swearing after a request to stop;
• racist, sexist, homophobic, transphobic, religious, disability-related or other discriminatory abuse;
• sexual comments, propositions, images, exposure or harassment unrelated to a legitimate clinical need;
• bullying, repeated unwanted personal contact or targeting staff through private accounts; and
• deliberately sending graphic, intimate or traumatic material without a genuine clinical reason or warning.

Disruption and misuse

• an excessive volume or pattern of duplicative contact that materially prevents the service from responding to the person or other patients, after reasonable boundaries and adjustments have been offered;
• recording or broadcasting a private consultation without agreement;
• publishing private information about a patient or staff member without lawful authority;
• malicious allegations knowingly presented as fact, fabricated evidence or impersonation;
• cyberattack, scraping that disrupts service, malware, unauthorised access or attempted circumvention of account controls;
• deliberate property damage or theft; and
• commercial misuse of a patient channel or staff member’s time.

Clinical and medicine-related misconduct

• falsifying identity, symptoms, medical history, prescriptions, results or documents;
• obtaining or attempting to obtain medicine for another person;
• pressuring, bribing, threatening or harassing a clinician to prescribe;
• selling, sharing or diverting prescribed medicine; and
• repeatedly refusing essential monitoring while demanding continuation of a treatment that a clinician considers unsafe.

4. How we assess an incident

We assess:

Factor	Questions considered
Seriousness	Was there violence, a credible threat, discrimination, sexual misconduct, fraud, patient-safety risk or serious disruption?
Intent and understanding	Was the conduct deliberate? Could illness, disability, distress, medication, capacity, language or misunderstanding have contributed?
Pattern	Is this an isolated event or repeated after explanation, support and warning?
Impact	Did it create fear, harm, confidentiality risk, service disruption or an unsafe clinical situation?
Immediacy	Is anyone currently at risk or is urgent clinical/safeguarding action required?
Adjustments and alternatives	Could a reasonable adjustment, advocate, different channel, named contact or communication plan reduce the risk?
Care consequences	Would a restriction interrupt medication, monitoring, results, urgent information or continuity of care?
Evidence	What do messages, calls, records, witnesses and the person’s own explanation show?

Where practicable, we will hear the person’s account before making a lasting restriction. Immediate safety action does not need to wait for a full review.

5. Possible responses

The response will be proportionate to the conduct and risk. It may include:

1. a calm reminder or request to change the behaviour;
2. a pause or end to the current call, message thread or consultation;
3. a written warning describing the concern, expected conduct and consequence of repetition;
4. a reasonable communication plan, such as a named contact, written channel, scheduled calls, message-frequency boundary or use of an advocate;
5. an accessibility or clinical review to identify a safer way to communicate;
6. restriction of a particular channel, feature or staff contact while preserving a workable alternative;
7. suspension of non-urgent account or commercial functions during investigation;
8. cancellation or refusal of an order where fraud, misuse or safety prevents lawful supply;
9. transfer, suspension or termination of a clinical relationship where it is lawful, safe and professionally justified;
10. preservation of evidence and a report to a platform, employer, professional regulator, safeguarding authority or insurer; or
11. contact with police or emergency services where a crime, credible threat or immediate risk is suspected.

A serious threat, violence, sexual abuse, doxxing, cyberattack or suspected crime may justify immediate action without prior warning.

6. Clinical context, disability and reasonable adjustments

We recognise that communication may be affected by pain, hormone or medicine effects, anxiety, trauma, mental illness, cognitive impairment, neurodivergence, learning disability, sensory impairment, language needs or acute distress.

Before imposing a non-urgent lasting restriction, we will consider:

• whether the person understood the effect of the conduct;
• whether there is a clinical or safeguarding concern;
• whether an interpreter, advocate, carer or trusted representative could help;
• whether written rather than spoken communication, longer appointments, a predictable response timetable or another adjustment is reasonable;
• whether the same safety objective can be achieved by a less restrictive measure; and
• whether the proposed action could create a disproportionate barrier to care.

The Equality Act 2010 requires service providers to avoid unlawful discrimination and make reasonable adjustments for disabled people. [2] A disability does not require staff to accept violence or serious abuse, but it may materially affect how we prevent, understand and respond to an incident.

7. Medication, identity and fraud concerns

A concern about identity, medicine diversion, forged documents, misleading clinical information, payment fraud or unauthorised account use will be handled as a safety and security matter, not merely a conduct issue.

We may pause an order, verify identity, ask for original evidence, consult the clinician or pharmacy, preserve relevant records and report the matter where required or justified. We will not state publicly that a person committed fraud unless this has been properly established. A genuine error or inconsistency will be distinguished from deliberate deception wherever possible.

A clinician remains free to decline or stop prescribing on clinical grounds even if conduct is otherwise acceptable. Conversely, a conduct concern must not be used as a pretext to conceal or avoid a legitimate complaint about care.

8. Ending or restricting a healthcare relationship

Removal from a healthcare pathway is a serious step. Except where immediate safety or law requires otherwise, we will normally:

1. explain the conduct or clinical concern;
2. consider the person’s account, health context and reasonable adjustments;
3. use a warning or less restrictive plan where it can manage the risk;
4. obtain appropriate clinical or senior oversight;
5. confirm the decision, reasons, scope and review route in writing;
6. state how urgent information, records, outstanding results, prescriptions and complaints will be handled; and
7. provide reasonable information about alternative or urgent care where appropriate.

We will consider the risk of abrupt interruption, particularly where a person is receiving ongoing prescribed treatment. A service will not continue a prescription that a clinician considers unsafe, but the decision should include appropriate safety-netting and transfer information.

A commercial account restriction does not erase a clinical record, prevent a lawful data request, or remove the right to complain.

9. Recording, privacy and information sharing

We record incidents accurately, factually and without inflammatory labels. A record may include the communication, date, people involved, immediate risk, action taken, the person’s explanation, adjustments considered, decision and review date.

An incident is placed in the clinical record only where relevant to care, prescribing, safeguarding, staff or patient safety, continuity or a professional record-keeping duty. Administrative security records are kept separately where appropriate. Access and retention follow our Privacy Notice.

Information may be shared with a clinician, pharmacy, partner, safeguarding body, emergency service, police, regulator, court, insurer or adviser where necessary and lawful. We disclose only what is reasonably required for the purpose.

10. Staff responsibilities and support

Staff and clinicians should:

• remain professional and use de-escalation where safe;
• end an interaction if continuing presents a safety risk;
• call emergency services where necessary;
• record facts promptly and preserve relevant evidence;
• report the incident through the designated governance route;
• avoid retaliatory, humiliating or discriminatory responses;
• consider safeguarding, clinical context and reasonable adjustments; and
• seek support after a distressing incident.

Managers are responsible for consistent decisions, risk assessment, staff training, lone-working and communication controls, post-incident support, review of restrictions, and learning from trends.

11. How to ask for a review or complain

If we impose a lasting communication restriction, suspend an account for conduct, or end a service relationship, you may ask for a review by emailing help@mytrt.com with the subject “Conduct decision review”. Explain why the facts, context, adjustment or proposed restriction should be reconsidered. A person not materially involved in the original decision will review it where practicable.

You may also complain to the Medical Director under our Complaints Policy, telephone 0800 157 7521, or write to Elevate Healthcare Group Limited, 71–75 Shelton Street, London, England, WC2H 9JQ. If the complaint concerns the Medical Director, it will be assigned to a director or appropriately senior clinician who was not involved.

Requesting a review does not automatically suspend an urgent safety measure, but we will complete the review without undue delay and reconsider interim arrangements where possible.

12. Emergency and safeguarding action

If conduct suggests an immediate risk of serious harm, we may contact emergency services or a safeguarding authority and disclose information needed to protect life. If you or someone else may be in immediate danger, call 999. For urgent medical advice, use NHS 111 where appropriate.

A statement about self-harm or harm to others is treated first as a potential safety concern, even if it is also abusive or coercive. Staff should escalate it for appropriate clinical or emergency assessment rather than attempt to manage the risk through ordinary complaint correspondence alone.

References

1. Health and Safety at Work etc. Act 1974
2. Equality Act 2010