Staff will be trained to de-escalate difficult situations

NHS Greater Glasgow said the step was a deterrent which would only be used in the most extreme circumstances.

Patients would be given a written "yellow card" warning for unacceptable violence or aggression.

If their behaviour continued they would be handed a "red card" which barred them from treatment on that occasion.

The case would be reviewed every time the patient returned for treatment.

Citywide policy

The decision to withhold treatment could only be taken by a senior clinician.

Glasgow's first citywide policy on dealing with violence and aggression towards healthcare staff covers hospitals, GP surgeries and clinics.

Treatment will not be refused to emergency patients, people with head injuries and those not responsible for their own actions, such as those with learning disabilities.

Incidents of violent and aggressive abuse are a serious factor for healthcare workers in our hospitals and communities Sir John Arbuthnott NHS Greater Glasgow's chairman

There were an average of three assaults a day on staff in Glasgow's hospitals over the year ending in March, and about 20 incidents of physical violence daily in community-based settings.

NHS Greater Glasgow's chairman, Professor Sir John Arbuthnott, said: "Unfortunately evidence shows that incidents of violent and aggressive abuse are a serious factor for healthcare workers in our hospitals and communities.

"This is clearly unacceptable, and NHS Greater Glasgow is totally committed to reducing and deterring such incidents as well as ensuring staff are trained to deal with situations when they do arise."

Staff are also to receive advice and guidance on dealing with difficult situations.

Sir John added: "It is our preference that we never reach the situation where we have to withhold treatment; preferring instead to de-escalate a situation before it gets to that stage."

This policy sends out the message that violence against healthcare staff will not be tolerated under any circumstances Joe Gallagher Royal College of Nursing

The policy was welcomed by Dr Phil Munro, an accident and emergency consultant at the Southern General Hospital.

He said staff deserved the chance to work without fear of intimidation, abuse or violence.

"My colleagues and I are all too aware from personal experience what it is like to deal with an aggressive situation," he said.

"The new policy therefore is helpful to us as it is clear, pragmatic and based on common sense."

The Royal College of Nursing's officer for Greater Glasgow, Joe Gallagher, said: "This policy sends out the message that violence against healthcare staff will not be tolerated under any circumstances."