The NHS has launched a crackdown on verbal attacks on staff in its latest bid to combat rising levels of abuse.
Attacks against staff have almost doubled in five years
Hospitals and primary care trusts are being advised to adopt a sliding scale of sanctions against offenders.
The NHS Security Management Service advice ranges from discussing the abuse with the offender, to legal action.
Staff attacks, including both verbal and physical assault, have nearly doubled in five years and now cost the NHS £69m a year.
in 1998, there were 65,000 reported abusive or violent incidents against staff. Last year that had risen to 116,000.
However, a report by the National Audit Office suggested the figure may be even higher, as two in five incidents are thought not to be reported.
The guidance calls on NHS bodies to implement their own strategies for dealing with offenders.
For low level abuse, offenders should be given a verbal warning and given an opportunity to discuss the problem.
NHS staff should be given protection, such as through a security guard, if they are treating persistent offenders, the guidance said.
And for the most serious offenders, criminal charges, injunctions or anti-social behaviour orders could be taken.
The NHS presses for prosecutions in the majority of physical attacks.
Health Minister Lord Warner said the government were determined to do "everything" to protect NHS staff.
"We hope that this guidance will demonstrate that anyone who abuses NHS staff, whether that attack is physical or not, will be appropriately dealt with."
June Chandler, head of health at public service union Unison, which represents 250,000 NHS staff, welcomed the guidance, saying: "Threats to staff must be tackled firmly and with commitment, so that no health worker is in a position where verbal abuse is considered to be simply part of the job."
Sheelagh Brewer, senior employment relations adviser at the Royal College of Nursing, said the range of sanctions was "comprehensive" and if fully deployed should make a significant impact.
"Verbal abuse can often be as damaging as physical abuse but the abuser is less likely to face any punitive action."
Julian Topping, of the NHS Employers, part of the NHS Confederation, which represents health service managers, said: "It is crucial that we make the NHS an attractive place to work and creating a safe environment in which employees can work has to be the first step.
"At a time when employers are doing their best to recruit and retain staff to work in the NHS, clear guidelines like these can only be welcomed."