I’m a GP Practice Manager - AMA

[Menora]

My background - I am 40 and previously my whole NHS career has been in Community Services, so I am more of a fresh set of eyes in primary care. I started out as a receptionist many years ago.

I will and do answer telephones when the practice is busy, there is no job I won’t ask my staff to do that I wouldn’t do myself.

I deal with a lot of complaints, mostly about frustration with services and commutation. I can advise you how to make a good, effective complaint and how to get the answer you want from your practice.

There is a new contract change this year, with regard to access. I can answer how GMS operates

I can answer general questions people have about primary care, although I understand all practices are run differently so I might not be able to answer something very specific. I am also not a trained clinician so I can’t answer anything medical.

[RagzRebooted]

How does your practice plan to deal with the new access requirement in the contract? I understand that you can no longer say 'call back tomorrow', but does signposting include telling people to call 111? Fill out an e-consult? Go the the pharmacy? (We do this already).

[Wagtail23]

Do you think we're in already or heading for a crisis in primary care due to lack of GP capacity and/or stress and burnout?

[NameChange900]

How do you keep your staff motivated? This is a question from someone who loves a GP very dearly, he is very close to his practice manager as they've worked together for 25 years, but he's burnt out and cries at home, and his practice manager isn't aware as he and other staff are worried about her also.

[CC4712]

There is a new contract change this year, with regard to access. I can answer how GMS operates

What is this referring to? What is GMS? Is this about how patients can book appointments?

Do you manage the profitability of the practice or mainly complaints?

[SweetSakura]

Why do I have to be so firm, bordering on aggressive, with receptionists? They always relent eventually so why do they say no in the first instance? It's fine for me as I am comfortable being assertive, but it is utterly frustrating.

[KnickerlessParsons]

Do practice managers make a point of recruiting rude receptionists? Or do they get that way because of rude patients? In which case, could the receptionists only be rude to the rude patients and nice to the rest of us?

[tillyandmilly]

Please don’t take your anger out on Receptionists - it is not their fault you cannot get the answer you want - I work with medical secretaries and the abuse they get from patients is astounding - I have never been aggressive to Receptionists secretaries- I was brought up to be polite to people and treat them with the same respect - whether a cleaner or a Dr

[RuthTopp]

I've heard the new directive coming in for all gp surgeries is that when phoning we will not be told no appointment but phone back next day , we will now be given the next available appointment ?
If true - yay !

[RagzRebooted]

@RuthTopp

I've heard the new directive coming in for all gp surgeries is that when phoning we will not be told no appointment but phone back next day , we will now be given the next available appointment ?
If true - yay !

It will be more complicated than that, or we'd end up booked until August by the end of the week!

[CC4712]

Does your practice send info to patients on what tests they can access?

For example, I think I should have been offered a well women check up at age 40- but heard nothing from the surgery about this. I only found out recently from a friend- I'm now 45!

[BarelyLiterate]

Most of us with recent experience of dealing with Britain’s healthcare system would agree that in its current state, it is failing & not fit for purpose. So why?

Is the NHS underfunded, is it dysfunctional & badly run or both?

[Menora]

Ok! Wow so already questions let’s go!

The new contract change - you can direct patients to 111, urgent care, pharmacy or an online consult. You just cannot say ‘there are no appointments call back tomorrow’.

There is also a financial incentive in IIF for all patients to be seen within 2 weeks of first contact

This doesn’t help with creating capacity, if you can’t get through on the phone etc. I don’t know what many practices will do. This does not mean you will get an appointment on the same day you call

Receptionists
A lot of them have worked there for years and they can become jaded and frustrated. It is hard to motivate your lowest paid, most abused staff. But I don’t think anyone should be rude to patients and I try to protect them by letting them have access to me if they can’t manage a call or they need help. I also give them training

Often the GP partners will set the criteria for the reception to use/say to patients so receptionists are not free wheeling, they are working within the constraints of their employers.

[HappyHolidai]

You say you deal with complaints about frustration with services and "commutation". What is commutation in this context? Why is it a problem?

[Livinghappy]

Why won't GPs allow booking for future appointments - example non urgent, perhaps a skin condition that does Nedd treatment but isn't urgent.

[Arrangingmyknits]

Do you offer your receptionists (nursing staff/GPS) any form of counselling or coaching or OOH support due to the horrendous day in day out abuse and bullying from “assertive “ patients AND their relatives?
Is your staff turn over high due to them deciding that they are not able to tolerate these conditions any longer?

I wanted to add, THANK YOU for doing what you do in the most impossible circumstances beyond your control. For many, you are all very much appreciated.
My GP practice are absolutely outstanding.

[Menora]

@Wagtail23

Do you think we're in already or heading for a crisis in primary care due to lack of GP capacity and/or stress and burnout?

Yes. The salaried GP is no more. GP’s also do not want to join as partners. Partners need to rethink recruitment, but they are looking to the government to help with incentives. If your GP’s leave, you will not find a replacement. You will find locums who do not do your admin or hold a patient list. Partners are ageing out of primary care and in burn out. Those who are younger have families and are struggling with their work life balance filling gaps in staffing.

General practice is in trouble. The reimbursable ARR staff (paramedics, physicians associates, physios) need a lot of supervision and support they are not a quick fix.

[Muchtoomuchtodo]

Do practices share best practice with each other?

in my area they all seem to operate different phone systems and have different policies on getting appointments, booking in advance (or not), whether you can be seen face to face (or not) which seems to cause a lot of inequality.

[ProudThrilledHappy]

My Gp and those of most people I know seem to have all implemented a process where everyone wanting an appointment - both urgent or not urgent- must all try to phone the practice at exactly the same time in the morning and hope to get through. If you don’t get through in time for one of the appointments you are told to call back tomorrow. No advance appointments can be made with GPs, only with the nurses for things like blood tests etc. An online appointment system was eventually put in place to relieve pressure and assuage complaints, but was disabled after two weeks and now we are back to the ridiculous hunger games phone battle to get seen regardless of the urgency or reason for appointment.

Is there a reason why so many GPs are working in this way, can you explain the rationale behind making everyone who wants an appointment call at the exact same time? Wouldn't it make more sense to ask non urgent patients to call later or email instead, and reserve non-urgent appointment spaces for them?

[Menora]

@HappyHolidai

You say you deal with complaints about frustration with services and "commutation". What is commutation in this context? Why is it a problem?

Usually communication this is things like not getting all of their medication on their prescription or the wrong medication. Changes to medication from a hospital appointment are often slow (you have to wait for the letter) and consultants do not explain shared care agreements with patients. If you start on a new med with a consultant your GP might not be able to instantly take over prescribing it. Also if you went to A&E and had tests then left, they don’t automatically come back to your GP - they go to A&E.

I rarely get complaints about clinical staff irs mainly about processes

[YearoftheRabbit23]

Does your practice still require masking by staff and patients? What mitigations do you have in place to stop infection with airborne pathogens (COVID, flu, colds, lots of other things your patients come seeking treatment for)? Eg ventilation, keeping sick staff off work until recovered, HEPA filtration?

[HappyHolidai]

Thanks, I didn't realise commutation is medical jargon for communication!!

[Menora]

@ProudThrilledHappy

My Gp and those of most people I know seem to have all implemented a process where everyone wanting an appointment - both urgent or not urgent- must all try to phone the practice at exactly the same time in the morning and hope to get through. If you don’t get through in time for one of the appointments you are told to call back tomorrow. No advance appointments can be made with GPs, only with the nurses for things like blood tests etc. An online appointment system was eventually put in place to relieve pressure and assuage complaints, but was disabled after two weeks and now we are back to the ridiculous hunger games phone battle to get seen regardless of the urgency or reason for appointment.

Is there a reason why so many GPs are working in this way, can you explain the rationale behind making everyone who wants an appointment call at the exact same time? Wouldn't it make more sense to ask non urgent patients to call later or email instead, and reserve non-urgent appointment spaces for them?

The new contract changes is hoped to put a stop to this. I think often they don’t open diaries as they all become filled up too quickly then you have nothing urgent left. You also often do not know if you have the staff coming to work as sickness is high. It is chicken and egg, how do you create capacity from nowhere? Also you don’t want to have to cancel appts on the day.

your advance booked slots are often already taken by patients who need a follow up at the GP’s direct request, so they can be ‘saved back’ for this reason. It’s not the best way of managing it, but here is a ‘session’:

GP session = 4 hours
3 hours clinic time, 10-15 min appts per patient - 12-15 patients per hour
1 hour admin (this is vastly underestimated)
this may also include supervision time for other staff

Then they may have an urgent call list in the practice, which is either limited or unlimited numbers but has to fit a criteria for what is urgent. The surgery closes at 6.30 so often if the list is long they don’t leave till 8 or 9pm.

All practices vary in size so I don’t know how many GP’s you have on duty at your surgery but most GP’s work 6 sessions a week. it is recommended that there are 70 GP appointments per week per 1000 patients (equivalent to 118 appointments per week per WTE GP).

This creates the demand vs capacity issue when hundreds of people call on Mondays and would technically outstrip your entire week of appts in one day alone.

[Menora]

@HappyHolidai

Thanks, I didn't realise commutation is medical jargon for communication!!

Sorry on my phone, typed too fast! It was communication

[Menora]

@CC4712

Does your practice send info to patients on what tests they can access?

For example, I think I should have been offered a well women check up at age 40- but heard nothing from the surgery about this. I only found out recently from a friend- I'm now 45!

This isn’t compulsory it’s optional, so they can and should offer it (it earns income for NHS health checks) so if they don’t offer it, this suggests they aren’t prioritising this income. Or they might be behind and you will eventually get an invite. You can call to ask

[Menora]

@Arrangingmyknits

Do you offer your receptionists (nursing staff/GPS) any form of counselling or coaching or OOH support due to the horrendous day in day out abuse and bullying from “assertive “ patients AND their relatives?
Is your staff turn over high due to them deciding that they are not able to tolerate these conditions any longer?

I wanted to add, THANK YOU for doing what you do in the most impossible circumstances beyond your control. For many, you are all very much appreciated.
My GP practice are absolutely outstanding.

There is a local well-being service for staff set up by the ICB and also one run by NHS England which I have used myself. We do direct staff they often do not use it. I send the emails to staff with the info and I tell them at staff meetings. We actually had someone come to a team meeting and then 3 people went off sick with stress the same week 😫