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.

How much are GPs paid to ask if you smoke? (I never have and am thoroughly bored of being asked). How much do GPs get paid to administer the flu vaccine was it the same amount as the COVID vaccine?

No we don’t, we follow the NHSE advice and masks are no longer mandatory, but our staff will wear PPE for a high risk patient. A lot of buildings are too old to mitigate a lot of these risks and opening windows and cleaning is the only option. Staff do get sick a lot but most caught COVID outside of work not in work, we had no traceable outbreaks

They are paid for this, and to refer you to stop smoking services. I would have to find out exactly how much, it’s not a lot - so a big reason is because often you cannot have any elective surgery if you smoke nowadays so it is an incentive to help the patient too.

£10.06 to administer vaccines. COVID it was slightly more, and more for housebound.

Yes, I certainly do but some old school practices are competitive and secretive. It’s a business after all, so each company has their own priorities and objectives. They don’t want to lose or share their income with another practice unless it’s beneficial. Mega practices are more common now but it comes down to being an independent contractor and no one can enforce uniformity on them

Well done to doctors for asking if you smoke-it affects so much of your health.

OP you are doing a grand job, and I can't imagine how you all manage so well that the practices hold up.

You all deserve so much more respect than you get 💐💐

GMS is the contract the practice holds, which means it operates under GMS services
list here of GMS and the contract.
https://www.england.nhs.uk/gp/investment/gp-contract/
Holding and abiding by this contract is part of your income and proving essential services to your patients. The other part is made up by fulfilling targets such as QOF. If you don’t meet your targets you do not get £. But you must fulfil your GMS contract and you can get sanctioned

I assist the partners managing finance and profitability but it’s not my business I am an employee. I am meant to maximise profits yes, but I am constrained by their priorities and wishes of how to operate. I also deal with and try to resolve complaints on their behalf. They are liable for mistakes made by anyone so it’s a lot of responsibility

So if a GP asks me 3 times if I smoke in a routine medication review that has nothing whatsoever to do with surgery will a complaint stop it from happening again and again?

lots of GP practices are notoriously failing to meet the needs of their patients. What’s your opinion on why this is and how do we solve it?

Would you ever consider buying in and becoming a partner yourself?

Yes - they don’t get paid every time they ask you. You can ask them to stop asking you, and 3 times is excessive in one consultation!

but I don’t think they will entirely stop as they are providing care for your health and they will keep encouraging you to stop if you are flagged as a smoker, if you need surgery they won’t refer you until you stop either.

No I don’t want to do this, also I think it’s good I am employee as I really think I need to advocate for the staff. Not all GP partners have their employees best interests at heart and if the only person you can go to is also biased by income or partner pressure it wouldn’t be right for me. I mean the partners could sack me, and being a partner means more security but I am not comfortable with it

How much do you earn as a practice manager and would you recommend it as a job?

They are, and its lack of GP’s. They need to make being a GP more attractive but I am not sure how they will do that. Eventually I think they will push partnerships out of business and either NHSE or ICB’s will become direct employers of GP’s. This will be less risk for partner GP’s, but less profit, so I don’t know if it would work in reality. They have put in some new ideas like reimbursable GP clinical support such as paramedics and pharmacists but all this has done is create competition in other sectors, as paramedics leave ambulance services for a day time job with no shift work but lose their enhancements etc etc, soon we will have an entirely self employed locum workforce of clinical staff!

How much do your receptionists earn? Ours are on NMW (they got a 2% rise last year, but the rise in NMW this year means they are back on NMW) which is ridiculous for the amount of responsibility they have, not to mention workload and abuse from patients.

Are e consults becoming harder to do deliberately or is it just my surgery?

Previously it was anytime of day.

Then it went 8-6 weekdays

Now it's 8-1 surgery open days only.

For people who work FT like me and cannot do an e consult in that time and cannot spend an hour on the phone daily to be told "ring back tomorrow" what will be the options for getting an appointment.

So far I had to wait until my AL (3.5 weeks since I first started symptoms) and then 3 weeks until the GP responded and a further 2.5 weeks for the blood test they've ordered.

I'm dreading how I'm meant to actually find out the doctors opinion on the results (although I'll see them on the nhs app).

It seems at the minute the answer to reducing waiting lists is to make actually contacting a surgery so difficult that no one gets added to them.

I don't blame the surgeries directly for this as they need to manage their services within the terrible situation as it is.

But surely there has to be a better system for speaking to a GP than a small window to complete a form in that excludes people who work FT from having an LT condition?

£45k and it depends. You can get a lot more if you are going in to save a practice from financial ruin or CQC failings.

You can’t make friends with anyone at work as either they are your employer or your employee. It is a lonely job. Your partners will use you to play each other off. Your staff are like having lots of needy baby birds and you are stretched really thin. It’s stressful, you are trying to fill holes that cannot be filled. Nothing you do ever really solves a problem truly, you just try your best. If you have a thick skin you will be ok but you have a lot of responsibility and worry, people depending on you. I had burn out once already!

Yes, NMW. I do try to get them more money.

You don't have to be like that, they have to give in and pull strings to stop you calling back and upsetting more staff, they will definitely slag you off in the staff room though. You sound horrible. Imagine if they had to do that for everyone, it would be chaos.

Another receptionist question.

They want to know what's wrong with you and then make a judgement on if it's urgent or not for an appointment. They don't have a medical background. As an example a child drinking and weeing more than usual....def not urgent but actually could be in DKA.
Or a patient may not want to tell them something of a personal matter.
There's no trust on the patient who is calling to make an appointment.

Thanks Menora,

Can I ask please what is it currently about GP that is most unattractive.
Obviously I can take a guess it’s hours/ stress / workload etc but probably best for those who have no idea to stop guessing or we will never get to the bottom of this!

My advice is that it’s ok to be assertive but you should ask for an explanation as to why something can’t happen, and the reason or ask to speak to someone senior. but always be polite. That receptionist is not enjoying saying no. They tell me they wish they could always say yes. They also tell me they often offer another solution and this is shot down as not good enough, so all my work trying to guide them to offer other solutions often gets lost.

All that happens is that ‘pushy’ patients are given what they want because it’s easier and other polite patients who don’t push have to wait. That’s fine if you are ok with that, it’s your moral prerogative but they aren’t giving it to you as you are correct, they are doing it to get you off the phone. Sorry if that’s brutal but I’ve been a receptionist and no one wants to really argue with a patient when you can see 20 other calls waiting.

Regarding 56 day prescribing of very routine but essential drugs such as Levothyroxine that only need a 12 month blood test. If a patient t has been stable on the dose for years, why maintain the 56 day rule and not allow a 365 day supply to be prescribed? For an otherwise we'll patient surely that would save costs.

I am very I.pressed that my GP has the time to do something 6 times a year that needs only to be done once. How do they have the cheek to tell people they are overworked.

Do the GPs insist on the receptionist calling them Dr Blah or is it first name terms behind the scenes? Do they ever have a laugh with the staff or do they really think they are a superior version of God?

Patients are constantly told not to waste the Dr's time. Are Dr's remotely concerned about wasting patient time..

Do you, your GPs and receptionists accept that the NHS is free only at the point of delivery and is not something patients shoukd be grateful for?

Genuinely to put you with the right person.
on the screen in front of them they might have a list, and different staff, so your sore ear can go with a nurse and your rectal bleeding would be a GP. You need to remember lots of different types of staff work in healthcare not just doctors. Also clinicians like to know the reason on the appointment notes so they aren’t going in blind. Also receptionists are given criteria by the GP’s/managers to work from. They don’t make it up themselves. They do not care about gossip about what’s wrong with you, they are just taking notes or navigating you.

Why do some GP surgeries refer for an mri and others don't?
How can you get around this.

I fell over 13 weeks ago and hurt my back, but I've had an x-ray and ultrasound and then referred to MSK which now has a 13 week wait. So that'll be 6 months, since I fell, before I'm even seen by them. My GP says only MSK can order an mri.

Private oesteopath says many clients their Gp is allowed to order an mri, many gp's can't.

I'm being failed here. I don't know what to do next?

For medication there are external prescribing safe guidelines to follow. It is not safe to give a years worth of certain drugs that need monitoring with tests. They don’t invent these rules themselves they follow prescribing guidelines

Staff all call each other by first names but not to or in front of the patients. I only know a very few GP’s who act like this; most are just normal down to each, nice people and don’t pull rank on people. Even the more annoying GP’s I would still want as my doctor, they are good at medicine.

No one asks patients to be grateful and no one talks about this really, but it’s also not helpful to say to them ‘I pay my tax so I am entitled to this’. This is the comment that riles along with ‘I pay your wages’. It’s not necessary