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.

Not my thread, but the UK vaccine schedule is online, and also in your red book.

If you believe a clinical error has occurred contact the practice manager who will investigate.

I can't answer this from the OPs perspective but I'm a GP receptionist.

You are right in that we are not medically trained, however we do a lot of training about triaging calls and we ask for a brief description of the concern as certain things the patient says will be a red flag for a same day urgent. We also ask what is wrong as certain clinicians cannot help with all issues (such as some ACPs can't do gynae or under 1s for example).

However, if someone told us they felt it was urgent for the day we will always book them in for a same day urgent, but make a note the patient told us it was urgent.

@SpringNotSprung
Thank you. I have now complained to my MP.

I will try to answer what I can. I’m sorry that the ICB could not help you. The ICB and hospital trusts create processes and pathways that are imposed on GP’s and patients. This isn’t meant to be passing the buck. As a PM I will contact the ICB for a patient to try to find an answer but I often can’t change an external process. I agree perhaps your MP can help but I am sorry you are in this situation. I hope you can get this sorted. You can also complain to NHS England about multiple organisations and they will investigate it for you.

The only pathway and process a GP has input into is their internal processes such as access, appt rotas, staffing and such like.

SAR’s/FOI’s - I’m sorry to hear about your loss. I think there is confusion as once a patient dies their record is sent to centralised Primary Care Support England, who become the holders. If a solicitor asked for the records, likely a practice would cooperate with electronic records as a legal request, but for a relative it would be via the PCSE access to records scheme. If they just divert you back to your GP, ask your practice to contact PCSE directly to clarify their position. It’s likely PCSE will hand you off back to the practice and in that case it might be cause to complain to PCSE or NHS England
https://www.nhs.uk/common-health-questions/nhs-services-and-treatments/can-i-access-the-medical-records-health-records-of-someone-who-has-died/

No they don’t get pissy. GP’s don’t get input into any of these processes or design of services so patient feedback is important. GP’s also operate within limitations of what is available to them and they don’t have a direct line exactly to do something outside of those boundaries, but a good PM will try to assist you where they can.

Service commissioners are ultimately responsible for the services they are commissioning, and if it’s not fit for purpose you should tell them about it. GP’s also get angry about the red tape

But they say no, until I push, and then they say yes. It makes no sense! Just say yes from the outset if it's within your gift to do so.

Eg me "I need xyz because my specialist has asked for it. You will see there's a letter on the system".

Receptionist "computer says no"

Me <explains again why I need it and that there is a letter on the system, often we go round and round for five minutes>

Receptionist <finally relents>

The most frustrating thing is my condition affects my voice so I often feel quite ill /lose my ability to swallow after talking for ages .

If they can do it, just agree to it from the outset.

Thank you @Sidge. There was definitely an error, which the nurse eventually admitted after several questions from me. I will contact the practice manager.

Monthly - and this is common, I would expect my reception manager to tackle this but if they were not I would speak to the person directly and let them know to take more care. For things that aren’t needed - like coding, or important like demographic info I wouldn’t necessarily spend time correcting it. I think it’s ok to highlight just kindly as it might be someone has literacy issues?

@Menora that's interesting but where I live local GPs sit on the CCG commissioning board. One of the partners at my practice is the Chair of it. You would think they would know what's what.

I don't necessarily believe they do get cross about the bureaucracy. I think they often hide behind it to get the cheapest deal which isn't necessarily the right thing for the patient. My GP told me I couldn't be rereferred to the best rheumatologist in the area because the CCG had decided all referrals had to be made to the local district hospital and patients no longer had a choice. My MP forwarded me the letter to him from the CCG confirming what the GP said was not so and I could be referred to a neighbouring teaching hospital.

@Menora thank you. Our last team meeting was 7 months ago. We don't have a Reception Manager, just 4 Receptionists, one who is full time, which we feel is not enough considering the work we have to do.

I know there could be literacy issues but I haven't always been a GP Receptionist and I had to learn to spell medical words. Being a former Secretary perhaps it's just in me that I need to know how to spell them.

@Iwasafool @SpringNotSprung You can ask to set up with repeat dispensing (eRD), essentially a batch of pre-authorised prescriptions sent to your pharmacy which you can then collect at monthly or bi-monthly intervals without having to request from GP

@NellBoBo yes of course you can but that doesn't alter the fact that we still have to.go and collect them, the pharmacist had to request and dispense them.

I work 50/55hpw. I resent 30 minutes of my time and £2 parking charge to collect a prescription more times than is clinically necessary. The GP shouldn't be wasting time on this and neither should the pharmacist or I. I can only assume Doctors aren't as busy as they make out if they have time to waste. I don't. Also respect should be mutual. If they wish me to respect their time, they may respect mine.

No, my surgery won't do that, the only way I can get a repeat prescription is to log on every 28 days and order it. It doesn't let you do it before 28 days so if it clashes with a bank holiday I then have to send a message asking if I can have the prescription early.

@Menora Would you be able to advise me in how to make an effective complaint please?

A question about blood test results. I have a number of conditions that are under shared care. When a consultant orders my bloods, why can't I see the results on the NHS app?

Just a few things that puzzle me -

How come they are always running late for appointments, even at 8.15am? I don’t understand how they’re already running half an hour late at 8.15am when they only opened at 8.00am.

How come they say there are no appointments available but the waiting room always seems to be empty?

Why do they say there are no face to face appointments but we can offer you a telephone appointment? Surely if someone has time to call me then they could spend the same time seeing me face to face?

In my area the decision to limit prescriptions to 56 days max is not made by individual GPs, it is made by an area management board, I can't remember the name.

The GP practices are audited on the percent of medications they prescribe for longer prescriptions, and criticised for doing this (contraceptive pills are exempt from this).

The GPs I know are very frustrated by this! They would rather be able to prescribe longer courses when appropriate, up until the next time monitoring is required for stable long term medications. However they get flagged up if they do this.

Yes this is ICB prescribing team. A high risk med needs to be monitored. It is clinically irresponsible not to

It was also done in my area for stable prescriptions needing infrequent monitoring. It was annoying for the GPs and the patients too. The board said it saved money overall.

Hi,
The AM start being late is probably down to staff pouncing on them when they get in, to ask them questions, or calls they have had to make that are urgent. Sometimes they come to see me before their clinic starts to discuss something.

I don’t know your practice, you could ask your practice manager this question perhaps. The waiting room is full at different times where I work. Also they may have filled the telephone appointments for that day and be bringing in those who need a face to face on as and when basis. Most surgeries have a policy that children with temps will come in, lumps, conditions that need an exam, but clinicians are able to triage by telephone very effectively nowadays so not everyone needs to come in

As my point above I know patients do not agree with this as it’s not what they want, but it’s far more time efficient to use the telephone to consult with a patient unless it’s something that needs a physical exam, and the clinician is usually happy to be the one who makes that decision. You need less time for phone calls, it’s easier to wind them down and move onto the next. 10 mins is not as long as you think and often patients try to wedge in 2 or 3 other issues along with the first one.

I don’t think people realise what is imposed on GP’s and what policies they do and don’t control
cost saving is top priority for any ICB

Certainly the practice manager

Good question and it is ‘not well’

111 is the PAID contractor for out of hours GP’s, this took place years ago. People act like 111 is the same as A&E - it’s not, if you need a GP on the weekend or evening, they are paid contractually to be your GP during those times.

With this in mind, 111 have become more conscious of people using 111 ‘in hours’ (between 8am and 6.30pm) so they will direct you back when your GP is open. They aren’t being contracted during these hours for routine things.

Many ICB’s imposed a directive onto GP’s and PCN’s that they must offer a certain % of 111 direct booking appointments every day. So you call 111, and they book a telephone call back within 2 hours directly with your GP. So we also have to manage all of those patients daily. We also get 111 reports and they must all be read and actioned, the layout is annoying.

They don’t work well together and patients are pushed from pillar to post with both services pushing work away. I don’t know how to solve this but patients aren’t imagining it

I am sorry this is a lot of red tape, it is for safety, cost saving, efficacy etc. GP partners are liable for errors or harm and to avoid this, they want to check your levels. Pharmacies get paid per prescription, yes. Batch prescribing is more common now

This is a very tiny representation though, and this GP often is trying to keep the peace between GP’s and ICB. I know our ICB GP board member and she does fight for the GP’s but she doesn’t always win. I’m glad you got your issue sorted with your referral. There are so many changes all the time to pathways, the best person to ask is always a medical secretary