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.

Thanks for the work you do OP, I'm a GP who thankfully escaped to Canada just before Covid, the pay and conditions are world's apart and I often think of the shit show my colleagues are fighting against currently back home.

Just in your opinion, what do you see GP services looking like in 10 years time? As they are or do you think it'll be more akin to dentistry where some are subsidised but largely people pay at point of use?

Yes, happy to help. You can PM me with more detail if you like.

essentially try not to write it when you are angry, and keep it factual. Outline clearly what has happened, and then what you would like to happen next, or ask them what they are going to do next.

A written complaint can be quite effective as it gives all the details that you might forget in a phone call and it also gives you the chance to outline the impact it has had on you. The practice should answer each of your questions and look into each issue and tell you why it happened, and what they will do to rectify it. It’s hard without context to give you much advice but if it’s clear to read, not too dense or full of emotions this gives them a good base to start with. Include emotions, but don’t write the whole letter from an emotional point as this can be hard to separate from fact.

If you don’t feel happy with the response you can ask for a meeting or even an appt with a partner to discuss in more detail. You are entitled to have your complaint dealt with and resolved with every effort possible.

I would write a complaint in the style of
include dates and times if possible
outline a timeline of what happened
describe what went wrong for you
how this impacted you
what you would like to happen next

I am adept now at managing emotional complaints but they can become very hard to resolve as I can’t take someone’s feelings away. I can explain why something happened, I can say sorry, I can advise them it’s taken seriously and a new policy in place but I might not be able to help them emotionally. I would also try to find a partner they engaged well with to help

@Menora why does it take so long to get a GP Report for an insurance application and what do you think could be done to make it easier for surgeries to expedite them?

Hello - DH had his GP practice in London for 25 years but handed back the contract last year. We moved to Quebec where DH is working in a family health care clinic. Finally he has a work v life balance!

Hope you’re enjoying Canada - whereabouts are you?

GP here… thanks a million for what you do. 💐

Recently, to sort out prescription issues, I insisted on an appointment with my GP. A F2F appointment was offered at a fixed time. A telephone appointment would have suited me better but could only be offered between 1pm and 5.30pm. Why is there no cognizance that patients are as busy as Dr's and have equally professional jobs? Why couldn't I have had the fixed time F2F appointment over the phone instead? That would have taken 10 minutes of my time, not 45 minutes. It would also have indicated the existence of mutual respect.

Taking on board your comments about 56 day prescribing, the appointment was to sort out why the practice was prescribing 84 Amitryptiline every 14 days since January. I take one for sleep. Prescriptions had also been raised out of sync for levothyroxine 100mcg and 25mcg, sometimes at 14 day intervals also, which I have taken for more than 30 years and for which the GP doesn't give a stuff about monitoring. Not once since 1989 has any GP ever inquired about how I am feeling due to my thyroid condition and it is always me that requests a blood test. I have tested this and prescribing carried on fir three years once despite the GP not requesting a blood test.

FWIW I demanded an appointment with one of the GP partners because the practice was blaming the pharmacist, the pharmacist was blaming the practice and I had spoken already to the prescription team (twice), the practice manager (once) and got a random call from the practice pharmacist to check if I knew how to take my meds properly as I was calling about them.

If the practice can prescribe 800 Amitryptiline in 4 months when I take 1 per day for sleep, with no GP thinking beyond the script they were signing and certainly not checking my medical records, does that not blow the monitoring and cost saving arguments out of the window?

I spent about 8 hours of my time sorting out a practice cock-up, including 8 or 9 quite unnecessary pharmacy trips, and not one person, including the practice manager, did anything to sort it, despite it being, as you say, an ICB initiated cost issue. I expect I'll wait a long time for an apology but if I were to show up 10 minutes late for an appointment, I'd undoubtedly get a tongue lashing from one of the semi feral receptionists.

In short - why are patients not afforded the same levels of respect as the GPs, both personally and in the context of their time. The only way I can see it improving is if and when money changes hands

This thread has been fascinating in parts and depressing in others. The OP has worked hard and patiently to answer questions and help people with explanations where she could. Could posters please try not to snipe or make snide comments. Take your frustration where it belongs, with the politicians.

Interesting stats from the BMA on GP appointments

General practice appointment bookings reached a record high of 36 million in October 2022.
The number of standard (non-Covid vaccination) appointments booked has remained high since. In March 2023, 31.6 million appointments were booked – this was 4.3 million more than the previous month (February 2023), and 1.9 million more than the same month the previous year (March 2022).
Despite this incredibly high demand, GPs are working hard to maintain access: 43% of appointments in March 2023 were booked to take place on the same day, and 83% of appointments were booked to take place within 2 weeks.
The majority of appointments are delivered face-to-face, with 70% of appointments in March 2023 being booked to take place face-to-face

It's a helpful thread, thanks OP.

@Yellowdays I think the OP had been super too. However I would respectfully ask that some more information is provided about the efficacy of 56 day prescribing beyond the ICBs insist. I'd like to know what GPs are doing about bureaucracy and inefficiencies and I'd also like to know why practices don't sort out their errors and why some practices don't seem to respect the patients. Since 1981 I've been registered with four surgeries, due to house moves. The practices I describe were prevalent at three of them. I'd like to know why.

One was excellent (same CCG as the previous one), it was organised and spotless and the GPs were fab but that's one out of four.

I wonder it it might be because they are too busy and run off their feet to sort out every process which needs a GP involved?

In short - why are patients not afforded the same levels of respect as the GPs, both personally and in the context of their time

GPs in the UK recieve very little respect from patients, it would indeed be nice if they did.

More GPS aside, if someone have you a magic wand what would the one (or three) thing(s) you would change in general practice that would make life easier/more efficient?

I’m not a clinician. Again, the guidelines are in place for safety reasons.

Your practice sounds like there are issues with coordinating medication reviews and for that it sounds like you are experiencing problems with out of sync medication, which should be addressed but I can I be honest? Your complaint to me so far has been really hard to unpick, it’s not clear exactly, also you combine this with asking why legislation/protocols are in place and why GP’s can’t work outside of them.

I think in order to resolve your specific issue to get your medication, you need to listen to the explanation and how it can work for you. It might not be the solution you think makes most logical sense ie. exempt you from all medication monitoring, it might cost more money for the NHS to do it this way, but ultimately, you need a solution that works for everyone and is practical and safe.

It’s not always going to be possible to change a process especially if you don’t have the medical knowledge to understand the basis of it, and why. high risk meds need monitoring, this is why the U.K. has a really good safety record and the USA does not. We are safe, and for good reason.

If you ask for a medication review and ask:
-to sync all your meds together correctly
-why there have been errors
-what they can do to avoid further errors
-to know all your future review dates and when to expect a BT

the reason why this happens could be many different ones but essentially disorganisation is the main one

GP’s do fight for change but it’s often on deaf ears. They don’t spend time pushing back on prescribing guidelines though, sorry and I don’t think this will change. They work within the boundaries of this and aren’t looking to change it

@yellowdays I hear what you say but a well run, commercial organisation would look at processes that didn't work and adapt them. My GP has raised 11 prescriptions since 1 January. Even with 56 day prescribing there should only have been two in four months. With common sense applied there could be 1 in 12 months. This is where my patience runs thin, particularly when one conversation doesn't sort it out. They are making work for themselves yet constantly whingeing and blaming the public.

@Menora do you think the system can continue like this and that services would improve if money changed hands like in Europe, Australia, etc. In the UK I get fantastic service from my dentist, who accepts NHS patients also. Sadly he is thinking of giving up NHS work, not for the money, but because the ICB, Commissioners make every transaction so bureaucratic and he says difficult and quite unpleasant to deal with.

At my GP practice one GP also provides GP services to our local boarding school, another is a Director of a local private health provider, another does two clinics a week privately at one of our local private hospitals, another has an executive director role on the ICB or its equivalent. These are all paid roles in addition to the part-time practice roles where it is quoted that the average GP salary is £79,000. £79,000 isn't bad in my opinion for a part-time contract that allows other income streams to be maximised.

I find it hard to buy into the overworked mantra against this background and as GPs are fundamentally self employed do not understand why they only pay minimum wage to the receptionists. They could pay more, they might get higher performing staff as a result and be able to make synergistic resource efficiencies. I imagine they would also have a more motivated and valued workforce that could only benefit the patient. As a practice manager, do you agree with that. Whilst there are exceptions at my practice, I am pretty sure the people (all women on minimum wage) who man the phones and reception desks are pretty much unemployable in a commercial, even a public sector environment like the CS, local government or school offices.

@Menora I think you missed the bit where I spoke with the prescription desk (twice), the practice manager (once), the pharmacy (once) to resolve the errors. Explaining clearly what I needed and when and requesting synchronisation. Diddly squat was effected despite those conversations. Also, BTW, Levothyroxine is not a high risk drug. It's a simple drug that replaces a hormone the body can't make. Once a patient is stable, as I have been for 35 years it needs annual monitoring at most.

Only when I spoke with a practice partner at a 10 minute consultation was the matter sorted out. A consultation that shoukd have been available for a sick person, but in all honesty I had exhausted every avenue open to resolve it.

I’m glad to hear you have no issues with your dentist as there are huge numbers of people who have no access to NHS dentistry - myself included. NHS dentistry is in dire straights and will not continue for much longer. I don’t know how they solve this, I don’t work in commissioning and I am not an MP.

Surely it makes logical sense if you can make more money working privately than NHS you would just choose to work privately? After all a dentist is the same as a GP….self employed and working for profit? Why do you view your dentist as any different from the GP’s you talk about, the way they are chasing money? Your dentist is doing the same thing on the same type of contract?

no one at my practice is unemployable elsewhere. I’m not sure where you are going with this. NMW is obviously not what I want for them but it’s also not unusual, many roles are NMW.

Some of your commentary style is slightly leaning towards becoming offensive, very sweeping generalisation and stereotyping.

I am sorry you do not buy into thousands of professionals telling you they are over worked and that you believe it’s a mantra. I think that respect works both ways and if you approach your practice with the view that they are not over worked and it’s a myth, this might be a barrier to better communication with your practice. You could open your mind and be less judgmental, it might help you?

I apologise.

I think my dentist is different because money changes hands. He asks about the family, appointments run to time, he is helpful, his staff are helpful, he explains options clearly. If I have an emergency, such as a broken tooth, they fit me in on the same day. I book my 6 month check-ups well in advance to get an 8.30am appointment. It's never an issue. My GP practice just doesn't run like that.

What I think is shameful, is that rafts of the public are no longer able to access NHS dentistry because of the hoops the CCGs/Commissioners/local health economy have put in place for the dentists to reclaim the fees. My dentist is happy to do the work for the prices agreed - he's not happy with the endless bureaucracy to claim for it and the rules being put in place about what treatment can be provided when, in opposition to his professional judgement borne of 30+ years of practice. NHS dentists seem to be decamping because of commissioners not because they don't want to do NHS work per se.

If my GPs ran a private and NHS list from their practice, as my dentist does, that would suit me very nicely. I suspect the GP practice, however, would have to raise its game in those circumstances because the sort of inefficiencies I have described would not be tolerated by people who were paying for their services.

It's a difficult one because privatisation of the railways and water hasn't worked well.

Again my apologies - I am just at the end of my tether re the logic. Re NMW - we are in the SE and their are so many jobs available just now. GPs in London shoukd be paying the London Living Wage as a minimum.

Have to say I agree about the unnecessary extra prescriptions. I've been on same dose of one drug since 2008 and another since 2015 and every month my GP does a prescription for them both. One needs an annual blood test, the other needs nothing. My condition is not going to go away, though it might get worse. Thankfully it hasn't significantly in 15 yrs.

The amount of wasted time between GP, pharmacists and me in dealing with this 12 times a year rather than once or twice must add up. Multiply that by all the millions of people who are stable on drugs... it just seems crazy!

I do have a question. A previous practice gave me 2 months at a time but where I am the county policy is to make everyone go through this palaver 12 times a year and never prescribe more than 28 days. Who makes these decisions and why? Is there any way for a patient to get them to reduce everyone's unnecessary bothering around?

I used to have to have 12 prescriptions a year, which I managed to get down to 6. When it was 12 the anxiety around meds was unreal due to the number of times the GP forgot to send it to the pharmacy or the number of times I had to explain myself why I am ordering a week early because of holidays and what not. And there were prescriptions amongst them that would give you withdrawal symptoms if you didn't take your tablet. Thankfully I am no longer taking those and a delayed prescription is not impacting me as much now.

Will a GP see and talk to an elderly person who fears their (in denial) spouse has dementia, if said spouse refuses to attend?

My late mother’s GP practice is still rarely doing face to face calls. She was told for two years that the pain in her chest was a pulled muscle, and her breathlessness “old age.” She had a stroke and was admitted to hospital, where she was examined and diagnosed with metastatic lung cancer. She died six weeks later.

Same practice also failed to diagnose my Dad’s lung cancer, telling him that there was nothing wrong with him and he was making it up. We complained to the GMC and got nowhere. I won’t go the formal complaint route again, but I do want to flag my mother’s treatment to the surgery, so that other old ladies aren’t treated so dismissively.

What is the point of econsult? My practice just ignores them (and emails) and you cannot get through on the phone at all

If someone made an appointment in their own name yet it was to discuss a family members (adult child) medical situation without that person there would that be allowed ? Would the GP just listen and take on board what was said but they wouldn’t be breaking any confidences as they are just listening ? Can this happen ?

@TheSeer

Clinical eConsults have a response time of 'the end of the next working day' by default whilst administrative eConsults have a 'within 3 working days' response time frame.