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.

Econsults - to drive traffic away from the phones. In my practice ideally this would work to allow elderly non internet users better access to the practice, with those able to use the internet to use that way to contact the practice. It is not really unusual way of contacting most organisations nowadays, either though a chat bot or some form of electronic communication. Non urgent queries than can be guided to a solution or appointment. The word response does not mean a resolution it just means acknowledgement of it and that it’s being dealt with. Unfortunately most people submit one and then phone up about it so it has not really driven traffic away from phones.

Okay to clear up some of the issues around medication all I’m really able to give as an explanation is that it is important to have safety mechanisms in place

whilst you may have experienced a stable condition, The fact of the matter is if you were taking high risk drugs you are at a higher risk than others to develop other health conditions, toxicity or exacerbation of your condition. It is really important that these are monitored the fact that you are stable and well is attributed to the monitoring that you have received. It has meant that you have safety been able to continue that medication without any adverse effects.

Removing those barriers and mechanisms is too much risk. It would be dangerous to do this, some people do experience side-effects, toxicity or exacerbation of their conditions.

The NHS now has provided centralised healthcare professionals indemnity and access to NHS resolutions to deal with litigation claims and there is no reason to add to this by removing a safety barrier. Litigation costs the NHS a lot of money.

On a patient journey, it would be better for patients to not experience adverse events that could’ve been avoided - such as organ damage.

I think it’s a small world view to take your situation and apply it to a huge group of people who could be on a very large array of different drugs or have different health conditions that may counteract with one another. I think that it is worth bearing in mind that all patients are different and this medication is high risk and that is probably not going to change in terms of monitoring. It is safer to do this.

It is more cost-effective for the NHS in the long run not just from a litigation point of view but also the cost hospital admissions or complex long term conditions is very large. Nobody wants to have a new health condition that they didn’t have before, that’s been caused by lack of monitoring of their existing health conditions.

I appreciate you do not agree, and I do not have a medical or pharmaceutical degree either, but what I find is that a lot of people do approach me with ideas on how to best manage the NHS but don’t want to join any parent focus groups. Join your practice PPG. Do something in your community. Talk to your local community. Get involved in healthcare services. Go to AGM’s. Write to your MP. I am a tiny tiny cog in a huge wheel - you need to vote for the politicians you believe are going to make changes in this country.

I think this is always worth booking an appointment to discuss. The GP can help assist the spouse in what to do. If you can not get the person to the appointment, can you try to ask them to sign a consent form for their spouse to help them with their medical needs? You could say this is to make life easier with appointments and prescriptions. Frankly, a good GP would not turn away a concerned spouse and they would try to help. It’s so difficult, I’m so sorry to hear this, I know it can be very challenging in this stage of dementia. At this stage I would also try to get something legal in place like an LPA unless you think they no longer have any capacity. Get some legal advice and book a GP appointment. Confidentiality is obviously important but a GP can decide what’s in the patients best interests

You can book an appointment but it is a grey area without consent, and it should technically be in the right name of the patient but there is nothing stopping anyone discussing what they wish to. We always advise people to try to obtain consent from one another in writing.

But ultimately if you are worried you can perhaps ask the surgery for a consultation to discuss, or send an email outlining your concerns. Unless the person has no capacity the GP might not be able to take any action on that persons behalf, and just give you advice. It is very hard to get someone with capacity to seek medical help when they do not want to, if you are worried about their actual safety then you can let the surgery know.

In person most people are very nice to GP’s especially male staff. They are far ruder to nurses and other staff but generally tend to speak nicely to GP’s and respect them to their face (or by telephone). It’s mostly online I see people coming at them. Most people sat in front of a GP wouldn’t be rude.

I’m so sorry to hear this, I’m sorry for your loss. I think you could raise this to NHS England who can investigate on your behalf. I do absolutely see that COVID changed practices, not always for the best. My practice has always been proactive in seeing patients face to face if they present more than twice with the same condition, but there have been a small number of similar instances where examinations and investigations were delayed due to COVID protocols.

Practices and staff should always be learning and training, for me this would be a significant event and we would take the time to have a training session on presentation of cardiovascular and respiratory presentations in men and women, and reiterate the pathways that should initiate a 2 week wait referral

Menora · Today 19:53
MrsSkylerWhite · Today 13:28

Will a GP see and talk to an elderly person who fears their (in denial) spouse has dementia, if said spouse refuses to attend?
I think this is always worth booking an appointment to discuss. The GP can help assist the spouse in what to do. If you can not get the person to the appointment, can you try to ask them to sign a consent form for their spouse to help them with their medical needs? You could say this is to make life easier with appointments and prescriptions. Frankly, a good GP would not turn away a concerned spouse and they would try to help. It’s so difficult, I’m so sorry to hear this, I know it can be very challenging in this stage of dementia. At this stage I would also try to get something legal in place like an LPA unless you think they no longer have any capacity. Get some legal advice and book a GP appointment. Confidentiality is obviously important but a GP can decide what’s in the patients best interests”

Thank you so very much. I’ll discuss this with my dad.

Yay indeed! I hope that's true 🤞

In terms of medication asides from the safety issues its also potentially hugely wasteful to give people large amounts of medication in one go.

Once a medication has left the pharmacy it’s not then given to another patient if no longer needed it’s binned. Imagine you give someone a years supply and 6 months in their health changes and they need a medication change. That’s 6 months medication wasted.

Many patients don’t actually take their medication as prescribed so then they’d end up with months of medication just stockpiled at home

@NellBoBo
I work in a gp surgery as a prescription clerk and many times patients have said they have overstocks of medication and receive medication they haven't requested. The pharmacies are to blame for this. A lot of patients have an arrangement with their pharmacy where by the pharmacy will order their repeat prescription for them. The patient calls the pharmacy to order what they need but the pharmacy will request everything on their list even though it's not all needed. It's pure bloody greed!
We only prescribe two months medication at a time, with the exception of birth control and hrt medications. As mentioned in previous posts, many people fail to understand the importance of regular medication reviews and why we don't prescribe greater quantities. While the doctors are prescribing regular medications, they are responsible for the patients health and wellbeing so monitoring is vital.

@Nutterjacks my medication doesn't need constant monitoring, just an annual blood test. The dose hasn't changed in more than 30 years. It's also as cheap as chips. Why therefore is there any sense in raising a prescription more than once per year, especially if Dr's are supposed to be busier than other professionals?

I am actually going to wrote to the local ICB/CCG, copying my MP, because I want an answer to this. It is reasonable.to stop doing unnecessary things when claiming overwork. It is what other professionals do.

You are correct with regard to pharmacy requesting everything I see it frequently especially with testing strips, lancets, shampoo, creams, inhalers and GTN spray. Also 2 monthly tablet orders can be requested monthly. My colleagues will just order what's been ticked but I don't, I sometimes check with the patient if necessary.

@SpringNotSprung You've been trying to get an answer on this question for a few years. I'd let it go.

"Supposed to be busier? "

New GP plan asks more patients to use pharmacies www.bbc.co.uk/news/health-65488030

Thank you for this thread. We are in the process of changing our GP practice. They are both in the same building. Our current practice has two male GP's, one who is not a great communicator and the other, although good, is very difficult to understand even with a face to face. The practice hasn't been good with my MIL recently, the admin staff and nurse practitioner being short with her about her back pain, she has osteoporosis and never complains. That aside I've had what feels like gall bladder pain on and off for 3 years. I have gall bladder problems in my family, I was sent for an ultrasound and told it was satisfactory. Nothing else was suggested and no follow up. On a recent appointment I brought it up again and my GP looked at the scan and said yes it was clear but you have a fatty liver did anyone discuss this with you at the time. Nope! He outlined what it was quickly and I was basically dismissed. I feel very uncomfortable calling the practice and asking for anything. Ive had repeat prescriptions declined and no explanation given, no call or notes on the system. I did complain about this eventually as i have a condition that i need medication for and its dangerous for me to miss it. The new practice has a wonderful reputation and a mix of female and male doctors, 4 nursing staff and a friendly admin team. They've been recommended many times, I'm hoping they have the capacity to accept us as new patients. X

Can I ask you how you respond to a patient's complaint? Do you call them or do you e mail? I ask because I have e mailed several times offering to discuss the issues I have had ( usually poor communication between the various parties in the practice funnily enough) and this has never happened ie a person to person discussion. I have received e mails.

You said earlier that a fussy ( was it?) patient is more likely to get an appointment and I have to agree that you have to be your own cheerleader in the NHS. I am probably that fussy complainer and I have found that it has made my experience more positive. I think they dread me 😂, recognise my name as it is very unusual but hopefully they see that I am actually a very knowledgeable , pleasant and responsible person about my health.

I do appreciate all that our practice does and the NHS and I have to say that our Trust area has started in the last two years some wonderful systems for getting quick access to consultants.

I would love to know this too.

I found it incredible recently that blood tests done at the hospital do not automatically go to the GP surgery! I physically had to go and collect print outs from the hospital and take them to my GP. Astonishing.

Please do write and query this. If patients don't push for change, it's unlikely to happen. I think things like this come down to GPs not having time to push for changes. It's like my house- I know if I Marie Condo-ed it, it would make day to day life better, but by the time I've been to work, got dinner ready, kids to bed and then tidied the mess, I've no energy for making more changes!

As an aside, I'm a hospital doctor married to a GP. It constantly blows my mind that people can believe GPs are paid a fortune to sit doing nothing. If that was the case, why on is there a GP shortage? Who wouldn't want this mythical job of £100k for 3 days of doing next to nothing?

Really interesting thread. GP surgeries obviously cannot cope with the increasing demand, coupled with decreasing GP numbers. Along with essential demand - does it make us reflect on the non-essential demands that we place on GP surgeries? We live in a very me, me, me world with a lack of understanding that every phone call, prescription request, appointment, complaint, sick note means someone else is told 'no more capacity today'.

Ok, investigations!

The person who requests the results is clinically responsible for them. It is unsafe and poor practice to request tests then expect another clinician to follow them up with the patient. This also often isn’t even possible with electronic systems as the tests are in X clinician name and cannot be cc’d in or sent directly to GP on completion. What is the point in seeing a specialist only for them to ask your GP to review the result? They asked for a specialist opinion for a reason and this comes down to what a clinician feels comfortable and clinically competent to do.

Your GP might be able to download them but then they take over responsibility for them. Rightly so they might not feel competent to do so, and they can say no to you.

Results done by your consultant will not automatically come to your GP, so they won’t be readily available in the app because the GP won’t know they exist, and the consultant doesn’t process them in the same way as primary care does

https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/primary-and-secondary-care/acting-upon-electronic-test-results

Different electronic systems usually and my post above

I will either call or email or write
I know a lot of people don’t like talking on the phone, and some do so I just have to choose the best way. You should hear back from them within 3 days. If you don’t - call and alert them to your email. It could have gone to junk mail as NHS mail has a strong filter

Yes, the new initiatives for advice and guidance are good and do work

It’s ok to be fussy but remember you just aren’t the only person in the world. Today I was answering phones myself and the whole time you are on a call you worry about the calls you can’t take, what if it’s a really sick child?

@Menora thank you for the info on blood test protocol. We get patients phoning the surgery who the Consultant's Secretary has told to ring for the results before we have even had a letter, even though the Consultant has requested them. Same goes for A&E clinicians who order tests then tell patients to go home because of the wait and to speak to their GP in the morning for the results. We direct them back, not ideal for the patient but they shouldn't have been told to ring their GP in the first instance.

It is really frustrating and not fair on the patient. This is the same for patients who need further referral, instead of doing it internally they pass it back to the GP. In the case of a 2 week wait this is just not safe

I hope so too, communication is the basic cornerstone of a good patient relationship. Vote with your registration if you are able to

I wrote a response to this on page 1 that might be useful 😊