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.

Sorry if I missed this one.

I try to be present with the staff and check on them, just show my face and ask if they are ok. I therefore notice if they are not ok. I try to encourage openness. If I am worried I will try to guide them to get support. I also try to help them figure out problems

https://www.england.nhs.uk/supporting-our-nhs-people/support-now/looking-after-you-confidential-coaching-and-support-for-the-primary-care-workforce/

This is a service that might be helpful?
I try not to put all my stress on other staff as it’s not fair. We had a manager before who did this a lot and it was tough. Asking for support is hard but it could lead to positive changes - they should confide in someone and try to work out how to find some solutions - this might be changing processed? I hope everything is ok

No but I think they end up this way, I have watched it happen. It’s really hard to keep them fresh and positive. It’s a really hard job. I think everyone starts out with good intentions but it can drain you. Tbh I have gently moved on a lot of these types of staff by keep challenging them to improve or see the patient perspective - with the hope they will improve but if they don’t, then I can recruit. If they are good staff but burnt out with patients I can always move them into another role but once this becomes a persistent problem with any aggression or rudeness towards patients I don’t tolerate it

Who manages your team? You need some form of structure so you can address these things. Misgendering someone is going to have rebound implications and cause more admin work. Can you speak to the PM if it’s causing extra work for you? Some things I would let go, like ad hoc internal notes/tasks but anything a patient can read, or external org should be spelt correctly and there is usually a spellcheck option?

In my opinion doctors receptionists are saints - I couldn’t do their job for even a day.

You can get online pharmacies to deliver to your house via post?

This is non NHS work, therefore it is optional private work and they do not even have to offer it. It will not take priority over NHS work or a SAR request. There is no easy way to expedite it, as really it is not a priority but you can ask for a timeframe and if they have a policy in place with how long this should take?

This is correct. We have never offered more appts and in part this is down to technology allowing streamlining. Telephone consults have created incredible capacity but they aren’t always popular as people feel like they have lost something they used to have.

In reality, in the practice most of COVID was fielding a lot of phone calls not by sick people but anxious people about vaccines and then resuming travel and vaccine passports. Now this has calmed down it’s mostly on the day minor illness.

Now I do have a frustration, that the majority of people have not even considered a wait and see approach, or been to a chemist. An awful lot of people wake up that day feeling rough, call the GP expecting antibiotics and get told it’s viral. People do want a quick fix or reassurance. We did a lot of work around reducing antibiotic prescribing but with COVID and then strep A, this has had a big impact.

They are, 99% but some don’t realise how intense it is and struggle. I support people’s decisions that it isn’t right for them but I try to be brutally honest when recruiting. I have actually sacked someone who was incredibly aggressive towards the public and refused to tone it down

OP, I am interested in becoming a community/patient governor at my surgery. Does it work pretty much the same as it does in schools? How much would l be expected to know about NHS trusts and budgets before applying if a position becomes available? How often does the board typically meet?
Thanks in advance.

When DH had his GP practice I’d hear them on the phone when I came to see DH - the receptionists had the patience of a saint! I took cakes and sweets in as a thank you and made them all a drink.

My dear departed mum always swore that doctors car park's are deliberately awful to park in, in order to raise your blood pressure just before appointments so that the surgery gets funding for referring patients for blood pressure tests.

Serious question - why is it, do you think, that when I ring for an appointment I am always given one, but when my husband rings he is always told to go away and use Ask My GP (and consequently never hear from the doctors)? Is it because I'm a mum, or would past health issues have given me a marker on my file?

No one really. We try to manage our work. We have a "head receptionist" (longest length of service) but she doesn't do any organising, delegation of work or training.

We book our own holidays which is a bone of contention with me especially bank holiday entitlement, my job share works Mondays and Tuesdays so she gets all those bank holidays off in addition to having her 14 day holiday entitlement minus Good Friday, she doesn't work Fridays. I work Thursdays and Fridays so this year it was my only BH which was included in my 14 days and 2 extra working days off, so I'm disadvantaged and she's quids in. I've tried putting my point across but it's been said that I also get the BH off that it's correct. I don't get paid for BH I don't work, she does.

It's a shit show. My CV is up to date but I don't want to work shifts. I wonder if other surgeries are better or worse.

Our parking is sometimes terrible, a lot of surgeries don’t own a lot of land for parking.

That’s interesting - I think in all honesty it will be down to how you both word things it’s communication. Am I right - You will call up and give an overview of what is going on and what you want, and your DH will either not say enough about anything much or waffle on a lot without purpose? 🤣 I find men and women are not really different per se, both genders can tell you their life story in detail, become confusing, just accept the first answer given and hang up or have laser precision directness that gets them what they need. My DM is terrible for fobbing herself off by waffling on then losing the point of her call and talking herself out of why she even called in the first place

Ok so where I am I will give example of holidays. No one should be disadvantaged really.

X works Monday & Tuesdays. They get pro rata of 9 bank hols a year, plus their annual leave allowance (I will use 4 weeks as an example, I don’t know what you get)
so 4 weeks pro rata + 8 days pro rata.
If the BH comes to more than their BH allowance, its not fair to take them from their leave as well, so they will get to ‘keep’ their annual leave allowance but all their BH allowance is used up

Y works Thursday/Friday. They also get their 9 days Bh and 4 weeks pro rata. They only use 1 BH day, so they get to keep the rest as bookable holiday throughout the year, Y also gets to choose what to do with their holiday

Yes, X gets BH off work but Y doesn’t have to work on Mondays and has more flexibility with their holiday booking whilst X doesn’t have to lose out because they happen to work Mondays and it’s a forced closure.

You should get to keep your pro rata BH entitlement - if you are not, you can challenge this.

If you need help with a CV I can help you? If you move to a larger practice I think you will find that the structure can be more solid, I assume your practice is relatively small?

https://www.acas.org.uk/checking-holiday-entitlement/bank-holidays-and-christmas

So you never offer to have a chat face to face? If so why is this?

Yes I may be fussy but I don't hold up telephone lines as I tend to book online or go in in person. It is wrong for you to suggest that someone taking a stand on poor issues in the practice may be hurting a sick child. My answer would be that is these issues were fixed and operating correctly there would in fact be more time for patients. i don't expect you to be able to comment on this as you don't know the issues I am referring to or my practice but a little bit of your "problem patient" here has slipped through.

Hi OP, I'm also a PM. Thank you for being brave enough to do this thread, it's been fascinating.

@menora I appreciate things like an insurance report aren't covered by NHS work but when dd badly broke her leg and we had to make an insurance claim relating to a cancelled holiday, the form had to be completed by the Dr. I took it in with stickers on the pages for completion and signature (not many) with a copy of the discharge form. It can't have taken more than 5/10 minutes. This was in 2006. The receptionist took a cheque, payable to the GP personally for £35, (£210ph if it took as long as 10 minutes) prior to completion and told me to come back after 2pm the following day. I did. It involved getting dd into a wheelchair, out of it into a car, folding it, lifting it into the boot, finding a parking space, lifting the wheelchair out of the car, getting dd into it (she was 8), arriving at reception. I was told rather blankly, the letter isn't ready, come back tomorrow, no apology, no please. DD was in the wheelchair in front of her. I explained things were quite difficult and asked if the paperwork could be posted. The response "we don't have a budget for postage".

Well no, perhaps not from the practice's NHS budget, but if I pay the Dr personally to do something and they don't do it when they say they will, is it too much to expect the Dr to put a first class stamp on something she made a personal profit from and didn't deliver on time? If she did three a week that was an extra £100pw in addition to her NHS salary in 2006.

I don't mind paying for something required that isn't covered by the NHS contract but I don't think it should come without an iota of customer service. In a commercial environment that attitude would result in dismissal.

It's a computah says attitude I have seen far too many times when dealing with GP practices. Surely nobody who works in a GP practice thinks that's right?

I do have face to faces, but most people never want this. Also I am not a clinician so a lot of the time I am facilitating in assisting a patient with a clinical query, and it usually wouldn’t be appropriate for me to sit in an appt with a GP for instance. I also need the patient electronic record in front of me sometimes and talking on the phone or emailing someone is more practical. The last time I had a face to face meeting was a few weeks ago with a GP, I allocated 30 mins (and was clear on this) and they refused to wrap it up in that time and it went on longer until I called a final stop to it, and they then asked for another meeting. The Gp had sick patients waiting. I’m being honest that I would rather be in control of the conversation to stop it running away. And I am being honest that some people are selfish

With the ‘problem patient scenario’, I am talking about taking up receptionists time making complaints whilst they are answering phones in rush hour. If you call with a complaint ask to speak to a manager so the reception team can get to the sick child call. A receptionist isn’t likely to be able to help people challenging policies or poor practice and you get more frustrated as they try to get you off the phone. There are other channels and methods to bring up issues other than the telephone with a receptionist unless it’s life or death clinically urgent. When I do calls I have found that people are looking to for answers bigger than a receptionist would be able to help, the topics on this thread are case in point. There will be a sick person waiting behind you on the phone whilst you complain about a prescription, so ask for the manager if you need to highlight something more significant

You can complain to the PM.

You are right that a receptionist is not equipped to deal with a practice issue and tbh I don't think that many people will go through the agony of sitting on hold for 30 mins or more in order to do so and especially not at 8.30 am. Different if they need an appointment and are not close to the practice.

I would like to help you but these are very very specific questions, so I am going to say I don’t know the answer I’m afraid. Yes you are entitled to a better service, as is everyone, an an ideal world you would be very valued special and precious as an individual with your needs met by each GP practice. I don’t know if someone would get sacked in another scenario, I’m not sure this is how many business operate, sacking their staff - can I ask what sector you work in? I imagine that they asked the Gp to do your form in 2006 and the GP forgot to do it, or was busy and tied up so it wasn’t ready and they were trying to save money on postage so asked you to collect it

@Menora but if the GP gorgon, having pocketed a personal cheque for £35 for 10 minutes work, saving practice postage isn't the issue is it? The GP should have given a 1st class stamp for work rendered outside of her NHS contract and charged for privately. There should have been no expectation of an NHS funded stamp being used.

Forgot, not gorgon, though it could be apt!

That’s for the explanation about why test results aren’t shared between hospital and GP. I didn’t realise the implications of who ‘owns’ interpreting them and sharing them with the patient.

That said… don’t you think it’s crazy that there isn’t a central repository where all the medical information about a person is held/shared? The fact that GPs may not have all the relevant info when making their decisions (and vice versa with consultants) just blows my mind!

Thanks!!!