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.

They do, I’m sorry but people will just call about what they want when they want and even if you try to limit call times (say after 10am, people still call in).

I am just using an example of when I have worked on phones, usually calling at 8am on a Monday to check a prescription went to the chemist before they pop to the chemist, asking for blood test results from a few weeks ago they just remembered, complaining about things that happened at hospital appointments (especially a change of medication that takes time to process), private forms taking a while, and my favourite - booking a smear test but not knowing any of their free dates etc. I don’t think people stop to think about how long their call might be taking whilst they ask a receptionist questions about how long they need to wait for an MRI scan or to wait around while they go look for their diary.

Well this is in the works, so technically there are systems but depends where you live and what systems are used. Your summary care record is central and this would show the relevant headlines about you to an ambulance crew. If you have all your bloods done at one hospital that’s easier but through patient choice people go to other hospitals and that pathology system is different and doesn’t automatically feed into your GP’s.

I don’t know, it’s obviously their policy. In my own experience stamps are annoying to have to keep buying as a lot of practices do not have company credit cards so to go to the PO, someone needs to pay out of their own money to get reimbursed and then they are likely to buy smaller numbers of stamps per time. You can order from companies online now, but some will charge you for small deliveries so you then wait until you have a bigger order. This was 2006 so I imagine online stamps were no so prevalent and someone had to physically go up the PO and post everything or buy stamps. We have a franking machine but I am a bigger practice and we used to post out a lot of flu invites, which we do less now so in the future it probably won’t be cost effective to have one, as they are expensive

What is the point of sending invitations (by text) to 'join a weight loss scheme' ... I haven't been weighed at the GP surgery - or even been in for an appointment - for over two years but I seem to get one of these texts every six months? .
Do surgeries get paid for the number of people that sign up the schemes?

10 mins is your assumption, did they tell you it was only 10 mins? It’s a % of the GP’s time but it’s usually a flat rate fee no matter how long it took. They don’t just fill in the forms they have to check records and read info before filling information in.

Yes, ok you probably should have had a stamp. If you had complained to me I would have given you one if you had no one else to collect your letter. I can see this has been on your mind for a very long time and you are concerned about many of the specific functions and actions of your of general practice in some fine detail. Have you considered moving to another practice or is this your experience at all practices? I don’t think I am able to help resolve many of these things as I do not work at your practice but you could get involved with the practice as a PPG member

Yes they do get paid if they have signed up to this income scheme this year (or last). We chose not to

What do GPs think about patients using private schemes such as Push Doctor? Does this help them or complicate things?

the main issues are with online consultation services such as Gender GP who are prescribing off licence medication and then pushing it back to primary care. As long as a private GP isn’t working off licence and has access to make referrals then should work, but if they do not, they will always send a patient back to the GP for a referral, and that GP hasn’t even seen the patient and might not want to take clinical responsibility for a condition they haven’t even assessed

@Menora I'm a bit late to the party on this one, but my question is - do you recruit the receptionists? and do you think I could do the job?

I am about to finish a level 6 (Scottish qualification) course in Administration and Business and I have the Medical Terminology and Medical Reception Units as well. I am 35, and have worked previously in care home and retail but cannot get references as it was too long ago. Last time I worked was 2016, then I was a carer until the family member I cared for went into a home last year. I've been at college for 2 years. I can get a reference from college only. My children are now teenagers and I don't have any commitments except holidays twice a year for a week, so I can easily cover shifts or absence, even at short notice. I'm pleasant, fast learning, and good at multitasking, however I am not great at being assertive or good with confrontation but I am hoping there are procedures and that I'd learn to be okay with it. My only restrictions are that I cannot lift more than 5kg or be on my feet for hours.

Do you think I have a chance? If so, how should I approach the interviews? I think I have some advantage in that I have the qualification and I am very flexible with hours, but I am wary of how to explain that my children are now older and so I can be very flexible, in a role where confidentiality is one of the most important things, without coming across as over sharing.

Hi,

Thanks for the thread.

Please can I ask a question relating to the receptionist role when part-time. (largish surgery)

How often is extra hours likely to come up? is it like an overtime system where you apply for extra hours?
Can a receptionist have a second job? (or is that frowned upon)

@Menora

Do the staff call you by your first name? What qualifications do you have?

I ask as at University I had placements in a surgery and the staff called the PM Mr ....... Also he had no qualifications, just worked his way up from clerical work.

Do you feel practices should offer more out of hours services? i.e clinics on a Saturday morning (this used to happen, but none in my area have offered this for many years).

I recall a time when the GP used to do night calls and be in surgery the next day!! (I don't agree that was safe).

Disappointing if the reception staff are on NMW. I recall a time when this work was generally better paid than shop/factory/hairdressing etc.

Do you think the independent business model of GPs contracted to provide care by the NHS is outdated? It doesn’t seem to have moved on much since its inception in 1940s.
Do you think a better service would be provided by salaried GPs working from walk in centres with diagnostic facilities be an improvement on the current model, and remove the “luck of the draw” aspect of whether you get a good gp or not?

Why has the service not returned to pre covid standards ? Just a lack of staff ? One could prebook weeks ahead and when you went in the waiting room was full with people seeing several gps and some nurses , busy and thriving .
Now if you go in there's usually one other person there at best so obviously a lower throughput going on .

Do you not manage your booking diary on a daily basis ? I work at a really busy vets , the practice manager manages the computerised appointments on a daily basis depending how many vets and nurses are consulting . There are x number of prebook able slots, x number of slots that can be booked on line and x number of emergency on day slots . I don't see how taking away the ability to prebook is helpful for surgery or patients?

3 questions if that's ok?

1. I have one child with a history of cellulitis in the skin near his eye and another with a history of cholesteatoma in his ear. So if they have an eye or ear infection they need to have antibiotics asap. It's always a battle to get the receptionist to give them an appointment and I end up feeling like a hypochondriac. Is there anything I can say to the receptionist to make them understand that they need to see the gp and not the pharmacy?

2. Why is it so difficult to get a repeat prescription since covid? I used to be able to phone the surgery on the same day every 4 weeks and all our meds would be ready to be picked up from the pharmacy in 48 hours, 24 if you asked for them to be marked urgent. Now you aren't allowed to order prescriptions by phone. There is an app that only dh can use because the rest of us haven't got passports and pharmacy 2 u take at least a week. It's so annoying.

3. whenever I have tried booking an appointment for a blood test, the receptionist always asks if the Dr has requested that I have one. Do many people try and book blood tests without being told to by the dr? Seems bizarre to me but then I really hate blood tests and wouldn't ever volunteer to have one.

Why did the GP service effectively just drop out in covid?

Surely in a national pandemic, GPs should be on the front line. Why were they allowed to effectively just shut down and tell everyone to see a pharmacist instead?

Do you think the decimation of the service is deliberate to force everyone to clamour for a paid service like the US?

DH was a GP during the pandemic and the surgery saw patients in person every day. However decisions on how GP’s operated were made by NHS England. DH and his colleagues had more appointments during lockdown, either by telephone, video or in person. The GP service was busier during lockdown, not quieter. He also had an increase in visits to care homes where patients had caught Covid, become seriously ill and in many cases, died.

Yes they have 2nd jobs it would depend on your contract and there are often extra hours, these are often as hoc

Yes they all call me by my first name and I walk around and say hello to everyone every single day. I buy them cakes sometimes.

I have no formal qualifications! I have 25 years experience in the NHS. I have done it all. Cleaning, reception work. I am not afraid of getting my hands dirty.

Opt in to out of hours is optional.
Most GP’s opt out of OOH and they are penalised for this financially, usually 111 operates OOH instead. When the GP contract changed they no longer had to do OOH. There is a still a GP service doing it, just not necessarily your personal GP. It was crippling to small practices who only had 1 or 2 GP’s.

However there are 2 other contracts OOH - one is extended access and one is extended hours. They can either opt to do this themselves or contract it out to their PCN. This is a set number of hours per week - for instance it may be 10 hours a week evenings/weekends for a large surgery and far less for a small practice. They can offer remote consults during this time or a joint service at a central location. The model is flexible.

Hello.

1. All you can say is your child is unwell and needs to see a GP. You could write to your GP to see if they will allow a special note on your child’s records to ‘always’ get AB’s however it’s a GP decision whether to issue them. The surgery ought to have a daily urgent list your children can be added to. However I do know that everyone is trying to get on this list at the same time.. and saying similar!
2. It is a legal requirement, they relaxed it during covid but it’s correct - your request has to be in writing not verbal. Calling to request prescriptions completely clogs the phone lines too so urgently sick people cannot get through. Surely they should have some form of other online access via their website that you can submit a request? I would ask them
3. Yes. They very much do call to ask for their own BT. Especially iron, thyroid and prostrate. It is correct you cannot phone up and ask for a BT they must always be authorised by a HCP. This might be done for a medication review which is fine, it will be authorised in advance due to your meds. This is mainly for safety and to avoid waste. When GP’s go to review results if there is zero clinical rationale for the test being carried out this makes the review very difficult. Also every time you don’t book an appt, and the GP does this out of clinic it’s basically the same as an appt (they have to review your record) but this work isn’t recorded and is lost in terms of counting. It’s hidden work that GP’s do that doesn’t get counted in national stats

Hello. I know that people seem to think this and I really do not know how to show or tell people that this wasn’t the case.

Everyone I worked with was completely exhausted. None of the surgeries in our local area closed. However we did limit normal routine footfall on site for safety reasons. NHS England had a total triage ops procedure they put into place as a blanket across all surgeries to protect GP’s from all catching covid and having to isolate/close for days on end and buckling the service to an even more extreme degree. An outbreak of more than 2 people related to the workplace had to be reported to public health and they would close you down and decontaminate your whole site before you could reopen. Obviously this was not ideal so they locked the doors to stop Patients wandering around coughing and infecting all the staff or other very vulnerable patients.

We obviously didn’t write government policies but we had to follow them and later on the gov have been shown to have made errors of judgment. The main focus was circulation of air and limiting the numbers of people on site at a time to essential only.

However I know that in hospitals it was not the same scenario with sick patients lying in corridors and scenes of carnage of huge numbers with no beds. But patients that sick wouldn’t be on a trolley at their GP surgery or waiting for a hospital bed as GP’s are not acute emergency providers. There is not really any way GP’s open as usual would have prevented a lot of that happening and there is some argument that by doing what we did, we helped prevent even more people getting sick.

Vulnerable People were already isolating at home so we did not want them to catch it from us either. However when lockdown was relaxed and people mixed again this wasn’t all that useful in some ways and we would see surges.

There were still F2F appts but these were filtered into COVID and non COVID and sent to different places with certain HCP’s. It is also the case that HCP’s have their own health conditions so some of them were at risk with their own health and I actually personally know someone who caught covid at work from a patient and was seriously ill in hospital for months themselves. The extra cleaning involved was intense and staff had to wear PPE all day long. During this time they tried more telephone consults and realised these were actually very useful for many patients, so this took off as a success.

The intention to protect services was actually successful- we had no outbreaks and never closed. We did have a lot of staff constantly isolating (MANDATORY IF +) so every day was an operational disaster zone. I have never worked so many hours day in day out. I got burn out as did many of my colleagues. I had COVID twice and had to isolate and worked from a laptop at home while I was actually very sick, I had no choice we were so busy. I never usually would feel I have to work while I was sick and neither would anyone else but we did.

Behind the scenes it was not as it appeared on the daily Mail or from the routine patient end. I don’t know how else to answer this but to say I am sorry, we followed government policies so take it up with them!

Prostate. Not prostrate 😂

@AlwaysPrettyOnTheInside

To let you know that NHS England are still driving forward self care at a pharmacy. Pharmacists are being given more prescribing rights for minor ailments to relieve pressure on primary care. Also they have removed many things from the prescribing formulary in primary care and patients have to go buy it over the counter. This is an issue in a cost of living crisis we know but it’s meant to be reducing the cost to the taxpayer and waste in the NHS. You will still be directed to a pharmacy for many minor ailments and in time you will be able to get antibiotics and other prescribed medicines at the pharmacy. This is due to lack of GP’s in the U.K. also.

@Menora thank you for a very articulate response. Can you please address why, when the rules relaxed and society reopened, many surgeries maintained the covid protocols and many have not relaxed the requirement to access digitally even though it is an unacceptable barrier for some, especially the very elderly.

Yes thank you.

I prefer to deal with things myself and for routine things I tend to know what I need and have no issue putting in an electronic request and having it delivered or ready to collect. Or with a video call appointment. So the new system would work for me. If I get what I need with the minimum fuss, all good. For anything more involved I'd imagine I'd be that ill I'd need to go to a&e anyway.

Will they still offer a traditional service for those that find this approach difficult though?

And if front line services are being cut and changed like this, are they working to remove the layers of unnecessary managers and the procurement issues/costs in the NHS?

Any other business wouldn't be bled dry by greedy suppliers, they would be told the (sensible) price that the company is willing to pay for items.

For example, I've seen contracts on the government tendering site to supply a counties nhs sites with pens, and the advised fee has been in the millions.

Surely thats unnecessary and each site could have someone responsible for ordering stationary and cut the ridiculous cost to something more sensible.

That's just and example but many suppliers charge extortionate fees just because they are billing the NHS.