Is a GP "practice manager" a GP?

[Paq]

I'm submitting a complaint about my GP practice over a decision that the practice manager made about my post-operative care. Basically, the surgeon asked for the health centre to carry out a task through my discharge summary. The practice manager refused to schedule it because reasons. So this has not been done.

I'm cross and concerned, obviously. But before I submit my complaint, I wanted to know if the practice manager is a doctor or other health professional who who have made a clinical decision on denying/delaying my follow up care.

For those who want more information, the task was a full blood count as I was anaemic post op and they wanted to know if this would resolve itself on its own or if I needed additional treatment. The practice manager decided that the discharge summary was not sufficient authorisation for a blood test and wanted a form to be filled in on a system. The hospital ward/doctor had never heard of the system so couldn't/wouldn't do it meaning that I'm stuck in the middle not getting the information I need for my recovery.

[Paq]

@Sandylanes69 I understand, I was merely clarifying that I was at no point treated as a private patient.

[bornintheuk2]

I would think that it's all to do with costs. Blood tests cost money, so the GP will need to know who asked for it so they can be invoiced correctly.

[Sandylanes69]

@Paq

@Sandylanes69 I understand, I was merely clarifying that I was at no point treated as a private patient.

Sorry Paq, my bad 💐

[AgeingDoc]

I'm sorry you've had this experience OP but the Practice Manager has probably done nothing wrong and is following the correct procedure. It stinks though. The current structure of the NHS makes providing genuinely patient centred care very difficult. Nothing is properly joined up and everything revolves around money. I have had to take one of my children over 100 miles for tests that could potentially have been done locally because he is under the care of a tertiary centre and as far as primary care are concerned they are paying for that whole episode of care to be carried out by the specialist centre and don't want to be involved. We've had problems getting his prescriptions too, though that's thankfully resolved now.
It's frustrating for staff too. I used to do a pre op assessment clinic, and back in the dark ages, if I wanted an opinion from a Consultant colleague in another specialty I could just refer the patient to them directly. In fact as there was a Cardiology clinic running in the next room at the same time, sometimes they would even see my patient on the same afternoon if they had people who didn't show up and so had gaps.
But then a rule came in that Consultant to Consultant referals were not allowed anymore unless the patient was an inpatient. So instead of picking up the phone to a colleague I then had to write to the GP to ask if they would make the referral. Extra work for me. Extra work for the GP practice. Almost certainly extra delays for the patient. But all about money.
Most of the coal face workers, be they clinical or administrative are decent people and we don't make the rules, but we do have to follow them. My former Secretary was disciplined when she found a space on a clinic for a patient who phoned her in tears and didn't follow the correct procedure for example.
You are right to be annoyed but probably directing your ire at the wrong person. I hope you can get it sorted and feel better soon though. I agree with the PP who suggested contacting PALS as in my experience they are very helpful.

[TroysMammy]

In my surgery we are getting a lot of patients ringing asking about the blood results a hospital consultant has requested. We are having to bounce it back because even though the GP can see the results they haven't requested them for medical care. Same scenario with radiology results.

Another favourite is a consultant telling the patient to get the blood form from the GP. That means the GP's name is on the form and they are then obliged to follow up results no matter what the outcome.

[Madwife123]

They are right the discharge summary isn’t a request. The hospital should have submitted a request correctly. In the hospital I work in we send patients home with an ICE blood request form to take to phlebotomy. You are complaining to the wrong person. It’s the hospital at fault here.

[Paq]

@Madwife123

They are right the discharge summary isn’t a request. The hospital should have submitted a request correctly. In the hospital I work in we send patients home with an ICE blood request form to take to phlebotomy. You are complaining to the wrong person. It’s the hospital at fault here.

That's the form! However, my complaint is not about the fact that the admin process has been stuffed up, it's that the patient's care has been allowed to stall as a result.

Thanks for the information, really useful. Why did none of the 5/6 staff on the hospital ward know what this form was?

[cptartapp]

We regularly do such blood tests but they would be requested by the GP reading the discharge letter which wouldn't go anywhere near the practice manager?
These 'simple' blood tests however do use a lot of our appointments. We might do fifty follow ups a week. Meaning longer waits for your smear or your baby to be vaccinated. Nothing is ever 'simple'.

[Madwife123]

@Paq

That's the form! However, my complaint is not about the fact that the admin process has been stuffed up, it's that the patient's care has been allowed to stall as a result.

Thanks for the information, really useful. Why did none of the 5/6 staff on the hospital ward know what this form was?

I have no idea! I’m guessing not all hospitals use it. But even if they don’t use ICE they will have another system to request bloods and can give you the form when you go home. Would have saved all this!

[TheSparkling]

Actually OP I think your GP practice should be doing the blood test and the follow up. I work in primary care and it is very common for a discharge letter to ask the GP to do a, b and c and monitor and treat conditions which can be dealt with in primary care.
Every patient discharge we receive is actioned like this and the GP will follow up. Especially as you have been treated by your GP for anaemia prior to your hospital stay. I think your practice manager is wrong in this case.
Saying that I would need to read the discharge paperwork to see if they are clearly asking the GP to do follow up bloods, the hospital doctors can be vague sometimes.

[primroseknows]

@RuthW

Reading your post again I'm not surprised it was refused. It was requested by secondary care therefore needs to be organised by secondary care especially if not actually clear what they want. Primary care are within their rights to refuse.

No, the Practice manager does not have to be clinical.

A clinical person would have to take responsibility for ordering the blood test, ie a GP.

Agree. Primary care are not obliged to act on hospital instructions. There is also more to it than just doing an FBC blood test. If the hospital haven't provided the blood form, then the GP surgery would need to raise the form, state clinical justification for the test, the result would go back to the GP to be read. It actually wouldn't go back to the hospital routinely either.

A number of surgeries I have worked for would insist the hospital raise the blood request form and you go to the hospital phlebotomist for the blood to be drawn.

[Anewuser]

@LadyGardenersQuestionTime being just the patient, I’ve never understood why GP surgery don’t do wound care or take out stitches. Last time I had surgery, I ended up buying sterile scissors and tweezers and taking my own stitches out.

[primroseknows]

@Anewuser

@LadyGardenersQuestionTime being just the patient, I’ve never understood why GP surgery don’t do wound care or take out stitches. Last time I had surgery, I ended up buying sterile scissors and tweezers and taking my own stitches out.

We do wound care, stitch/suture removal and we are a tiny practice currently. It's Al down to what the management deem is the best use of our time aka where the money is.

[BungleandGeorge]

If you want to complain just complain that the test wasn’t done. The rest of the circumstances you don’t know.
it is the hospitals responsibility to complete the course of treatment required for your in patient stay. They should have sorted it out so your complaint may be misdirected. Were you actually anaemic (should have been given treatment) or was your iron level low. They’re not the same thing.

[Kazzyhoward]

@AlwaysPlayingYellowCar

I’ve had hospital specialists ask my GP surgery to do blood tests and they always did them without complaint, why wouldn’t they?

Because it costs them money! Our GP surgery also refuse to do blood tests required by the hospital consultants. They'll only do blood tests requested by one of their own GPs and just tell you to contact the hospital dept if it's a consultant request, even for regular blood tests for things the GP prescribes for, such as B12, vitamin deficiencies, etc.

[Paq]

The doctor on the ward did suggest to go into the Emergency Gynae Unit for a blood test which I thought was just nuts. I can drive post op and it a 3.5 hour round trip on public transport. When I'm supposed to be resting.

I appreciate the GP is busy. The hospital is also, funnily enough, very busy. And I know my "simple blood test" takes time away from other appointments. I try at all times to tread lightly on our poor benighted health service but logically, following up on post operative care correctly should indemnify GP time in the future.

[Paq]

Typo - can't drive.

[TrishTrix]

The person who requests the blood test is medico-legally liable to deal with the results.

If secondary care want the result they organise it, and chase the result.

GPs aren't paid for this shit (and I'm a hospital doctor).

[Muggyoutthere]

@RuthW

Reading your post again I'm not surprised it was refused. It was requested by secondary care therefore needs to be organised by secondary care especially if not actually clear what they want. Primary care are within their rights to refuse.

This
The concept that the hallowed secondary care gods get to just tell the lowly GPs what to do is helpful for no one.

If the hospital wants a blood test they can do it themselves. Ditto sick notes, follow ups, scans etc.

[Muggyoutthere]

@Paq

They were happy to do it as long as the hospital filled in a particular form, but the hospital did not know what they were talking about.

However, fundamentally, they put their administration ahead of my care. And didn't tell me that's what they were doing. I had to phone up and ask.

I'm able to advocate for myself and have people around me but what if I was really unwell, or elderly, or alone? Or otherwise vulnerable? What comfort would the practice manager gain from following admin procedures if it meant a patient came to harm?

The GP practice can decline any of the parts of the blood test. But because they try not to make life hard for patients sometimes they will agree to actually take the blood if they have space in their clinics and send it to the lab but it has to be requested on the system by the hospital so the hospital is responsible for the results.

m The practice by declining it will have sent that decline to the hospital who are responsible for following that up and contacting you. So again your anger is directed wrongly.

You aren’t listening OP. So determined are you that your Gp practice is at fault. No wonder all the GPs are leaving. They can’t get out quick enough.

[FixTheBone]

@AlwaysPlayingYellowCar

I’ve had hospital specialists ask my GP surgery to do blood tests and they always did them without complaint, why wouldn’t they?

Because it's not work they're commissioned to undertake, and therefore work they don't get paid for.

Simple concept, but the execution can be complex, often lots of grey areas.

GPs quite rightly get peed off with hospitals asking them to do stuff that would have taken seconds... I. E. Printing a fbc form with your discharge summary and asking you to come back to a phlebotomy clinic to get it done. Same goes for sick notes, prescriptions and countless other jobs that overwhelm. GPs daily.

[Riverlee]

Practice managers are often accountants or reception staff who have worked their way up. They are not usually doctors.

However, it sounds like the hospital is at fault here. Gp surgeries are under no obligation to do what a consultant suggests. The consultant should have arranged for the hospital to carry out the further blood tests if he thought it was necessary. Similarly, if s/he suggests to the surgery to follow this up, then the surgery are perfectly in their rights to want more information before carrying out the tests.

[Kazzyhoward]

@TrishTrix

The person who requests the blood test is medico-legally liable to deal with the results.

If secondary care want the result they organise it, and chase the result.

GPs aren't paid for this shit (and I'm a hospital doctor).

Yet, it's the GP who does the prescriptions and reviews etc for things like iron deficiencies, vitamin deficiencies, etc., so it's clearly within their domain. OH has had this, he has cancer, and the chemotherapy obviously affects the vitamin/iron/calcium levels, which the oncologist won't deal with as she says it's the GP, but the GP won't do the blood tests, even though they're the ones who'll end up dealing with the supplements/vitamins required ultimately. OH just gets constantly fobbed off and passed between them.

[Riverlee]

The ice form is basically a form which lists all the different types of blood tests available. The doctor would tick what blood test is required. The hospital is definantky at fault here because the surgery hadn’t got the info they needed.

[BungleandGeorge]

The hospital are supposed to provide your entire treatment course. If they identify something by chance eg you go in to have a mole looked at and they discover you’re anaemic then you can argue that they let the gp know (what to do is up to the GP though) as it’s not part of your treatment course. If they’re giving you a treatment or a surgery which causes anaemia they are obliged to sort it out. It’s a professional responsibility of the person treating you. At the least they should agree what will happen with the person they’re passing the responsibility to.
unfortunately hospitals do this all the time and just send people home without having sorting them out adequately. And yes the GP will often pick it up due to patient care but it’s not their responsibility to. And when you multiply this excess workload by all the patients in the practice suddenly it’s significant. Complain to the GP but also complain to the hospital and perhaps they’ll start training their staff to do a proper discharge which isn’t putting the patient at risk?