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.

[cptartapp]

@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.

I can take out stitches all day long. But the practice don't get paid for it. It brings in no money. Which puts the lights on, pays the wages of the staff and dictates whether they can afford to pay overtime to run more clinics to reduce backlog.
I'd happily do woundcare all day but patients then waiting twice as long for their cancer injection or repeat smear may not be best pleased.

[RollinRollinRollinRawhide]

@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 primary care get so many requests to do tasks like this, they no longer have time to actually see patients.

[Paq]

@Muggyoutthere that's quite the reach.

Again, my complaint is not about a botched process, it's about the fact that a patient was left without care. Obviously this was not a life or death situation but if it was, and the subsequent enquiry found that the GP did not contact the patient because the hospital filled the form in wrong, I think they would come in for criticism.

[RichardMarxisinnocent]

@Madwife123

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!

Correct, not all hospitals use the ICE system so I would imagine a junior doctor at a hospital which uses a different system may well not know what ICE is. Having read the posts since mine, seems it not authorisation the GP practice wants, they just want the hospital doctor to request the fbc themselves on whatever system the hospital uses for their order comms. Can you speak to the hospital clinical team again and rather than mention ICE form just say the GP has asked that the hospital request the fbc themselves?

[tobeornottobe1]

@endofthelinefinally

The hospital doctor should have given you a blood form so you could go back to the hospital for your post operative blood test. It isn't the GP's responsibility.
Speak to PALS.
Once the hospital has the result they should prescribe whatever you need and write to your GP.
GP may then wish to follow up after your course of treatment.

This should be followed up by the GP as per the discharge summary.
The GP should request the bloods and then check the results not the surgeons, they would never be able to follow up the patient after discharge this is what the GP is for.
Just like GP refer into a speciality , specialities also refer back to GP.

[AgeingDoc]

@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).

Agree, but reading the OP's posts again, given her anaemia is long term I'm not so sure it's quite as simple as the surgical team dumping post op care on the GP. (And I am an anaesthetist so it is not in my nature to be kind to surgeons). But it's quite possible the surgeons are seeing this as a long term issue and that they are just giving the GP the heads up that it needs a bit more of an eye keeping on it rather than it's an acute post surgical problem that they should deal with. So they are not necessarily being unreasonable in passing the issue on to the GP - that may well be what is clinically and logistically best for the OP - but contractually the GP/Practice Manager may well be correct. Patients with multiple conditions, or with an acute problem on a background of long term conditions often seem to fall down the cracks in my experience, which is very poor.
It's the system that's rubbish. Everything is so fragmented these days. Of course it's never been perfect, but I am old enough to remember multiple reorganisations of the NHS and it has definitely been less bad in the past. As an example I worked in a hospital which served a dispersed rural population and we used to get a lot of pre-op investigations done in primary care to save patients long journeys to the hospital. But not now. And it's not because the GPs are meanies who like inconveniencing their elderly patients, there just isn't the capacity and the way money flows these days doesn't help. We have too many people working in silos looking after conditions not people, with their pot of allocated funding for that specific task and nothing else. The failings are largely of policy and process, not clinical incompetence.

[Uncreativename]

@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 then the blood test will come out of the GP’s budget and not the hospitals

might seem minor but it will be a significant cost if GP’s start doing bloodwork for hospitals.

when I worked in a &e. GP’s regularly sent patients to a&e for x rays, instead of doing the request themselves and so sending patient straight to x-ray.

purely because whoever requests it pays.

[Blort]

This is infuriating to read! Can you get an emergency appointment with gp?

[olympicsrock]

This type of thing gets complicated. Form my point of view as a specialist , I want a patient to have the right test in the most convenient place for them. It is generally at the GP practice as nearest. But some GO practices use different pathology forms/ systems from the hospital. In our trust , patients just turn up to pathology for their tests which are on the computer but there are no forms so nothing physical to give.

It may be that your anaemia is well within what it normally is for you as someone with chronic anaemia who the practice manager has declined the surgeon’s request. It could just be that they are making a political statement.

[Sandylanes69]

@Blort

This is infuriating to read! Can you get an emergency appointment with gp?

... along with all the other CFs pretending their non-emergency must take priority...

[endofthelinefinally]

I think much depends on exactly what was written in the discharge letter by way of explanation from the surgeons,
In the original OP the B12 deficiency and GP management and monitoring of chronic anaemia wasn't mentioned at all. Consequently the first responses were based on the supposition that the blood test was a routine post op blood test to check recovery from anaemia due intraoperative blood loss.
Then later on the OP explained about the B12 deficiency. So that changed the whole picture.
The discharge letter contents is important in terms of who arranges and follows up the tests.

[Nutterjacks]

@endofthelinefinally

The hospital doctor should have given you a blood form so you could go back to the hospital for your post operative blood test. It isn't the GP's responsibility.
Speak to PALS.
Once the hospital has the result they should prescribe whatever you need and write to your GP.
GP may then wish to follow up after your course of treatment.

This

I was going to say the same. If the hospital initiates treatment, then they are responsible for that patient and should arrange follow up.

[QuintanaRoo]

I have a similar issue. I have an ongoing chronic health condition for which I am under the care of a consultant hundreds of miles away. The consultant has put me on medication and every three months I need my liver function checked. The GP practice refuses to do it as they say it’s the hospital’s responsibility. So every three months I have to take a day off work, spend £100 on a train ticket and spend all day going for a five minute blood test!

[HesDeadBenYouCanStopNow]

@tobeornottobe1
This should be followed up by the GP as per the discharge summary.
The GP should request the bloods and then check the results not the surgeons, they would never be able to follow up the patient after discharge this is what the GP is for.
Just like GP refer into a speciality , specialities also refer back to GP.

You're completely wrong. The person who requests the test is responsible for reviewing the results and arranging care. If the surgeon wants you too be tested then they need to put in the request for the test. Where the blood's drawn is irrelevant, the practice can facilitate this if the surgeon puts in the request. But a discharge summary is not a mechanism to task a GP, they are not staff that work for the surgeons, who can jolly well do their own jobs.

If you are unwell and the surgeon hasn't finished their care properly then complain to PALs at the hospital.

Suggesting that a surgeon of any doctor in a hospital doesn't know what forms to fill in to request blood tests is insane (it is 100% a lie all doctors know how to do this as part of their induction at the beginning of every rotation).

[tobeornottobe1]

@HesDeadBenYouCanStopNow

@tobeornottobe1
This should be followed up by the GP as per the discharge summary.
The GP should request the bloods and then check the results not the surgeons, they would never be able to follow up the patient after discharge this is what the GP is for.
Just like GP refer into a speciality , specialities also refer back to GP.

You're completely wrong. The person who requests the test is responsible for reviewing the results and arranging care. If the surgeon wants you too be tested then they need to put in the request for the test. Where the blood's drawn is irrelevant, the practice can facilitate this if the surgeon puts in the request. But a discharge summary is not a mechanism to task a GP, they are not staff that work for the surgeons, who can jolly well do their own jobs.

If you are unwell and the surgeon hasn't finished their care properly then complain to PALs at the hospital.

Suggesting that a surgeon of any doctor in a hospital doesn't know what forms to fill in to request blood tests is insane (it is 100% a lie all doctors know how to do this as part of their induction at the beginning of every rotation).

Perhaps different areas follow different rules.
The standard for my area and where I practice is the following:
If I request bloods or any diagnostic test it is my legal responsibility to follow up these results, therefore in the OP case if the surgeon requests a full blood count on the OP it is their responsibility to follow this up in outpatients. No surgeon will follow up chronic anaemia they do not have capacity to do this and it is not their job. This is why it is followed up via the GP as the surgeons have asked for in their discharge summary. The discharge summary is a summary of care carried out by the surgeons and then sent to the GP to make them aware of what was done and what needs to happen, this is called transition of care also which is good practice.

[RoobarbandCustud]

The practice manager will know the procedures/processes better than the GP, if they refused it it would not be for clinical reasons but because the practice were not obliged/funded to do it.

[Paq]

@HesDeadBenYouCanStopNow I called the ward twice and spoke to five separate staff, one of which was a doctor. I doubt every single one of these people were liars. Given that actual medical professionals on this thread are disagreeing on the correct protocol it seems the most likely explanation is the complex and fragmented system is "to blame".

However, to reiterate, my issue is not the broken process, it's the fact that the practice manager only focused on getting the right form filled in and at not point (that is apparent to me) did anyone consider the ongoing welfare of the patient, nor communicate with me.

Yes I could request an "emergency appointment" to speak to the GP but I won't. As everyone says, there's far more important things for them to deal with. This should be simple and it's not my fault it's not.

[Sandylanes69]

It's also not the practice manager's fault. Get that GP appointment in July and move on with your life, or contact PALS, or both.

[HesDeadBenYouCanStopNow]

@Paq

@HesDeadBenYouCanStopNow I called the ward twice and spoke to five separate staff, one of which was a doctor. I doubt every single one of these people were liars. Given that actual medical professionals on this thread are disagreeing on the correct protocol it seems the most likely explanation is the complex and fragmented system is "to blame".

However, to reiterate, my issue is not the broken process, it's the fact that the practice manager only focused on getting the right form filled in and at not point (that is apparent to me) did anyone consider the ongoing welfare of the patient, nor communicate with me.

Yes I could request an "emergency appointment" to speak to the GP but I won't. As everyone says, there's far more important things for them to deal with. This should be simple and it's not my fault it's not.

I only know for my county, but we take rotations for all other areas and the drs all seem to come with the same principles. The person requesting the test is the one who completes the form and is responsible for dealing with the results.

If your surgeon asked the GP to review a long standing condition that's different than requesting a blood test. The OP described a request for a blood test, not a note to ask the GP to review an existing condition.

[Pushkinia]

A hospital registrar tried to push me to get blood tests the hospital wanted done at the GP surgery instead of the hospital because “it would be more convenient for you!”

What she really meant was it would be more convenient for her!

I refused because it’s not a GP job to do hospital tests and they were done on the ward in which I was treated prior to discharge.

[tass1960]

I work in secondary care and my consultant often asks a GP to follow up maybe a repeat blood test in a few weeks. Some will and some won't and it is down to budgets as well as making decisions about what follows on from the result. It's actually no skin off the consultant's nose who does the test - it won't be them. They will fill in the form and ask me to arrange for the patient to come to the phlebotomy clinic at the hospital to have it done. It's shame when they have to travel a distance rather than popping to their GP but that's just the way it is.

Can you speak to then secretary to ask the consultant to leave a form at the blood clinic for you?

[Paq]

Thank you @tass1960. It's just so hard to speak to anyone. The gynae secretaries are also rushed off their feet and rarely answer their phones. To be fair they are great at calling back.

It's been an interesting experience to see how broken some parts of the system are, and if I wasn't the actual patient I would find the debate fascinating. But I am so it's not.

(BTW this is not the only issue I've had with post-operative care. I won't list them all because people would lose the will to live reading them all. Just wanted to reassure everyone that I wasn't throwing my toys out of the pram as a result of one missed blood test.)

Again, I'm not seriously unwell. I'm articulate and confident with no disabilities and with a support network. If this was a serious issue with a vulnerable patient then it could have consequences for their recovery.

[shortstayer]

I work in a tertiary service and regularly send blood forms to patients I've spoken to by phone / video. They get the samples taken at their gp or local hospital to avoid having up to a 4 hour round trip to the hospital I am based in. It's my name on the blood form so results come to me to deal with.

I appreciate this uses GP or local hospital resources to take the sample but we all work for the NHS and this is far better for the patient!

[cptartapp]

@QuintanaRoo

I have a similar issue. I have an ongoing chronic health condition for which I am under the care of a consultant hundreds of miles away. The consultant has put me on medication and every three months I need my liver function checked. The GP practice refuses to do it as they say it’s the hospital’s responsibility. So every three months I have to take a day off work, spend £100 on a train ticket and spend all day going for a five minute blood test!

You might think it's 'only' five minutes. But say there are 100 similar requests per month for the whole practice. (There are likely more). 1200 extra appointments per year at five minutes each is a huge amount of extra work. And of course there will be many no shows to these appointments, people who then who need to rebook. Wasting appointment time. I See it regularly.

[olympicsrock]

At the end of the day the health care system should be for the benefit and convenience of the patient not the system!
When patients are accessing tertiary services it is jot reasonable for those parts of the care that can be done in the community to be done over an hour away.
These days Hospital doctors can see the results on our systems so there is no need for the patient to travel to have it done.