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.

[ShipSpace]

If this is not evidence of just how broken the NHS is, then I don’t know what is.

We are now spending more money faffing around with sorting ‘who’ and ‘where’ things should be done, than we are spending on actually doing them.

No privately run, commercially led organisation would ever allow this to happen.

🤷‍♀️

[Saschka]

@ShipSpace

If this is not evidence of just how broken the NHS is, then I don’t know what is.

We are now spending more money faffing around with sorting ‘who’ and ‘where’ things should be done, than we are spending on actually doing them.

No privately run, commercially led organisation would ever allow this to happen.

🤷‍♀️

Of course they would - have you never dealt with an insurance company? Non-stop slopey shoulders trying to avoid taking on responsibility for anything.

I’ve worked in healthcare systems outside of the Uk, and they simply wouldn’t perform tests that they were not going to be reimbursed for.

[Uncreativename]

@ShipSpace

If this is not evidence of just how broken the NHS is, then I don’t know what is.

We are now spending more money faffing around with sorting ‘who’ and ‘where’ things should be done, than we are spending on actually doing them.

No privately run, commercially led organisation would ever allow this to happen.

🤷‍♀️

this is exactly why this happens.

gp’s are private entities contracted to the nhs. Every blood test they do comes out of their profit.

a commercial organisation is not going to do work for another organisation without being paid for it 🤷‍♀️

[ShipSpace]

Exactly. So it is precisely why the NHS no longer functions as an NHS.

[Paq]

@Madwife123 the discharge note specifically names the health centre and asks them to do a follow up FBC. The health centre has acknowledged this and will be delighted to do the test once the request has been submitted on the right form. I can see this information on my GP's patient app.

Your narrative is incorrect.

[Madwife123]

@Paq

@Madwife123 the discharge note specifically names the health centre and asks them to do a follow up FBC. The health centre has acknowledged this and will be delighted to do the test once the request has been submitted on the right form. I can see this information on my GP's patient app.

Your narrative is incorrect.

It’s not. You’re not understanding the system.

Discharge summary isn’t a request. They can write a request in there but that isn’t legally a request. To request a blood test they need to provide a request form. For my hospital it would be an ICE form, others use different systems but if no request form was provided the test was never requested. The health centre is happy to do the test once it is requested, the hospital hasn’t requested it. It’s that’s simple.

I deal with discharges from hospital every single day and if we want a follow up test we send the patient home with the form. That’s the process. Each hospital has their own process but a comment on discharge paperwork isn’t a legal request.

[Rowthe]

@2bazookas

Just ask for GP appt and when you get there, ask the DR to do the blood tests required by hospital.

Despite everything in the thread, you still come up with this suggestion.

This is why there srent any appointments.

Gps are busy doing work the hospitals should be doing, and the GP might not even be able to take the blood, and ask for you to book in with the nurse. That would be 2 appointments wasted.

[Muggyoutthere]

@WhatADrabCarpet

I'm probably being a bit dim here but I'm wondering if the problem is with the fact that GPs are private and cost their procedures accordingly which , with an NHS contract , they can accept or dismiss certain procedures.

Hospital consultants are employed by the NHS.

Dunno.

GPs cannot just cost most of their work however they like on a private basis - it’s all agreed on National tariffs.

This is part of the arguement in this thread that for example all work associated with a hospital procedure like an operation is costed and given to the hospital but they turf a load of it to the GP like follow up dressings, suture removal, blood tests, sick notes etc etc and the GP therefore isn’t being paid for it so isnt funded for the time of their nurses etc.

Some argue it can come out of the global sun which is the basic money GPs are given per patient to fund all their primary care in a year but that’s peanuts and barely covers a couple of a appointments per year yet alone anything extra.

GPs have to work out what’s coming in to decide how many staff they can employ and run their buildings and all the many associated costs.

The only work they can set their own charges for are truly private work like eg holiday forms or DVLA exams and even then there are recommended charges nationally which means the companies paying won’t go over anyway. And they are peanuts.

So when patients rightly feel it’s a huge inconvenience to have all the pre op tests and post op dressings etc at the hospital miles away so assume they can ask their GP to just do them, that’s why it causes issues. Everyone agrees it’s a faff but that’s how the government have agreed to pay for episodes of care- as a package to the hospital .

[CornishGem1975]

For all the bleating on about being one NHS, the services are so heavily disjointed to the point of inefficiency. I've always found there is such a 'them and us' culture and a general mele of 'that's not my job', obviously brought around by budgets and commissioning. As a patient, if you need a blood test you should be able to get it at the most convenient place for all - sending people to hospitals for routine blood tests is nonsense. Whole system needs a kick up the arse.

[taybert]

@Haywirecity can you not see that’s a clear safety issue? You didn’t even know the name of the drug you wanted. What if you’d got the date wrong?

[Kazzyhoward]

@CornishGem1975

For all the bleating on about being one NHS, the services are so heavily disjointed to the point of inefficiency. I've always found there is such a 'them and us' culture and a general mele of 'that's not my job', obviously brought around by budgets and commissioning. As a patient, if you need a blood test you should be able to get it at the most convenient place for all - sending people to hospitals for routine blood tests is nonsense. Whole system needs a kick up the arse.

Yep, fully agree. DH has cancer and has been passed between oncology and his GP for 5 years now as they argue between themselves so is responsible for what and just constantly pass the buck to the other. It's a disgrace. Navigating cancer is bad enough without a "not fit for purpose" and disjointed health service where the doctors are more concerned with their budgets than the health and wellbeing of a cancer patient.

[QuintanaRoo]

@Paq

Really @MumblesParty? I'm not asking for globs screening, just to check my anaemia. I've been having them regularly for four years and no one has batted an eyelid until now.

You’d probably be better off not mentioning the hospital request and making an appointment to see the gp and telling them you feel anaemic, tired, breathless, etc. I know it’s a waste of a gp appointment but you will get your blood test then at the GP surgery.

[Haywirecity]

@taybert

@Haywirecity can you not see that’s a clear safety issue? You didn’t even know the name of the drug you wanted. What if you’d got the date wrong?

Why is it a safety issue? The doctor reviews the prescription so he'd know what he prescribed from my medical record. As for the date, the receptionist could see on her screen that I'd been prescribed on that date and what it was for. She wasn't disputing I'd been prescribed the tablets. She just wouldn't put forward to the doctor a request for a repeat prescription because I couldn't remember the exact name other than they behan with 'F'. Is it up to receptionists to refuse to pass on to the doctor requests for repeat prescriptions? I suppose I could have opened my patient records and pointed it out to her on my phone. But she had the same records on her monitor.
So no, I don't see any safety issue.

[Haywirecity]

So when patients rightly feel it’s a huge inconvenience to have all the pre op tests and post op dressings etc at the hospital miles away so assume they can ask their GP to just do them, that’s why it causes issues. Everyone agrees it’s a faff but that’s how the government have agreed to pay for episodes of care- as a package to the hospital .

I don't mind having to shlepp miles away to get whatever done at the right place. What drives me nuts is that it's presumed we should automatically know where we should go. And that when we do go where we're told, if it's wrong, we're then spoken down to as if it's us that has made a huge mistake when in fact we've been given the wrong instructions. That's not a govt issue, that's just poor administration.
The stories I, probably most of us, could tell about bad nhs admin.

[taybert]

@Haywirecity if you had the app right there you could’ve found out the name of the drug. It’s the difference between the receptionist taking the responsibility for requesting the correct drug and you taking it. And honestly, when it gets to 6.30 and I’ve been working for 10 hours and sorted multiple problems for between 30 and 50 patients and I still have 500 prescriptions to check and sign it’s much much better if I don’t have to go in to the records to double check everything is correct. If I have to do that for every prescription then I’ll never get to bed!

Your second point about the communication is very valid and it’s equally frustrating for GPs and their staff to have to keep explaining this to patients because secondary care have given them bad information and dumped work on to us. That’s no excuse to be condescending. The majority of complaints my practice has to answer are about us declining work that is the responsibility of secondary care but that has been passed on to us. We’re between a rock and a hard place, we either do unfunded work which means we can’t do actual funded work (which pays our staff and provides the services everyone expects from a GP) or we decline and spend time answering complaints, again taking us away from what we should be doing. It’s incredibly demoralising. The passing of work from secondary to primary care is a huge part of the reason why primary care is so overwhelmed at the moment but everyone thinks we should just do more. We can’t. And it isn’t the patients’ fault that they think it’s our fault because that’s what they’re always being told.

Anyway, apologies for the rant. I’m going to unfollow this now, it’s putting my blood pressure up on my only day off this week (I need to stick to my mumsnet rule of only clicking on threads where GP means grandparent)

[Paq]

@Kazzyhoward I'm so sorry about your husband's illness and experience, I wish you both all good things. Your story is exactly the scenario I worry about given my small insight into the system.

Incidentally, DH had surgery in March and all discharge information and subsequent care has been done through our health centre with zero problem. It was a different hospital so maybe they are better at form filling!

[ShipSpace]

All the people who work in primary care, explaining why it can’t be done in primary care 🤦🏻‍♀️

[HesDeadBenYouCanStopNow]

@ShipSpace

All the people who work in primary care, explaining why it can’t be done in primary care 🤦🏻‍♀️

The blood can drawn in primary care, provided the hospital complete the form confirming the test they want (there are more than dozens of different blood tests including multiple ones including the letters fbc). The person requesting the blood test will take responsibility for reviewing the results and dealing with them.

Given that this was noted on a discharge summary it is the acute hospital that has identified a need, following inpatient treatment, and only they know why they are concerned and what they are looking for,

I agree tests should be executed as close to home as possible and it sounds like the practice will be happy to undertake a test once they have confirmation of the correct test and authority to complete on behalf of the requester. It's not admin for admin's sake, none of us know the test needed until someone actually completes the form so that everyone knows (and yes it would be an ICE form across our entire county too)

[Lavenderflower]

This is interesting. Whilst I do support GP''s. I think they perceptions are warped. For example, someone put then GP are not paid to write sick notes. I cannot issue sick-notes but regularly write letters for benefits, social services etc. General practice is badly underfunded. It is true that they only receive a small pay per patient. However, a lot patient do not visit they're GP thus, they are still receive payment.

[Paq]

Just fyi this a redacted version of my discharge summary with "actions for GP" showing repeat FBC.

[Madwife123]

It’s not legally a request. It’s not good enough unfortunately. I can see how you think it is reading it but as someone who does discharges day in day out there is a criteria to follow and that means the requester needs to formally submit a request. This is important for accountability and also budgets. It’s frustrating that the NHS is so disjointed that this is required but that’s the system we work in. The hospital are in the wrong here.

[FixTheBone]

@ShipSpace

If this is not evidence of just how broken the NHS is, then I don’t know what is.

We are now spending more money faffing around with sorting ‘who’ and ‘where’ things should be done, than we are spending on actually doing them.

No privately run, commercially led organisation would ever allow this to happen.

🤷‍♀️

Part of the problem is that the GP is a privately run business....

If it was all the same potnif money, same systems, same staff, same contracts, it wouldn't be an issue.

[FixTheBone]

@Paq

Just fyi this a redacted version of my discharge summary with "actions for GP" showing repeat FBC.

Unfortunately meaningless....


What if the actions said;

Transfer me a million pounds.

Remove the patient's appendix

Do the hokey cokey in the practice car park...?

Theybcan only request things that are actually the GPs job to do... The GP is the equivalent of a hospital consultant, it's not their job to do all the annoying little jobs the hospital can't be bothered to do themselves...

[WiseUpJanetWeiss]

@Sandylanes69

They're not. They're making decisions according to the processes they are TASKED WITH FOLLOWING.

Process before patient is not a good look for the NHS.

I work in the NHS and will defend it all the live long day, but things like this undermine patient confidence and provide another stick for the “privatise it now because that will miraculously fix everything and make it cheaper” deluded fools to beat it with.

A patient being left to navigate the fight between primary and secondary care is appalling. How many negative outcomes have this kind of disjointed nonsense as a root cause?

Of course the root cause of the disjointed nonsense is Andrew Lansley, but that’s a different thread.

[Sandylanes69]

@WiseUpJanetWeiss

Process before patient is not a good look for the NHS.

I work in the NHS and will defend it all the live long day, but things like this undermine patient confidence and provide another stick for the “privatise it now because that will miraculously fix everything and make it cheaper” deluded fools to beat it with.

A patient being left to navigate the fight between primary and secondary care is appalling. How many negative outcomes have this kind of disjointed nonsense as a root cause?

Of course the root cause of the disjointed nonsense is Andrew Lansley, but that’s a different thread.

Totally agree, but blaming individuals gets us nowhere.