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]

@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.

Well, this post does indeed sum up the situation nicely.

Broken NHS.

No amount of extra funding is ever going to make a difference while nonsense like this is going on all over the system.

[Madwife123]

@ShipSpace

Well, this post does indeed sum up the situation nicely.

Broken NHS.

No amount of extra funding is ever going to make a difference while nonsense like this is going on all over the system.

These type of things are a direct result of no funding. GP surgeries are cash strapped so are refusing to do work they are not paid for. The requester of a test pays for it. If they were using the same pot of money and money wasn’t so tight they wouldn’t need to argue amongst themselves over who pays for a test.

[Wishiwasatailor]

@Paq ice is just the system that some hospitals use to request blood tests. Other hospitals use different systems (cyber lab etc) if it’s not the hospital that your gp is attached to they might use a different sustem

[ShipSpace]

@Madwife123

These type of things are a direct result of no funding. GP surgeries are cash strapped so are refusing to do work they are not paid for. The requester of a test pays for it. If they were using the same pot of money and money wasn’t so tight they wouldn’t need to argue amongst themselves over who pays for a test.

🤦🏻‍♀️

[Paq]

Again, huge thank yous to the posters in the know who are schooling me in NHS systems and processes. But some of you are proving my point. My complaint is that the focus on the process is to the detriment of the patient.

I'm not looking for heads on a plate. I have managed large business operations myself, I'm studying for a MBA so I'm well aware of complex systems issues. Feedback from service users can improve the way organisations do things. My situation is trivial in comparison to other, more critical or vulnerable patients but if I've been caught out by this then so have they, and they may not be in a position to say anything.

[HesDeadBenYouCanStopNow]

@Paq

Again, huge thank yous to the posters in the know who are schooling me in NHS systems and processes. But some of you are proving my point. My complaint is that the focus on the process is to the detriment of the patient.

I'm not looking for heads on a plate. I have managed large business operations myself, I'm studying for a MBA so I'm well aware of complex systems issues. Feedback from service users can improve the way organisations do things. My situation is trivial in comparison to other, more critical or vulnerable patients but if I've been caught out by this then so have they, and they may not be in a position to say anything.

I think all people are trying to do is point you at the right area to complain. The issue is with the hospital rather than the GP practice.

And if you want to tackle the wider issue of fragmented NHS then you could complain the NHS England or you counties ICB.

It would be great if the NHS was a single organisation that worked as one, unfortunately it isn't and has never been. I personally would love it to be but I'm not sure where the funding to buy out the private organisations that provide the bulk of the service will come from (I'm referring to GP practices)

[Sidge]

The hospital are at fault here. Yes they suggested the GP check a FBC in a week but haven’t actually requested it properly. They need to put the form on ICE (or whatever system they use, the actual request).

The practice manager hasn’t made a clinical decision, they’ve made a business one in not agreeing to do something that hasn’t been properly regulated.

I appreciate it’s frustrating. It’s frustrating for us too as well often get a patient booked in for a blood test that they tell us the hospital have asked them to get but there’s nothing on ICE, nothing in a letter and we can’t just guess what they want taking! And the results wouldn’t even go back to the hospital team to review, they go to the requesting clinician (I.e. me). Then I’m responsible for reviewing and actioning them and I didn’t even ask for them!

So the poor patient has had a wasted trip, and we’ve wasted an appointment (which are in desperate demand too) so all round a frustrating experience.

[Sidge]

*requested, not regulated. Stupid aurocorrect.

[TroysMammy]

The hospital obviously don't factor in that the patient may not get a blood test appointment in a week.

They no longer have phlebotomy services in my health board and waiting times are approximately 2 weeks or more for an appointment in a hospital.

If the hospital need a blood test in a week then they should be arranging it through the urgent system not leaving it up to the surgery to arrange it.

[TroysMammy]

Sorry that should be surgery based phlebotomy services.

[Madwife123]

@Paq

Again, huge thank yous to the posters in the know who are schooling me in NHS systems and processes. But some of you are proving my point. My complaint is that the focus on the process is to the detriment of the patient.

I'm not looking for heads on a plate. I have managed large business operations myself, I'm studying for a MBA so I'm well aware of complex systems issues. Feedback from service users can improve the way organisations do things. My situation is trivial in comparison to other, more critical or vulnerable patients but if I've been caught out by this then so have they, and they may not be in a position to say anything.

You are right to complain. I don’t think anyone is saying you’re wrong to complain. They are saying you are complaining to the wrong place.

A complaint to the GP will be dismissed as they followed what they are supposed to follow and the hospital will never be aware of the complaint (disjointed systems remember). If you complain to the hospital the discharge process will be looked at and hopefully improved in future.

[mycoffeecup]

@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.

They aren't a GP, but your surgeon was entirely in the wrong here. if they need a test doing which is essentially part of your episode of care, they should have generated a form (which they will 100%) know how to do. It's entirely reasonable for the PM to know this, and bat back this unresourced movement for work from secondary to primary care.

You need to complain to the hospital, via PALS - google PALS (name of hospital) and start the process there.

[WiseUpJanetWeiss]

@mycoffeecup

They aren't a GP, but your surgeon was entirely in the wrong here. if they need a test doing which is essentially part of your episode of care, they should have generated a form (which they will 100%) know how to do. It's entirely reasonable for the PM to know this, and bat back this unresourced movement for work from secondary to primary care.

You need to complain to the hospital, via PALS - google PALS (name of hospital) and start the process there.

Undoubtedly you are correct about process, but the point here is that the patient should not have to do this chasing up herself.

Maybe a complaint to the CCG or the ICS is in order (after all secondary care is a commissioned service) but how would patients know this? Who is advocating for the patient? Is this nobody’s priority? It’s a mess.

[mycoffeecup]

@WiseUpJanetWeiss

Undoubtedly you are correct about process, but the point here is that the patient should not have to do this chasing up herself.

Maybe a complaint to the CCG or the ICS is in order (after all secondary care is a commissioned service) but how would patients know this? Who is advocating for the patient? Is this nobody’s priority? It’s a mess.

True. A complaint needs making to the surgical team, for exactly that reason. They should have properly arranged the follow-up.

[PinkDaffodil2]

The PM is unlikely to have a clinical background. However they’ve not made a clinical decision - they haven’t said that medically you don’t need the blood test, rather that it’s the responsibility of the hospital to arrange.
It sounds like they have acted appropriately in pushing back this inappropriate transfer of workload.
Your compliant should probably be against the hospital who think you need the blood test, which it’s their job to organise and act on the results (they are paid to do this). They a) didn’t arrange it themselves to start with and b) still didn’t sort it when your PM pushed back.
Historically GP practices would often do extra work like this, but currently most don’t have the resources to safely do the things which are their job, let alone doing the work of secondary care too.
The exception to the above is some GP practices have an arrangement where they are paid to do certain blood tests for the hospital, but I’m sure the PM wouldn’t have pushed back if that were the case here.
(there’s no way you would be expected to know all this - and it really sucks for the patients stuck in the middle. Most GPs would do really trully urgent blood tests then argue the toss later, but loads don’t have the capacity to do bloods in the timescale needed, we often don’t get eyes on the letter for a week or two, and if work isn’t pushed back they just keep sending more over)

[WiseUpJanetWeiss]

@mycoffeecup

True. A complaint needs making to the surgical team, for exactly that reason. They should have properly arranged the follow-up.

Who should make the complaint? The patient, or the GP?

[Paq]

The PM is unlikely to have a clinical background. However they’ve not made a clinical decision - they haven’t said that medically you don’t need the blood test, rather that it’s the responsibility of the hospital to arrange.

I agree they have not made a clinical decision. They have made an administrative decision which has clinical implications, which they are not qualified to understand.

Also, and probably my fault for not putting it in the OP, I have been treated for anaemia for FOUR YEARS before this surgery. It was noted on my admission records which is why the hospital did the blood tests in the first place.

[PinkDaffodil2]

No one is saying not to feed back, but your PM had acted entirely appropriately so I’m not sure what you are hoping to gain by feeding back to them?
As you understand systems I’m sure you can appreciate why there are really sound reasons it’s way way safer for patients if responsibility for an episode of care lies with the same clinical team, and there are clear processes in place for when it’s safe and appropriate (and funded!) to handover between primary and secondary care.
In this instance the thing to do to to feed back to the hospital (which I’m sure your PM already has, and takes a lot more GP resources than arranging a FBC!) to ensure their processes are safe and fit for purpose.
Clinically - you really want the results of that FBC to go back to the surgical team who know how to interpret it in the context of your recent operation. Not a random GP with no context and hundreds of other bloods to check while eating their lunch.

[PinkDaffodil2]

@WiseUpJanetWeiss it is best practice for the GP surgery (probably the PM) to feed back, but great if the patients also can. Anything that helps make the systems safer.

[WiseUpJanetWeiss]

@PinkDaffodil2

@WiseUpJanetWeiss it is best practice for the GP surgery (probably the PM) to feed back, but great if the patients also can. Anything that helps make the systems safer.

That doesn’t sound like a system. And in this case the GP appears not to be interested.

[Corgiowner]

@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?

Ditto I’ve been in hospital recently and an urgent blood test was requested on my discharge summary for 2 days after discharged. GP receptionist rang in a panic because she thought I’d not had it done I’d been readmitted!!

[PinkDaffodil2]

@Paq but it seems like clinically the surgical team is happy for you to wait longer for the blood test (otherwise they would have arranged it themselves as a matter of urgency when the PM first fed back).
I guess I’m trying to say that if the letter had gone to a GP - they would have done exactly the same as the practice manager. If there was an indication of urgency from the surgical team that makes it even more inappropriate for them to not do it themselves, and even more important that they receive the result. The PM received confirmation that the hospital team had got their message so knows the surgeons are aware it’s not been done. It’s absolutely unequivocally their responsibility not the GPs.
Had there been any clinical query (or if they couldn’t contact the surgical team for some reason) then they would have asked a GP I hope, but nothing in your posts suggests this is the case.

[PinkDaffodil2]

@WiseUpJanetWeiss well we can’t force patients to feed back so not sure what else you expect other than the practices to feed back?
Regarding systems our practice feeds back via the Datix system and / or a local system for inappropriate workload transfer, plus sometimes emails to individual consultants, clinical directors, heads of departments etc depending on the severity, potential or actual harm caused. Done by GPs and management. I do plenty as a GP but we rarely / never get feedback from datix and the local systems so I prefer to email too especially if there’s a pattern developing.

[WiseUpJanetWeiss]

@PinkDaffodil2

@WiseUpJanetWeiss well we can’t force patients to feed back so not sure what else you expect other than the practices to feed back?
Regarding systems our practice feeds back via the Datix system and / or a local system for inappropriate workload transfer, plus sometimes emails to individual consultants, clinical directors, heads of departments etc depending on the severity, potential or actual harm caused. Done by GPs and management. I do plenty as a GP but we rarely / never get feedback from datix and the local systems so I prefer to email too especially if there’s a pattern developing.

It sounded from the OP that the GP has not fed back to the hospital and has relied on the OP? But maybe I missed something.

My point is that the “somebody else’s fault” attitude upthread is not putting the patient front and centre of decisions. Clearly from what you have said this is not an attitude taken at your practice - this is very reassuring!

[confusedlots]

It's a potential governance issue which is why many GP surgeries push it back to the hospital to make their own arrangements. So the hospital ask the GP to do a certain blood test, GP does it and gets abnormal results and then who's responsibility is it to follow up? It's the GP's because the blood results have been returned to them. But the aftercare is the responsibility of the hospital and they should be doing whatever follow up they deem necessary.

In this situation many GP surgeries now ask the hospital to provide the blood forms with the hospital consultants details. They will facilitate the blood test at the surgery, but will use the consultants forms to send the bloods to the labs so that the results are sent to the consultant and it's their responsibility to act on it accordingly