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.

[mycoffeecup]

@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 as a matter of safety, as well as common courtesy, the clinician who wants the blood test doing should request it themself. Funnily enough, we GPs have quite a lot of our own work to do. We're not just sitting around twiddling our thumbs waiting for the great consultant in the big shiny building to give us work. We are not their junior doctors.

[ButterCrackers]

@mycoffeecup

Because as a matter of safety, as well as common courtesy, the clinician who wants the blood test doing should request it themself. Funnily enough, we GPs have quite a lot of our own work to do. We're not just sitting around twiddling our thumbs waiting for the great consultant in the big shiny building to give us work. We are not their junior doctors.

Is doing a blood test not part of your job?

[mycoffeecup]

@ButterCrackers

Is doing a blood test not part of your job?

Requesting a test that I need doing, as part of my assessment of a patient in primary care and that I will action is, of course, my job.

Requesting a test that a consultant wants doing in secondary care, and that s/he will action, is the consultant's job.

[saveforthat]

@mycoffeecup

Because as a matter of safety, as well as common courtesy, the clinician who wants the blood test doing should request it themself. Funnily enough, we GPs have quite a lot of our own work to do. We're not just sitting around twiddling our thumbs waiting for the great consultant in the big shiny building to give us work. We are not their junior doctors.

Wow. Touched a nerve there.

[mycoffeecup]

Quite apart from the workload issue, there have been many well-documented significant events due to things slipping through the net when one team asks another team to do a test on their behalf.

[mycoffeecup]

@saveforthat

Wow. Touched a nerve there.

Yeah.

I spend over an hour a day batting back requests for me to do unfunded work from secondary care. If I didn't have to do that, I could provide a few more appointments each day. Maybe 15 per week for a full time GP? 600 or so per year?

[Thethruththewholetruth]

@ButterCrackers

The manager would have end of school leaving qualifications at a minimum. They have not done medical studies and are not a medical specialist. A GP has to follow a hospital specialists recommended tests and follow up. The practice manager therefore has to organise the tests the qualified doctor wants you to have. I hope that you complain . The practice manager has no say in your medical treatment.

How rude!! I work at 4 GP practices and they are all more qualified than that, one is an AMP and able to prescribe with 30year plus experience, hardly just a school leaver!!

[Riverlee]

“We are not their junior doctors.”

I so agree with that. I used work in a surgery, and so many patients thought that what a consultant said, the doctors must do. They didn’t seem to realise that a consultants letter was advice or recommendation, not an order. Consultants aren’t gods, they’re just doctors who have followed a different route through their career,

[mycoffeecup]

@Thethruththewholetruth

How rude!! I work at 4 GP practices and they are all more qualified than that, one is an AMP and able to prescribe with 30year plus experience, hardly just a school leaver!!

Nope.

A consultant has to do the tests that they recommend. They have to arrange them, write the forms, see the patient and give them the result.

I have to do the tests that I recommend, as a GP. I have to arrange them, write the forms, see the patient and give them the result.

The PM will be acting on advice from the GPs, to try and take some of this unnecessary admin off them. The complaint is entirely to the surgeons.

[Thethruththewholetruth]

@mycoffeecup

Nope.

A consultant has to do the tests that they recommend. They have to arrange them, write the forms, see the patient and give them the result.

I have to do the tests that I recommend, as a GP. I have to arrange them, write the forms, see the patient and give them the result.

The PM will be acting on advice from the GPs, to try and take some of this unnecessary admin off them. The complaint is entirely to the surgeons.

You totally missed my point, I didn’t say they were qualified to do anything but to make out they are thick school leavers is rude!!

[SoShallINever]

@mycoffeecup

Because as a matter of safety, as well as common courtesy, the clinician who wants the blood test doing should request it themself. Funnily enough, we GPs have quite a lot of our own work to do. We're not just sitting around twiddling our thumbs waiting for the great consultant in the big shiny building to give us work. We are not their junior doctors.

mycoffeecup, I think the majority of the public don't realise that GPs are actually medical consultants.

[ButterCrackers]

@Thethruththewholetruth

How rude!! I work at 4 GP practices and they are all more qualified than that, one is an AMP and able to prescribe with 30year plus experience, hardly just a school leaver!!

End of school qualifications are needed. That’s not rude - that’s the job description. If you have more qualifications then good for you.

[tass1960]

@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?

I seriously think if the OP phones the consultant's secretary and tells them what the GP is saying the consultant will arrange for it to be done at the hospital. It's a simple solution and the blood test would probably have been done or at least arranged by now if a phone call had been made to the secretary either by the OP or the surgery. I often get such calls and it really isn't a biggie.

[mycoffeecup]

@tass1960

I seriously think if the OP phones the consultant's secretary and tells them what the GP is saying the consultant will arrange for it to be done at the hospital. It's a simple solution and the blood test would probably have been done or at least arranged by now if a phone call had been made to the secretary either by the OP or the surgery. I often get such calls and it really isn't a biggie.

Your consultant should not be doing that. It's clearly against good practice. If a consultant asks me to do a blood test, rather than arranging it themself, they get a pointed email - if the reply is anything other than an apology, it gets escalated to their medical director.

Yes, there is the occasional exception (very old and frail, hospital a long way away) - but usually then, again, the consultant can refer to the district nurse to have it done at home.

[tass1960]

Shouldn't be asking if the GP would mind doing a blood test and if they won't arranging to get it done? What is wrong with thatt? Some GPs will do it and some won't. It will save some patients another trip to the hospital if they will.

She won't generally ask the GP. The bloods are done during the appointment by a phlebotomist but if any are missed or she decides she needs a different test no harm in asking. The blood results are usually back before the clinic letter is typed anyway so it's not a specific letter asking the GP to do the bloods.

My point regarding this thread is not about what my consultant should or should not be doing. Just that the OP should contact her consultant's secretary and let them know so that they can then arrange to have the test done in secondary care.

[PerfectYear321]

@SophiaElise

Because they don't have to.

Using the OP's example, what happens if the test reveals that the patient is severely anaemic? Whose responsibility is it to remedy this?

Post-op care is the responsibility of secondary care.

And at the centre of all this is a poorly patient who needs a test. How unprofessional all round.

[Kazzyhoward]

@PerfectYear321

And at the centre of all this is a poorly patient who needs a test. How unprofessional all round.

I agree, but in the modern world of the NHS, the actual patient is just a number, not a person, and so-called medical "professionals" have lost sight of actually doing the best for their patients. It's all too fragmented these days.

[PerfectYear321]

@Kazzyhoward

I agree, but in the modern world of the NHS, the actual patient is just a number, not a person, and so-called medical "professionals" have lost sight of actually doing the best for their patients. It's all too fragmented these days.

Very true

It quite noticeable since COVID. It's like all the empathy has gone

[cptartapp]

Best for who though? Everyone only ever considers themself.
It isn't 'best' for other patients to be waiting longer than they should for cancer injections, childhood vaccinations and overdue smears if our time is spent doing routine follow up bloods.
The workload has trebled and there simply aren't enough appointments. Nothing to do with empathy.

[Lapland123]

@cptartapp

Best for who though? Everyone only ever considers themself.
It isn't 'best' for other patients to be waiting longer than they should for cancer injections, childhood vaccinations and overdue smears if our time is spent doing routine follow up bloods.
The workload has trebled and there simply aren't enough appointments. Nothing to do with empathy.

This

[Paq]

Final update for those who want it. The practice manager phoned me yesterday. She was, as you would expect, much better at explaining the situation than the staff at reception and, after a lengthy explanation of NHS systems and processes, eventually acknowledged that no, this wasn't the best experience for the patient.

Everyone who mentioned the ICE form/system was spot on. It still hasn't been done so I'm still waiting and everyone seems content for that wait to be open ended. The practice manager's logic was much the same as the posters on this thread but I will always find it incomprehensible that non clinical staff are delaying a clinical decision. I say again, if I was a sick baby or a cancer patient the wait could literally be life or death. Luckily I am just a slightly narky, slightly anaemic old hag.

This was the final straw however and I've decided to change practice. They are unpleasant to deal with, insist on written letters, no emails, their appointments process is terrible and their app is awful. I've not been that impressed with the GP care, very passive, "wait and see/probably nothing/have you tried ibuprofen?" attitude, which eventually led my condition to escalate leading to the need for major surgery. No doubt my departure will be unnoticed, other than one less irritant to deal with.

And no, I don't have much hope that the next practice will be any better but it's worth a try!

Final observation about my experience. I was struck by the level of mistrust different parts of the health service have in each other. Some of the hospital staff I spoke to were incredibly rude about GP surgery staff and vice versa. They are quick to blame "the system/processes/funding etc." for their own failings but other people's failings are apparently a result of their ineptitude, laziness, passing the buck etc. That's not going to help with delivering integrated care.

[Letitrow]

Its a nightmare, everything is so fragmented that the experience as a patient also feels disjointed. I'm a nurse in the military but we often work in NHS hospitals and oh boy I still don't understand how different parts of the NHS work together and communicate; in many cases they don't! It's mainly down to funding and governance, in this case without the correct forms the GP practice won't get paid, stuff like this wildly affects patients who reasonably should be able to pop to their local surgery instead of travel potentially some miles to a hospital for a blood test. Reality is though can't blame them for not doing it with the set up as it is, it can be many requests and tests a day which add up.

The entire thing needs an overhaul in my opinion. It's frustrating for everyone.

[FixTheBone]

@PerfectYear321

Very true

It quite noticeable since COVID. It's like all the empathy has gone

Close, but not quite hitting the nail on the head.

Substitute empathy for good-will.

Since the pandemic, the resources have diminished and the demand increased, I used to have 4 theatre lists per month, I now have 1. I have ever increasing numbers of patients on my waiting list, and all that happens is that I spend all day answering complaints, or requests for care to be expedited.

Before the pandemic, I'm not sure most people realised how much of the NHS ran on good-will, I probably provided 20% of my work over-running on theatre lists, clinics, doing admin, training and revalidation in my own time, we're now getting constantly squeezed to manage a situation that has become literally unmanageable. Given that reality, most people have given up even trying.

There was a time where if I put in some extra time, effort or hours, I could clear a waiting list, get an extra case done, file all of my outstanding scan results, empty my inbox. But now, it will never be possible, not without some more resource.@

[Lovepeaceunderstanding]

No but also this decision is not within their remit.