to think that the receptionist at our GP surgery always asks why we need to see the doctor when we phone to make an appointment?

[astragirl]

Surely that's personal info, no? I so want to tell her to mind her own bloody business!

The reason this happens is that GP practices are trying to ration out their appointments to ensure there is reasonable access. However, the implementation that most of them choose to use is pretty crappy because it makes patients feel uncomfortable and isn't particularly effective.

Receptionists aren't the right people to do triage in this way. Triage should be done by the most senior clinician available - it's faster, safer and more likely to be accepted by patients. Receptionists like those at Sidge's practice terrify me - that "basic medical training" is a perfect example of a little knowledge being a dangerous thing, and encourages receptionists to tell patients that their requests are "wrong" in some way. The algorithms are completely inadequate to the task at hand. Algorithms work well for blue-light services because the range of life-threatening emergencies is much more limited than the full range of medical conditions, and because massive international effort has gone into developing them for this purpose. The same is not true of general practice.

That's why there are some practices (like Stour, in Devon) that have GPs answering the phones. A third of the time, the GP tells the patient how to care for themselves without coming in. Another third of the time, the GP says "come in and see the nurse". And the final third, the GP gets the patient to come in to see a doctor.

But you only really need to do triage at all if you've not got the right number of appointments at the right time in the first place. Lots of places provide good access without any triage at all.

Incidentally, Sidge, this isn't true:
"Well receptionists are bound by the same confidentiality agreement that clinical staff are."
Receptionists sign a confidentiality agreement with a practice. But nurses and GPs are bound by NMC and GMC codes of conduct, and risk being unable to practise their profession if they breach the rules. The bar is much higher. Patients by and large don't want to disclose private medical information to non-clinical staff, and that is perfectly reasonable.

At our surgery we do ask the receptionists to ask, in as sensitive a way as possible, whether the appointment is an emergency or not, and whether they need to see a specific doctor, or a nurse. They do not ask the actual reason, despite the fact that it would be extremely helpful, because patients frequently complain about being asked.

But the problem we have is that in any given surgery, each of us will see at least 2 or 3 patients who would have been better served seeing someone else; and had they said what the problem was to the receptionist, they would not have wasted an appointment and their own time.

For example if a patient comes in wanting liquid nitrogen treatment, and they have not told the staff, there is not sufficient time to prepare the equipment and perform the treatment in one 10 minute slot. Also most of my colleagues no longer do smear tests (the nurses do) so booking for a smear with the doctor usually results in a wasted appointment. Contraceptive pill repeats can usually be done by a nurse... etc etc

The system is there to try to help you, not to offend, or to provide the receptionists with gossip material.

Can I ask if the receptionist have medical training in order to triage patients? Im just wonder if they are really qualified to do this ?

Next time you see the dr tell them that the receptionist asks and say that you don't always feel comfortable giving that info. Just see what the dr says.

slhilly I was referring to our employment contracts with regard to confidentiality agreements. The clause in a receptionists contract is the same as mine.

Of course my professional requirements are different to theirs.

I was trying to make the point that non-clinical staff are bound by confidentiality rules too so there should be no concern when disclosing private information to them. Of course if that confidentiality is breached then they should be reported.

Algorithms and flow charts an work perfectly well with well trained and well-inducted new staff. They aren't a substitution for a clinical consultation but are a starting point for direction. Most pertain to emergency appointments where patients are short of breath, have chest pain, a wound, a cough or a fever. They're very basic and tend to mean call 999, come in sooner rather than later or come in later this morning. They're not being triaged per se.

Good post slhilly

dockate - It would be the doctor (or nurse?) who diagnoses then recommends liquid Nitrogen treatment. Not the receptionist!
As for smear tests, I had a smear test letter advising me to book an appointment with the nurse, I think I also needed to bring the letter with me so again, no need for any diagnosis by receptionists.

I get that all staff are bound by confidentiality but I still feel uncomfortable telling the reception staff my business so I will say "its personal" rather than going into my medical problems. YANBU! if it something minor like asking for GP to ring I will tell them why.

while I agree it can seem intrusive, it's also used for those who are under-playing their symptoms. 'just a bit of chest pain' for eg where the receptionist may be authorised call an ambulance for straight away.

I have worked behind the scenes in a gp practice and while most receptionists are lovely you do get the odd dragon (as anywhere). it's just because it's to do with health so we are more sensitive to it I think (I know I am). many put up with a lot of shit too, though that's no excuse for treating polite people badly of course

I don't understand why it's such an issue for people to tell the receptionist

because some receptionists are incredibly loud and indiscreet

when I moved house I went to a new surgery and in the hour and a half I was sitting in the waiting room I found out what every other person there was going in for because of the horrible, loud, unprofessional receptionist.

YANBU.

I hate this. I discuss my medical history with my doctor or nurse thanks, not someone sat behind the desk. I also don't like it when they give you blood test results because they read it like they are struggling to understand and I would rather things like that are done by a qualified person.

In many surgeries the GP is able to see a list of the day' patients and their complaint (asked by the receptionist) on their computer. It's really useful for managing time, and the information is useful for more complex patients as the GP can familiarise themselves with the patient and their history, call up test results etc before they come for the appointment. It also means that everything can be ready for any examinations or tests- so everything runs on time. But the patient can still say that it's private, and it will simply say this on the screen.

Think is I don't think a lot of people realise what a Nurse Practioner can do over and above a "Nurse" and so would request to see a GP when the NP would be able to do the exact same thing.

They don't do it at my doctors, which is a large practice, and somehow everyone ends up seeing the appropriate person.
I think it is a confidentiality issue. Are receptionists bound by any code of practice?

Where I work not all GPs do the same things.

Eg, only 2 can fit coils, only 1 an Implant. 3 do Minor surgery, 6 take smears etc.

A specialist nurse does the Diabetes & Asthma reviews much more thoroughly than the nurse.

If you made an appt and asked the GP to syringe your ears, give travel vaccinations, you would be asked to re-book with a nurse or HCA

Some people just want a BP check, or a prescription that is on repeat.

If you need certain things you will automatically be booked a double appointment.

It really does help us, but if you can't/don't want to say, just say "it is private" and nothing more is asked. This is published in our leaflets, websites & on the recorded phone message.

and yes, ALL staff sign a confidentiality agreement, including the cleaners.

I don't really mind the receptionist asking but what I do object to is them ask"if I really need to see a doctor?" I get that some people probably take appointments without needing them but the vast majority can't surely. If I didn't need to see a doctor I wouldn't be bloody phoning.

Chouflour I see what you are saying but those who don't phone when they don't need to phone are less likely to phone IYSWIM. A disproportionate amount of time is taken up by a small minority of people and I am not referring to those with chronic conditions.

I know what I am trying to say but is difficult to explain when I can't give specific examples. For confidentiality reasons not that I don't have any.