Being triaged for a GP phone appoitment by GPs Receptionist

[Pennox]

Curious to know if others think IABU here as this is a particular bug bear of mine. I should say that in the past I have had 2 particular concerns about GP receptionists which maybe colour my view. One, my mother was briefly a GP receptionist (not recently) and used to tell us all sorts about the patients at the surgery, much of which was personally identifiable if you knew those people in the local community. Secondly, I was given incorrect medical information by my own GPs receptionist just prior to Covid regarding my son which she shouldn't have been giving me anyway, and was given in an attempt to get me to go away and not persist in asking for an appointment, but, more importantly, because it concerned a severe allergy, could have been very dangerous if I'd not known it was rubbish and followed it. (And no I did not officially complain at the time as the practice makes that really difficult and covid kicked off, I should have done.) Anyway.

I had covid approx. 5 weeks ago and was feeling pretty much over it after 2 weeks of pretty rubbish flu type effects and then 2 weeks of fatigue, joint aches etc. So by end of last week was thinking great, I'm back! after a surprisingly rough month. I did not seek any medical attention during this time and self-managed. However, I think I've now developed a secondary chest and sinus infection which is getting worse and worse, all the usual gross symptoms which I wont detail here and got to the stage where I am feeling really rough again and cant work properly (from home). Im really behind at work after the initial 4 days off that I took and then being ill/fatigue/brian fog for another 3 weeks. So I reckon I may need antibiotics now and it wont just go away on its own - I'm not a medic but when this has happened a couple of times in the past that is what has inevitably happened. So, basically, I need a GP appt. To check and hopefully get some antibiotics. Online booking is 3 weeks out. So only option is the GP prescribed practice of phoning at 8 to ask for a same day/emergency appointment. Thisbused to involve queuing round the block at 8 as was impossible to get through on the phone. They've somewhat addressed this now so after about a 30 minute wait I got through and asked for a same day appointment and surely is a yes or no response, yes we have one available, no we do not. But they of course then ask you why. So I said I had covid recently and now think I may have developed a chest infection at the end of it and might need antibiotics to clear it up. She then started asking me a long list of medical questions about my symptoms. Was I coughing? Did I have a temperature? Was I coughing up phlegm? Was there blood in the phlegm? At this point I said can I ask you why you are asking me these questions? Is this my appointment? She said I am triaging you before putting you through to the list for a GP phone appointment (they are still doing all initial appointments over the phone). I asked if she was a nurse then or medically trained and she said no I am a receptionist but the GPs give us this list of questions to ask before we decide whether to put you through for an appointment or not.

AIBU to think that they shouldnt have non-medically trained people triaging attempts to get a GP appointment?

Its not so bad in this instance - the receptionist and the rest of the surgery now know I've got symptoms of a possible chest infection (its open plan and they're in the main reception), so what?. But bearing in mind she'd just confirmed my name, asked for my date of birth and echoed it back at me over the phone in front of who knows who standing in line in the surgery in front of her (that I can't see and could be my neighbour for example). What if it had been a call about depression or mental health/suicide or domestic violence? And more fundamentally than that, is it really appropriate to have non-medically trained reception staff, not bound by the same professional conduct standards as doctors and nurses, deciding who actually needs medical attention in the form of a doctors appt, and how quickly, or not?

@7thHell

Just book appointments online. You won’t be triaged.

Not all practices let you book online. Mine doesn't.

@Mrsjayy

Nhs scotland have an advert running telling us how Triage works they are probably sick of their receptionists getting grief!

@Mrsjayy

does the advert seem like it would be effective? That’s a good idea, actually, it’s a difficult situation.

I understand your point, TheSunWillComeOut2moro but dismissing receptionists as "touch type level two" is quite offensive. I did have qualifications in other fields and several other successful careers before becoming a receptionist!

@Sebastianthecoo in a+e you give brief details at the window before being called into a triage assessment with a nurse, they then decide how serious your problem is and how urgently you need to be seen. Whenever we have gone with our children we have been called into triage before we've even sat down in the waiting room. The person on the door merely books you in taking your name address etc briefly noting your issue eg "breathing difficulties", they don't decide if you can be seen or not like the gps receptionist does. They are admin not clinically trained staff.

And we have recently had someone very famous join the practice and I'd never dream of looking at their medical records without good reason!

does the advert seem like it would be effective? That’s a good idea, actually, it’s a difficult situation.

Yes its very informative.

My surgery does the question thing too.
And, yes, sometimes it is a privacy issue. With the advent of screens and masks, conversations are at full volume to make sure you are heard if there in person, so everyone in the reception area gets to hear all about it. I'm not sure if the person answering the telephone is in an office or the reception area - I usually do an e-consult anyway.
The other thing I have a huge concern about is the receptionist's ability to decide how urgent something is - they can put through requests for letters for referrals etc, but the 'non-urgent' ones are often overlooked because the GP specifically has to look for them. Urgent enquiries show as soon as the GP logs on for the day. I don't think it's appropriate for a receptionist to decide how urgent my need is for a pain clinic or neurology referral is - I've had to phone to chase both (and the GP had already agreed to do them). One referral took nearly five weeks to be sent, and was only done when the receptionist graciously marked it as urgent for me.

WeirdlyKind
Just book appointments online. You won’t be triaged.

Not all practices let you book online. Mine doesn't.

@WeirdlyKind

Apologies- I thought online booking was available for all NHS patients - obviously demonstrating my ignorance here.

Our surgery practically forces you to book online unless you need an emergency appointment, in which case you are actually triaged by a qualified nurse (I do actually know this because my friend is one of the practice nurses) however this is an inner London practice with 12,000+ patient list.

You need to get over this and let them do their job.

You are being ridiculous. They are given the list by the doctor to ask. This helps weed out people that may need to see a nurse or other HCP rather than a doctor. It makes things much quicker as the doctor has the information they need before speaking to you. Would you prefer to wait longer and have the doctor do the triage?

This is more or less the system that operates in my surgery. Except there is a recorded message from the doctor telling patients the receptionist has been trained to signpost patients to the most appropriate health care professional. In the case of my surgery that could be a nurse practioner, a phlebotomist, a physiotherapist or a gp.

I'm quite happy with this service. For example recent appointments for me have been blood tests, chest infection and a suspected brain tumour. I saw a phlebotomist, a nurse practitioner and, finally, the gp. I'm all three cases I was confident that the right choice had been made, and in case of the latter two appointments, I was seen the same day as I telephoned them.

Interesting responses thank you. To answer a few questions, yes I would always book online for this very reason if I could - you can just type a few words in the box so it goes to the right doctor. But, as I said, the earliest appointment on the online booking system is three weeks and I can't wait three weeks for antibiotics. I also appreciate that the receptionists are doing what they are asked to do with the triage questions - I have no anger or animosity towards GP receptionists at all and didn't say I blamed them (apart from the one that tried to tell me that it was fine for me to accept the prescription that had been mistakenly issued for Amoxycillin for my son that has a severe penicillin allergy because 'it's not the same' of course). I was asking a more fundamental question about how GP surgeries are set up and whether this system really appropriately addressed patient confidentiality concerns and comfort levels.

At my GP they definitely do answer these calls at main reception in front of the queue of people and within earshot of the waiting room (I know this because I have seen it, multiple times). However, they have introduced a back office overflow system in busy times only as a result of complaints about it taking hours to get through (of course it did, how can the front office receptionists deal with both?), I know this because they recently published it in their newsletter. But you don't know when you get through which area has picked up your call.

At the end of the day, I am not comfortable speaking to people about personal and medical symptoms in a reception environment when they aren't medically trained, rightly or wrongly, and the system should be able to accommodate that. Or put me through to a triage nurse in that case. I understand that some people are saying that there is probably one available in the background, but she was asking the questions in real time so it felt more like an automated checklist, which is fair enough I suppose if privacy and confidentiality were taken into account, but I don't see how it saves time really. When the GP phoned me a couple of hours later he asked me the exact same questions again and did a full medical history including allergies etc.

I also understand that they get a lot of time wasters and people with health anxiety booking spurious appointments, as well as a lot of social care issues that they shouldn't be dealing with and that clog up the system. I appreciate the efforts to try and optimise appointment booking, given they are so overloaded. My good friend is a GP and I know how hard it is.

I am just fundamentally uncomfortable with GP receptionists being put in that position. I don't think they should be and I don't believe they have the same level of medical knowledge and training as, say, a call handler in a dedicated call handling centre. There is such a high turn over of staff (because it's a tough, low-paid job) that they just can't be. If it is genuinely a workflow checklist that decided whether you proceed to the next level, 2/5 system says no, 4/5 get put on the GP call back list then perhaps they should then put you through to an automated system like banks do. And there must surely be nuance there in some case where a medically trained human has to use their experience and judgement.

I guess I will revert to 'it's personal' on the odd occasion when I can't wait 3/4 weeks for a routine appointment with online booking.

Would be interested to gear whether GPs find the system helps them?

I think the problem here is that a lot of people ask for GP appointments they don't really need, or certainly don't need with any urgency, they're just the 'worried well'. As the receptionists don't know who falls into that category, they have to try to ascertain it via a list of questions provided by medical personnel.

It's extremely frustrating for those of us who only request a GP appointment when we really need one (and know we do like @Pennox because it's something we've experienced before) but it's hard to see how else it could be better managed.

@user1471453601

This is more or less the system that operates in my surgery. Except there is a recorded message from the doctor telling patients the receptionist has been trained to signpost patients to the most appropriate health care professional. In the case of my surgery that could be a nurse practioner, a phlebotomist, a physiotherapist or a gp.

I'm quite happy with this service. For example recent appointments for me have been blood tests, chest infection and a suspected brain tumour. I saw a phlebotomist, a nurse practitioner and, finally, the gp. I'm all three cases I was confident that the right choice had been made, and in case of the latter two appointments, I was seen the same day as I telephoned them.

This. This is more and more the standard now, and if it isn't for you now, it will be soon. It works perfectly well, actually probably better now in my experience so far. I've been seen by the appropriate person in person where needed all through Covid.

This is to streamline the NHS resources and it does work.

I understand what you’re saying OP. This process (the same as 111) will lead to things being missed. Unfortunately there just isn’t the budget in the NHS to allow for medically trained people to be triaging. Another example of how it isn’t fit for purpose thanks to years of government mismanagement.

I think the confidentially issue is a different one and I definitely agree - I recently sat in the waiting room at the GP whilst they receptionist was taking calls and could have told you several people’s names, addresses, dates of birth and what is wrong with them. That is something to address with the practise manager

Your mother broke all kinds of confidentiality rules, and data privacy. If that happened today, she would have lost her job.

Only if the OP actually repeated what her mother told her to someone who knew the person who then complained.

I like the idea of the Triage advert - hopefully NHS England will also adopt that. It would be reassuring to be explicitly told that the reception staff were following a defined, monitored process with medical oversight in the background and that they had received appropriate training on how to triage and on privacy and confidentiality.

And no offence to Papergirl, who I am sure is very professional, comments like 'I haven't had any real training in how to triage, to be fair, but it's mainly common sense.' are not that reassuring.

Are you medically trained to know how to answer?

Many years ago my GP did the "you can only tell me one problem" at an appointment.
Fine. My elbow is the one that's causing me most pain. I'll ignore the pain in my neck which isn't as bad.

Guess which one turned out to the bigger problem.

Triage = decide the order of treatment of (patients or casualties)
So hopefully that list of questions is useful in correctly working out who should have priority.

But imagine someone ringing up "My head hurts" and getting grilled on how bad the pain is and how long it's hurt, when a direct appointment would have noticed the axe in the skull.

Both of our regular doctors were recently off and funnily enough most of the patients who had insisted they needed to speak to a GP quickly changed their minds when told we had a locum covering...

You're right, Pennox, there should be more training both in triage and confidentiality. I used to work for the police and they were red hot on confidentiality.

The confidentiality bit is the most concerning to me. At least with a doctor you have the option of complaining to the GMC in extremis.

And just to reassure people on the question around my mother. This was 30 odd years ago and she did get let go after a few months even then. I never repeated any of what she said, mainly because I already lived in a different area and didn't really know (or care) who she was talking about. She is and was totally unsuited to the job of being a GP receptionist, then and now, because she does like to gossip and isn't well educated so doesn't have a real understanding of things like confidentiality. As much as I love her for other things, she is totally unprofessional and I would never tell her anything confidential. Hopefully now the system is better and she would never be employed in that role in the first place.

My point is that I don't know that about individual receptionists and I don't know what training they have received or how they are triaging. Communication is maybe key here and that should go in the newsletters and ads.

Agree with you OP - have been triaged incorrectly by reception twice, it shows how low our expectation of care are that we think areceptionist triaging our health concern is absolutely fine.
Some patients call for the most trivial of reasons how about they didn't wish to discuss their reasons with you?

I'd would really hate it and move surgeries. At our practice the triage is done by a GP or ANP. You call before 11 and ask to go on the triage list, you get a call back usually within 15m and then they decide from there whether you need an appointment or just a prescription to collect from the pharmacy etc.

It was their system well before covid hit and it works really well, no having to repeat yourself to numerous members of staff and they will do referrals from the triage if appropriate.
The triage GP then has appointments from 11:30 onwards so they can book you in with them or one of the ANP's if you need to be seen.

@balalake

The confidentiality bit is the most concerning to me. At least with a doctor you have the option of complaining to the GMC in extremis.

Agree - receptionist loses their job - it's not like they can't get another because they have lost their license to practice admin.