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?

@Pennox

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?

Do you seriously think that call handlers in 999 or 111 have any level of medical training? Not in the slightest, in fact I would probably say that Gp receptionist may have more training!

Of course the receptionist wouldn’t mention covid and PE to you - their job is the gather information so a doctor or nurse can make a decision. She’s not giving you medical advise - it’s a fact find. This way the doctor or nurse gets to spend more time with actual patients who need them. (I am in no way suggesting you didn’t need to see a doctor btw)

I honestly don’t know why you have a problem with this? Do you know how many hundreds of hours are wasted in the NHS daily due to people using the incorrect services (e.g 999 or A&E instead of a pharmacy). This practise only increased time the surgeries get to spend with actual patients and less time doing admin.

If every person who called the surgery was just given an apportionment straight away, you’d never get in and then you’d be moaning too!

@freshcarnation I’m so sorry about your mum.

More for the knowledge of others - There might be a specific reason and you were told to call an ambulance for but usually when a person has died and it is not unexpected you don’t need an ambulance but can call your Gp/the out of hours service for a medical professional to come and certify the death and a funeral director to arrange for the laying out

Thank you @Cbtb It was mum's carer who told me to call an ambulance. And you're right it was in fact an out of hours doctor we needed. The paramedics rang me after 4 hours to say no ambulance would be coming and that they had arranged a doctor to visit. All sorted eventually but took about 7 hours

[quote Narutocrazyfox]@lovePoppy don't be so ridiculous, I haven't made anyone's job harder. If a referral is needed, the GP informs the admin staff as per the process. Me going through a lengthy checklist with the admin staff beforehand makes no difference to their time at all.

You do realise we pay for this service, through our taxes? I just don't like my time wasted. I do not require triage, I am perfectly capable of assessing when I need to see a GP. So why take up more of the receptionist's time?[/quote]
Unfortunately there are a lot of people who are not as well informed as you. "I've got a sore head, after drinking five bottles of wine , but my head is so sore it must be cancer, I demand an instant referral". Or " I couldn't be arsed to reorder my Pill when I saw five pills remaining so I ran out and I must have a new one now, and if I get pregnant it's your fault". Yes I've heard it all.

I agree with you OP I really object to having to disclose my symptoms or other issues to the receptionist. It's private and none of their business. I was recently instructed by my midwife to make an appointment with my GP regarding a possible infection to my csection wound and ended up having to basically justify why I needed to see the GP as the receptionist thought it was odd and why couldn't the midwife just deal with it....

they will have a script of questions to run through
I can get a bit irritated if I've already filled in a detailed e-consult form - one screening call I prefixed every response with "as I wrote in the e-consult form..."
The first e-consult I did, I had a chat with the GP about the econsult process, and she much preferred it to the 8am scrum, because she saw the patients that she needed to, rather than the ones with the fastest fingers, and the econsult responses were handled by assessed priority.
(the econsult submitted at 8.30 am. triage call at around 9.30. phone call from GP at about 11, face to face appointment at midday-ish).

So - the receptionist phone calls can be irritating, but if it focusses GP time on dealing with priority cases, I don;t have a problem with that.

My understanding is that NHS 111 staff aren't necessarily medically trained either (and the GP receptionist are generally an improvement on them anyway).

@Pennox

You do know that they asked because the doctors tell them right? Guess what, if you need follow up, it’s the admins who book those or send referrals. They also have access to your files.

So are you implying that if a patient pisses off a receptionist by being what you or they perceive to be unnecessarily difficult, but they might perceive to be due to valid confidentiality and privacy confirms, then the receptionists should vindictively and deliberatley delay or interfere with any further medical treatment they might need?

If so, that would be incredibly unprofessional and only adds weight to my concerns about the role of GP receptionists in my healthcare. Thankfully the receptionist i spoke to today obviously was progessional as the GP called me back and prescribed antibiotics within the hour so she obviously did not deliberately put me at the bottom of a list or anything.

How does econsult work? I use the GPs online system to book non urgent appointments and order repeat prescriptions. Is that different? Its not terribly convenient to be called at a random time tbh, I am on calls with customers for much of the day and have headphones on. But then its no different really from the GP receptionist saying a GP will call you back 'sometime today" - I'd just stepped into the shower this morning of course. Not sure what teachers, bus drivers, shop and restaurant workers and other people that don't have constant ccess to their phones all day are supposed to do though!

No, I’m stating that it’s very unlikely a lowly receptionist doesn’t know why you’ve been booked in.

Refunding to allow them to properly do their job doesn’t save you anything.

I do get irritated with the econsult form finishing off with do you drink/smoke/gamble every bloody time.

No - no more than I did last month - and wtf has it got to do with needing a repeat prescription!!!

The whole system is ludicrous.
Same where we are.
DH's grandma - in her 90s- had a pain in her back and side. MIL rang to ask for GP appt. Refused appt. request.
Had to have a telephone call from reception, 3 days later, to 'triage' request. Receptionist asked: age, general fitness, was pain new, score 1-10. Was she eating and drinking and going to loo normally? What medication does she take?
Receptionist then passed info to nurse who rang back 2 days later to say grandma could have telephone appt with GP in 10 days.
MIL was not happy but no way round it.
Telephone appt arrived and within 1 minute GP asked MIL to drive grandma to GP surgery immediately. Then asked her to take her to the hospital where she was admitted for 'tests'.
Test results ok - needs medication adjustment. GP rang MIL to say she needs to be put on xxxx and MIL said 'She already takes that'. GP looks at notes 'Ah yes. Well that's fine then'.
'No it isn't! If she already takes it, it obviously isn't working' says MIL.
'Yes, I can see why you think that. I will ask consultant and call you back.'
Calls back 2 days later with instructions for a different medication which has worked well.

The amount of wasted time and resource in this system is ridiculous.

What should have happened is MIL rings for GP appointment for grandma and gets one within 48 hours. Then receptionist time, nurse time would not be wasted, grandma would have been seen a fortnight earlier and been better faster. It is ludicrous and pointless and I am so fed-up with GPs.
My 90 year old aunt faces the same issues. Today a nurse came to give her an injection for pernicious anaemia- it has taken a month to get someone to do it. Turns out they have been going to her old address- she moved 3 years ago and has had 3 years of treatment at her 'new address'. They have been to her old address 4 times in the last month, no answer so just decided she was out.Didn't check address or telephone her.

What happens when elderly or vulnerable people have no one to speak up for them?

What is it GPs are actually doing that us more important than seeing patients?

“ What is it GPs are actually doing that us more important than seeing patients?”

Seeing other patients?
I’m a trainee Gp
0800 get in an check urgent messages such as death notices, admissions, safeguarding and sign letters. Check some results and repeat prescriptions.

I get paid from 0830
0830-1000 6 phone calls (I get 15min/patient real GPs get 10, that time includes reading the notes (can be very long and writing up my notes and arranging prescriptions referrals etc, so don’t have very long on the call)

1000-1130 4 face to face appointments (I get just over 20min, real GPs get 10-15min and as above that includes all reading and writing of notes)

1130-1145 meeting - usually where we decide who is visiting what patients later and distribute urgent notices

11.45-1245 admin - write any hospital referrals, read letters from hospital consultants and discharge letters, review test results, review repeat prescriptions, safeguarding referrals, etc

1245-1300 lunch

1300-1400 home visits - one or two

1400 -1600 6 face to face apts as above

1600-1700 admin as above (I stop being paid at 1630 but I can’t leave as:

17.00- 1730 debrief with supervising GP to go through any concerns etx

What part do you suggest I stop doing in order to see more patients?

In my practice there are usually two trainees, three GPs and a ANP for routine and urgent apts per day (and a HCP doing bps and bloods and a nurses doing smears and a pharmacist doing med reviews). Practice has not been able to recruit any other ANPs or GPs despite above average salary

Baby doctors like me manage around 6 phone calls and 10 face to face. Real GPs over double that. So we are having around 140 appointments phone/f2f per day. About half are booked in advance and the rest saved for on the day. We get about 100-150 urgent appointments requests per day, for 70 apts - how can it be managed without some sort of triage, there simply are not the spaces?

@Cbtb

“ What is it GPs are actually doing that us more important than seeing patients?”

Seeing other patients?
I’m a trainee Gp
0800 get in an check urgent messages such as death notices, admissions, safeguarding and sign letters. Check some results and repeat prescriptions.

I get paid from 0830
0830-1000 6 phone calls (I get 15min/patient real GPs get 10, that time includes reading the notes (can be very long and writing up my notes and arranging prescriptions referrals etc, so don’t have very long on the call)

1000-1130 4 face to face appointments (I get just over 20min, real GPs get 10-15min and as above that includes all reading and writing of notes)

1130-1145 meeting - usually where we decide who is visiting what patients later and distribute urgent notices

11.45-1245 admin - write any hospital referrals, read letters from hospital consultants and discharge letters, review test results, review repeat prescriptions, safeguarding referrals, etc

1245-1300 lunch

1300-1400 home visits - one or two

1400 -1600 6 face to face apts as above

1600-1700 admin as above (I stop being paid at 1630 but I can’t leave as:

17.00- 1730 debrief with supervising GP to go through any concerns etx

What part do you suggest I stop doing in order to see more patients?

Lunch. You could get another phone call in.

It's bloody awful that GPs feel the need to justify what they do.
I wish you all the best for the rest of your training. It sounds really stressful.

@Narutocrazyfox

Simply say 'my condition is of a sensitive nature and I only wish to discuss it with the Dr. Please put me on the list for a call back. If you refuse to do so, please let me take your name so I can complain to the practice manager.'

Works for me! I never tell a receptionist anything other than what I want the next steps to be.

@Cbtb

“ What is it GPs are actually doing that us more important than seeing patients?”

Seeing other patients?
I’m a trainee Gp
0800 get in an check urgent messages such as death notices, admissions, safeguarding and sign letters. Check some results and repeat prescriptions.

I get paid from 0830
0830-1000 6 phone calls (I get 15min/patient real GPs get 10, that time includes reading the notes (can be very long and writing up my notes and arranging prescriptions referrals etc, so don’t have very long on the call)

1000-1130 4 face to face appointments (I get just over 20min, real GPs get 10-15min and as above that includes all reading and writing of notes)

1130-1145 meeting - usually where we decide who is visiting what patients later and distribute urgent notices

11.45-1245 admin - write any hospital referrals, read letters from hospital consultants and discharge letters, review test results, review repeat prescriptions, safeguarding referrals, etc

1245-1300 lunch

1300-1400 home visits - one or two

1400 -1600 6 face to face apts as above

1600-1700 admin as above (I stop being paid at 1630 but I can’t leave as:

17.00- 1730 debrief with supervising GP to go through any concerns etx

What part do you suggest I stop doing in order to see more patients?

Now read my post and look at the time wasted by the systems involved and the poor care quality given to my grandma in law and aunt.

@thing47

I only ever ring the GP if it is for an urgent issue that cannot be treated at home, and by that point I really don't need a box ticking exercise from a receptionist wasting my time any further.

I do get this, and I am the same. But how does the receptionist know this? How do they know you have a serious problem? I think a few polite enquiries as to the nature of your issue is fine and shouldn't result in a threat to make a complaint. It's a bit OTT.

DH has a serious, potentially life-limiting, medical condition and he just politely says, 'if you look at my file, you'll see why I need to see a doctor as a matter of urgency'.

I've sometimes found that is the only way to get an appointment. "I'm in a lot of pain" doesn't get an appointment FFS Threats to go to a&e or requesting a name means appointments suddenly open up. Weird that.

@Ducksareruiningmypatio, 'Threats to go to a&e or requesting a name means appointments suddenly open up.
Weird that.'
I had similar recently. I needed some extra blood tests as they were needed for a neurology referral. On the day of my test I arrived to be told the nurse had to leave (fair enough, life happens). I was told I wouldn't be able to get a test for another month. When I said I needed it sooner and why, magically an appointment was available in five days. Yet another example of a person with no medical qualifications and no knowledge of my condition deciding how urgent my need was.

“ Unfortunately there are a lot of people who are not as well informed as you. "I've got a sore head, after drinking five bottles of wine , but my head is so sore it must be cancer, I demand an instant referral". Or " I couldn't be arsed to reorder my Pill when I saw five pills remaining so I ran out and I must have a new one now, and if I get pregnant it's your fault". Yes I've heard it all.”

So true!

Lulu

I’m sorry your family had the run around. Other than more GPs and nurses tho I don’t know how to fix it. It’s the part where you asked what GPs are doing that is more important than seeing patients that confused me - there isnt anything more important and that’s what’s taking up all the time (although checking their results is also pretty important). The reason you can’t see a GP is because their seeing patients - just your not that patient.

think good triage actually helps but bad triage does make it worse. If when you ring there are no appointments because other patients have the appointments for the next week or 10 days or whatever time frame then an appointment can’t be offered unless someone else’s appointment is cancelled. There aren’t dr’s and nurses sitting around not seeing patients that could see you/your relatives sooner - there seeing other patients.

Good triage would mean that the few appointments there are will go to those that need them more and those that need them less won’t get them. Otherwise all the appointments go to the people who call first and they could be people who - have an uneven fingernail, find that they sneeze when it’s dusty, have wrinkles on their skin, want their passport application signed, want calpol prescribed (all actual urgent same day appointment requests I have seen - usually by people who say “it’s a private matter”) and not the people who need them.

Good triage is done by a clinican though and that’s actually how it works where i work - one GP or ANP calls back all patients who say it’s urgent and allocates appointments as needed - they make around 100 - 150 calls per day. We think we manage to see the actually urgent patients on the same day because of this but patients often don’t like it because they have to speak to two doctors rather than one and “why couldn’t dr Jones deal with this when I spoke to him” but if the triage dr starts sorting out issues they never get to the end of the list. This does require a larger surgery with several doctors though.

Ideally there would be enough appointments for everyone who called to be offered one at the time of their choosing but due to the recruitment crisis that’s not going to happen anytime soon

@Cbtb

Lulu

I’m sorry your family had the run around. Other than more GPs and nurses tho I don’t know how to fix it. It’s the part where you asked what GPs are doing that is more important than seeing patients that confused me - there isnt anything more important and that’s what’s taking up all the time (although checking their results is also pretty important). The reason you can’t see a GP is because their seeing patients - just your not that patient.

think good triage actually helps but bad triage does make it worse. If when you ring there are no appointments because other patients have the appointments for the next week or 10 days or whatever time frame then an appointment can’t be offered unless someone else’s appointment is cancelled. There aren’t dr’s and nurses sitting around not seeing patients that could see you/your relatives sooner - there seeing other patients.

Good triage would mean that the few appointments there are will go to those that need them more and those that need them less won’t get them. Otherwise all the appointments go to the people who call first and they could be people who - have an uneven fingernail, find that they sneeze when it’s dusty, have wrinkles on their skin, want their passport application signed, want calpol prescribed (all actual urgent same day appointment requests I have seen - usually by people who say “it’s a private matter”) and not the people who need them.

Good triage is done by a clinican though and that’s actually how it works where i work - one GP or ANP calls back all patients who say it’s urgent and allocates appointments as needed - they make around 100 - 150 calls per day. We think we manage to see the actually urgent patients on the same day because of this but patients often don’t like it because they have to speak to two doctors rather than one and “why couldn’t dr Jones deal with this when I spoke to him” but if the triage dr starts sorting out issues they never get to the end of the list. This does require a larger surgery with several doctors though.

Ideally there would be enough appointments for everyone who called to be offered one at the time of their choosing but due to the recruitment crisis that’s not going to happen anytime soon

But what has changed? Pre-pandemic, you rang up and made an appointment, no one triaged it. Neither DH or I have seen a GP since before the pandemic. Why can't you just ring and get an appointment like you used to?

It is frustrating - I understand how you feel. It is just how things are now. My OH was a GP at a time when they offered a proper service, and receptionists made appointments rather than being asked to act as triage operatives.

It is a sad indictment of how things are now. But it is hard to know how else it could be done.

I am lucky enough to be with a small rural dispensing practice where they offer a more human scale service still.

Re blood tests, we are supposed to book them at ten minute intervals but if someone needed one urgently, I'd squeeze them in between two other patients. There's an element of discretion and flexibility.
I do find I'm more prepared to go the extra mile for someone who is polite though. I know people get worried and stressed about their health but if they start swearing at me I simply warn them that if they continue I'll be terminating the call. And then do it if they carry on.

@freshcarnation

I'm fine with this. However my mum died on Monday. When I rang 999 and asked for an ambulance I was asked if she could make her own way to A and E (no because she is dead). When I rang to chase up an ambulance after 2 hours I was told the call was logged, but to ring back if there was a change in her condition (resurrection?? being more dead?). Think those scripts need an overhaul

Jeez - that is dreadful. So sorry to hear this happened to you.

@ freshcarnation, this is not meant to be harsh, why did yoy want an ambulance?

@user1471505356
I believe that question has been answered.