Any GP receptionists about?

[MissPeachyKeen]

Not a bashing post. Just have a question about the triaging you all have to do.

Does it actually achieve that much?

I get that it might weed out a few time wasters or maybe even flag up where a 999 call is needed, but for the rest, given the sheer number of patients, what's the point??

The amount of detail I'm asked these days amounts to a detailed doctors appointment in itself (and I'm just not going to tell all that to someone other than my doctor, sorry) & that's what the appointment is actually for.

Shes fine now, was in hospital for about 2 weeks where it was a bit hairy a couple of times but she recovered well from that, thanks for asking!

I’m happy to give the receptionist the details they need so they can make me an appointment with the right professional.

We’re very lucky in that we have access to full time nurses, nurse practitioners, HCAs with specific training (for example diabetic foot checks), physiotherapists, a full time pharmacy team as well as a plethora of GPs, all with their own specialisms.

It’s daft making an appointment with a GP if I have an issue with, for example, my diabetes; the specialist nurse (actually a nurse practitioner in this case) has far more up to date training than a GP who may have last studied diabetes back in training umpteen years ago*

*ok, that’s based on a GP mate, as I don’t routinely go around asking for comprehensive training records of folk lol.

Likewise, we have a great female GP with a specialist interest in women’s health, so she is the best surgery resource for contraceptive/menopause health concerns. In fact, there’s a blooming great poster in the waiting room advertising who to see for what kind of query.

Medication reviews? That’s either the pharmacists on the phone or in person. Sports injury? You’ll get an appointment with the physio team. Diabetes foot check? The HCA, who immediately made an appointment with the recommended GP when I have even more peripheral numbness than is usual (for me anyway, spine is an clusterfuck so unpicking diabetes side effects and more benign tumours is like a really crap guessing game without imaging lol). And so on.

We are exceptionally lucky to have such a good, large team available (a quirk of selling 4 large, expensive, converted houses scattered across the town and buying the old sexual health clinic, in itself an old converted school). And this model does mean that there aren’t the long waits to see a GP as you’ve been triaged to see the best practitioner for whatever you need help with.

It’s bloody brilliant.

We have different members of staff for different issues. You may need a check up for a long term issue and I can make an appointment for you at that clinic. You may be needing meds so I can do a prescription repeat for you. You may have an issue that a nurse practitioner can deal with so I can offer you same day clinic with the nurse practitioner. We only have so many same day appointments so we triage to fill those with people who need to be seen same day. Within those appointments some are dr and some are nurse practitioner. We triage to give you the most appropriate care.

It's easy to say "I'd rather not say" or "it's personal".
If you are happy discussing menopause or your plumbing with either male or female, no problem, but if your prejudices are for female GPS for female issues then that's one reason.
What the patient says to the receptionist and what they say to the GP varies.
Reception staff get a lot of grief from GPs "why did you book Mrs bloggs in with me, her eye problems/dental problems should be directed elsewhere ". But if there is a note on her spot saying it was sore head or UTI, then it's clear the patient lied to the receptionist.
If the receptionist puts in "cough, runny nose for 2/52 two werks hours+ Tried OTC meds" then the doctor will deal slightly differently that "dead sore head not tried it, one day - feels it is emergency"

We have to use Patchs now and and it's a nightmare. I've been waiting over a week for a medication review and can't get my repeat meds without. People who are unable to use Patchs have been phoning for appointments and having the phone put down on them.

We are called care pathway providers now in my surgery.

Bad backs should NEVER be sent straight to a physio. One of the most basic principles of medicine is diagnosis first, treatment second. A doctor needs to see the patient first and order scans as required before a physio starts prodfing you about.

My surgery offers self-referral direct to physios - no GP appointment needed. I imagine physios are well-trained enough to know what conditions they can treat without a GP referral and when to advise a patient they need to see a GP.

I’m quite happy giving as much info as they need and my surgery is brilliant anyway . However the system does worry me ; my BiL died last month of cancer , he had been triaged for the last 6 months, before diagnosis in October, for bad back ( referred to physio) persistent cold ( try pharmacy OTC meds ) reflux ( same as cold) , upset stomach ( normal and drink plenty of fluids) . Perhaps if a Dr had seen him ( he looked ill ) and put all the symptoms together he might have been diagnosed earlier , who knows , but he was stage 4 before a locum at the walk in put two and two together . He might still have died but it might have been less traumatic and maybe he would have seen his daughter get married next month .

Our surgery has recently moved to an online e-consult system. It does take some time to answer all the questions about what my problem is, but I can fill it in and send it off anytime at all: in the evenings/weekends included.

So far, working well for me. They promise to get back to you within 2 working days. A GP looks at all the forms and prioritises them and decides who is best placed to deal with the problem. Get a phone call back or an email to say a prescription has been left or whatever. If it's urgent and they want to see you, they will. You can also still phone up if your problem is very urgent and they will fit you in, if it really is urgent.

Soooo much better than the 8am scramble to get through on the phone

It does feel intrusive, but I can see why they need to do it.

Errrr….you do realise physios make diagnoses themselves! We are well aware of when a triaged patient needs to be referred elsewhere. It’s not the 70s anymore and many practises employ extended scope physios

I bloody love physios, they're nothing short of miracle workers.

Something like 98% of back issues are caused by musculoskeletal problems so a physio is the perfect person to deal with it. Physios can diagnose - they're HCPs not massage therapists!

And scans/imaging are rarely indicated for uncomplicated back pain; if everyone with back pain was referred for a scan no-one else would be seen.

The Receptionists will have training and often are given crib sheets and flow charts to work from - if in doubt they can check with a clinician.

I can't speak for all surgeries obviously but ours receive extensive training as part of their induction, and it's ongoing.

People really need to get out of this mindset that everything needs a doctor. There are plenty of other healthcare professionals involved in primary care now and receptionists are best placed to direct to the most appropriate.

Have a look at this and you'll see why primary care is in crisis:

*Over 1000 practices gone
*1,900 fewer full-time qualified GPs
*Over 6,000,000 more patients on the books
*Equivalent of 1:2 population seen EACH month
*400 million consults per annum
*5-6% of overall NHS funding spent on practice contracts
*5% of all NHS staff

I think some element of triaging is necessary because most surgeries are operating with a much lower level of resource relative to demand. Would you be ok with giving the info to a doctor instead? Our surgery will shortly be moving to a new system whereby all queries are submitted via an online form and they are then triaged by two or more duty GPs who'll decide how they should be actioned - e.g. urgent face to face appointment, telephone call in a week etc. The only downside I can see is that the form shuts off after a certain capacity is reached, so we'll have to see what that capacity is.

the other downside is of course for people like my PIL who don’t have the internet. They do have mobile phones but not smart phones and have no email .

honestly I wish we could just go back to the old system where you could book a couple of days in advance . You would ring up , if it was urgent they would try and fit you in that day , if not you could book for the next day or the day after that or whenever they had a slot. It was all calm and civilised and there was none of this angst and stress .

There are so many patients with so few doctors that the next available slot on a first come, first served system may be 10 weeks away.

My last "non urgent, but something still needs to be done or it will become urgent eventually call" was 7weeks until I saw the doctor.

Sorry, I should have said that that's the default way of getting in touch. They're still accepting queries over the phone or in person, so hopefully those that can use the online form do, to free up the other capacity for your PIL and others who need it.

@BeyondMyWits 7 weeks! We're quite fortunate at my surgery in that there's generally a 2 week wait (3 around key holidays).

There have been some really interesting responses, I do think there needs to better comms to the public at how receptionists are trained to triage. Adding that they have been to the website or automated answering system doesn't cut it really...Short video with the partnered doctors on a website would be helpful I think.

Experience tells me (both mine and others) that physios as diagnosticians leave much to be desired.

Experience tells me that many people with musculoskeletal problems are mismanaged in primary care through lack of access and early referral to therapy staff ……having the option to self refer to physio is one of the biggest improvements in recent years ( although lack of resources often negates this benefit) . That doesn’t mean to say that I don’t think there is a problem with lack of access to medics that desperately needs to be addressed ..I specialised in palliative care and sadly all too regularly you saw the results of cancer not being picked up early enough. The GP crisis and the UK’s abysmal access to diagnostics has had a terrible impact on cancer care.