Message from the practice manager

This was written by a Practice manager somewhere in England and I found it on a Practice manager forum, whilst we haven’t experienced all of these things in lovely Crosspool we have to say that most of it resonates with us and we thought you might like to read it to try to understand what life has been like and what is currently happening in General practice up and down the land.

I love my job, I’m good at it, I get well paid for it, and I know I help a lot of people doing it.
This isn’t a “patients are awful” post, because I know it’s tough out there – I’m a patient too.
This isn’t a post to say the government / NHS England / Public Health / the system are awful – we are where we are.
What I came here to explain is how it is in GP land, what we are facing, and what you can do to help us.

So you may have noticed that earlier this year, the world got hit with a virus. It rocked everything we knew to be our foundations: our work, our school, our family, our friends. It made a lot of people scared, a lot of people sick, and heartbreakingly, a lot of people die. But we adjusted as individuals to the unusual way of life, we clapped for our heroes, our keyworkers including our GPs and their staff, and we felt strangely proud of ourselves for coping.

In GP, practice managers juggled clinical rotas to accommodate reduced staffing, total triage, and new infection prevention measures. We risk assessed everything from staffing levels, infection transmission, remote working, shielding staff, shielding patients, cleaning, “hot” patients and morale. We spent time learning Microsoft Teams, how long the virus lasts on different surfaces, the different grades of masks, and how to get hold of sanitiser. We spent time reading endless missives from Public Health, NHS England, and the CCG, and working out which one we’d already read because it had been forwarded to us from three different bodies. We dutifully attended the Thursday evening NHSE webinars where we were told what we’d already read, where we asked questions that weren’t answered, and our frustrations grew.

We worked hours and hours overtime. We propped up staff who were anxious, staff who were pressured due to colleagues working from home or unable to work from home. We came home exhausted each night. But we enjoyed the clapping. The feeling that you were actually making a difference. Being treated like a hero when you wore your NHS lanyard whilst going shopping.

We endured the farce that was the list of shielding patients. The tug of war between secondary and primary care about who was and who wasn’t. The ensuing requests for letters for employers and fit notes, and the weekly mandate to update the register based on the latest extract (usually with two days’ notice).

Roll forward to August. Now we were risk assessing staff who had holiday booked – would they need to quarantine on return? Could they then work from home? Can the remaining staff cope? The heartache of staff who were no longer able to attend their holiday, the confusion over whether healthcare workers were exempt, or could get tested on return, and the last-minute rota changes when a new quarantine rule was brought in.

Next came the usual escalating frenetic activity of the impending flu clinics – which now have to have additional PPE, and social distancing. “Barcodes” and “Drive-through” became buzz words. We were told (for many after the invites had already gone out) that we had to ask, in writing, the ethnicity of patients coming to flu clinics, and that CQC may or may not need a change in the registration of a practice if they were holding a flu clinic off-site.

And then our first non-working bank holiday since new year… and breathe!

Back with a bang into September, to the news for many practices that their delivery of flu vaccine, which was due this afternoon, wouldn’t actually come until next week due to a problem with the staffing of the refrigerated vans. This precipitated frantic phonecalls to local practices asking if they had any to borrow, followed by hundreds of calls to patients who were already booked in to reschedule.

Now, alongside the normal juggling of the workload, which is always immense in September due to flu clinics, something seems to have happened to the mood of the general public. The NHS are no longer heroes. Receptionists are there to be abused – “what do you mean I can’t have a face-to-face appointment with my GP? NHS England and the Daily Mail say I have a right to it”. Secretaries are there to be harangued about long waits for hospital appointments – “I’ve been given an appointment for a year’s time! I need it expedited!”, and clinicians are denigrated – “she wouldn’t give me my flu vaccine while I was there for a blood test”, or “he kept me waiting 15 minutes whilst I had to wear that stupid mask”.

But the most soul-destroying and time-consuming aspect of practice management at the moment? Without a doubt, complaints. Last year, we had a grand total of 12 complaints, this month, I’m already on about 12. And it’s not just my practice. Some are endemic of how pressured the clinicians are feeling, and focus on attitude (“he wasn’t sympathetic”). Many are due to the pressure on the system – complaints about delays on phone lines due to increased demand/channel shift, complaints about not being seen face-to-face, or complaints about delays in procedures like minor ops or steroid injections. Many are out of our hands, like the complaints about not yet having been given a flu vaccine appointment.

My impression is that much of it is because people are just fed up with the “new normal”. We are too! We hate having to wear all that PPE – it’s hot, restrictive, and hinders human connection. We hate all that extra cleaning. It takes up valuable time and makes our hands sore. We hate not being able to give patients what they want (and sometimes what they need) because there isn’t enough time/people/money/stuff.

I know it’s frustrating that you can’t get an appointment for your blood test. But did you know that bloods are taking sometimes twice as long at the moment due to the additional PPE and cleaning between patients? We only get a certain amount of funding for blood tests, and per blood they are costing us more to provide at the moment. The budget won’t stretch to more capacity.

I know it’s hard to get through on the phone at the moment, that’s because every other call is about the flu vaccine.

I know it might feel like you’re being fobbed off when you’re booked onto a telephone consultation rather than face-to-face. This is to keep you, other patients and our staff safe. You can be confident that if you need a face-to-face consultation after that telephone consultation, you will get it.

I know it’s annoying that you can’t book a routine appointment in four weeks’ time – it’s because the future is uncertain. We don’t know yet whether that GP will be in quarantine or whether we will all be in lockdown; so we are restricting future bookings.

I know it’s hard to get an appointment – having to pre-triage patients prior to face-to-face is taking up around 20% more time; PPE and infection control measures are taking up countless hours; some of our clinical staff can’t see patients face-to-face. For example, if they are in a high-risk category for COVID or they are isolating. This means that when they triage you into another clinician’s face-to-face appointment, it will take longer to see you as they need to get the information all over again. All these chip away at our capacity, and that’s been going on for four months now.

I know the clinician may be a little less “fluffy” in their consultation – telephone consultations are pretty relentless; wearing a mask for hours on end is uncomfortable; lack of socialising with work colleagues is isolating; the absence of light at the end of the tunnel is soul-destroying.

Do you know what though? I get it. I’m a patient too. We have more than our fair share of lovely patients, but there is always an unreasonable one every day or so, and that overshadows them all.

So what can you do as a patient to get what you need, whilst supporting your practice? Here are some tips:

• If you’ve got online access, check the practice website – if you have a question, it may already be answered here. Your practice may also have a Facebook page with useful information on.

• If you have a medical question, can you get the answer elsewhere? 111 has some really good information online or your pharmacist may be able to help.

• If you need medical help, most practices have an online consultation service – this often has self-help advice but will also allow you to submit a request to your practice. These are particularly good for avoiding the queue on the phones or to submit requests when the practice is closed.

• Follow the rules. If the practice asks you to wear a mask, it’s for the safety of other patients and the staff. If they ask you not to come to the practice for enquiries, but rather telephone them, it’s to reduce footfall. Don’t stand in reception arguing the point.

• Don’t abuse the receptionist. I’d say they have the hardest job in the practice at the moment because they are the first port of call. The phone calls are continuous, and it’s not their fault when the system is overstretched. They’re only following the rules they’ve been given when they have to say no, so swallow that sharp word and empathise with them.

• If something has gone wrong, feed it back but choose your words. If it’s a frustration, make it clear it’s not a complaint but rather feedback. If it’s a genuine complaint, set out very clearly the sequence of events, and what you feel has gone wrong. Make it easy for the practice to respond. We want to know when things need to be improved but it’s really frustrating to get vexatious complaints or complaints about things which are outside of our control. And please don’t threaten us with CQC or the media. There is a process to go through, and absolutely if you’ve been through that process and don’t feel that we have answered adequately, use those avenues to highlight the problem but threats aren’t constructive or necessary. On the flip side, send in the good stuff!

On the subject of feedback, who doesn’t love a compliment! Review the practice at www.nhs.uk, Google, the practice website, the Facebook page and tell the world what they’re doing well. It goes so far when we have a bit of positivity back.

I hope this has opened your eyes to some of the challenges we are facing, and thank you for taking the time to read how you can help.

Please share, because I bet your practice manager feels the same…

Read more at The Practice Manager – an irreverent view behind the scenes in a GP surgery. Staffing, patients, red tape, CCG, NHS England, Public Health and lots of fun!

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