Nye Had A Dream...

We had to send one of our receptionists home last Thursday. She had felt dreadful all day and quite frankly, she looked it too. Suffice to say, nobody was too surprised when her other half rang at around 6pm that evening to say she wouldn't be coming to work on Friday.

A quick perusal of the reception rota revealed the poorly one had been due to work what we call the 'Late, Late' shift - in other words, she was due to cover our extended access session and work until 8pm.

It was also half term, which meant two of the girls were on holiday. In short, at 6pm on Thursday we had nobody to cover the following days late shift.

Except, within seconds, phone calls and texts were made and the remaining staff had all offered to either stay on for a while after their shift ended,  pull a double shift, or do the morning, go home for a couple of hours, then come back to work until 8pm.

They did this themselves, without being asked. They understood what needed to be done and they just got on and did it.

Absolutely bloody marvellous!

I am sure I am not alone amongst practice managers in saying this stuff happens ALL THE TIME!

I'm convinced that the phrase 'The show must go on' didn't actually originate in the showbiz world, but in the slightly less glitzy domain of general practice where it refers to the reception desk. No matter what happens, that desk must be manned - and it always is.

Sometimes I wish the GPs would take a leaf out of receptions book. How many of us have had that sinking feeling when you realise the doctor who has just rung in sick was due to be the duty doctor that evening. Trying to get someone else to cover can be akin to getting blood from a stone!

But reception? A different kettle of fish. A really difficult job, lots of pressure, very little thanks and yet incredible levels of commitment.

A patient, aged 84, rang me today.

'I wish to make a complaint' he said. I was sorry to hear that, and said as much. 

'I think you should have air conditioning in your building' he continued.

So do I my friend, I thought. Fact is, we wanted it, but the CCG wouldn't cough up when they funded our 'house-that-jack-built' extension. Of course, I didn't say that. I didn't get chance...

'I'll tell you why' said the incensed octogenarian. 'Every time I sit in your waiting room, I end up with the flu!'

Oh dear..where to start? 

The building was woefully underfunded by the CCG?

If people presenting with colds managed their own conditions and stayed at home, they wouldn't spread it to at-risk patients like you?

Did you have your flu jab this year? (Lets gloss over the fact it was probably ineffectual anyway)

I quickly ran through all the options in my head and went with the 'lack of funding' option.

There was a pause.

'I am really quite rich. I may look into paying for you to get some air conditioning' he said. 'I will be in touch'.

The line went dead.

This is, without a doubt, the most unpredictable job in the world!

I’ve been a practice manager for more than 25 years and have seen a fair few changes during my time – some good and some not quite so good. But no matter what was called for and regardless of how intimidating the challenge, I’ve always been secure in the knowledge that the practice team could and would rise to it.

Now, yet more changes are afoot – and one’s definitely a change for the worse. Staff morale in the NHS has reached an all-time low. Worryingly, when I say ‘staff’, I don’t just mean reception and nurses; salaried GPs and partners are suffering too.

There was a time, not so very long ago, when a few sticky out lips in reception (or during a partners’ meeting for that matter) could easily be remedied by a swiftly arranged night out. The days of such easy solutions are long gone. Staff are often too exhausted to see each other outside of work hours and in my practice, partners’ meetings are so scarce during certain parts of the year that we’d never have time to arrange one anyway!

A recent report by The Kings Fund showed that NHS managers had identified staff morale as one of their top three causes for concern. Similarly, in September 2014, a British Medical Journal poll revealed that 40% of GPs were suffering from low morale.

General practice is massively over used yet hugely underfunded, and the oft-quoted statistic that general practice deals with 90% of NHS contacts for just 8.5 per cent of the total NHS budget keeps rearing its head in the medical press. Whilst I have no idea if it’s true, it certainly feels about right on any given Monday morning. Add almost constant negative media coverage to the mix and is it any wonder that one in 10 GPs suffers from burn out?

The pace and sheer extent of change within general practice over the last few years has been dizzying whilst patient demand grows (seemingly by the day). Simply put, there are not enough GP appointments to satisfy the demand – and the receptionists often bear the brunt of patient frustration.

Faced with a disheartened workforce and a lack of engagement from GPs, what can practice managers do? The first step is to ensure the staff and partners feel valued. We’re all quick to criticise things but can be a tad slower off the mark to give credit where it’s due. We should praise our staff to whoever will listen, and use social media to tell patients about all the good stuff we’re doing. Most importantly, we should tell the people we work with that we know how difficult things are at the moment. We know how hard they’re working and we know what a brilliant and important job they’re doing.

What is your take on the 'reviews' patients leave on the NHS Choices website?

Let me tell you why I ask. One morning last November I fired up my PC and opened an email from a patient who was having problems using our online repeat prescription service. He had emailed me the night before and was clearly frustrated by his inability to order his prescription. I emailed him back immediately and, without going into details, and even if I do say so myself, the practice went the extra mile in order to get this particular patient his medication. When the job was done, I emailed again to update him, and took the opportunity to explain about EPS, suggesting it may be helpful to him in future as his job takes him away from home for large swathes of time. I gave him my direct dial phone number and asked him to ring if he wanted me to explain how it worked. A job well done I thought as I moved on to the other 54 jobs I had on my 'must do today' list.

Fast forward to last week when I received a notification from NHS Choices that a patient has posted a review about the practice.

As always, my heart was in my mouth as I clicked onto the website. Imagine my relief when the first thing I noticed was the name of the aforementioned patient.

The eternal optimist in me thought 'Hurrah!' Surely this would be one of those all too rare 'I would like to thank all the staff for their efforts' posts?' (Lets face it,  most of the 'The service you get from this practice is a joke' posts are anonymous!) However, that eternal optimist, whom I have now christened 'Idiot', was to be disappointed. The patient concerned had RANTED about how useless we all were. Nobody escaped his wrath. And yes, he was describing the exact same incident of more than three months ago.

Now I know all about there being three versions of every story - my version, your version and the truth - but this was ridiculous. More importantly, it was inaccurate - and not in a small detail here or there, kind of way. No. More in a big fat lie, kind of way.

One of the points made was that the practice manager (that would be me!) never took phone calls, answered emails or 'gave a damn' about the patients.

That really ground my gears! Especially as I had saved my emails to him and his responses!!!  I wondered if perhaps he had experienced further difficulties with his prescriptions, but no - he had nominated a pharmacy near his place of work so that particular predicament was solved.

As far as I could see, he had not been into the surgery, had not been written to or telephoned by any member of the practice. I have no idea what had triggered this public outburst.

So what do I do? (I assume that punching his lights out is not an option..??)

NHS Choice reviews could be a useful tool for practice managers - but many of the negative ones are so non-specific that it is hard to glean anything useful from them. All feedback should be encouraged - the recent whistleblowing debate shows that a culture of transparency should prevail in the NHS - but should we really allow patients to post publicly such blatant untruths?

Dear Mr Burnham,

About this 'guaranteed appointment with a GP within 48 hours' thing. We have tried this before and, despite there being quite a few more GPs around in those days, it didn't quite work. I was wondering if perhaps we could have some sort of 'unless' clause attached to this particular pledge?

For instance..you can see a GP within 48 hours unless using that appointment means you are rather cleverly bypassing the non-NHS admin backlog, in order to get your letter that allows you to go to the gym free, a teensy bit faster.

The acknowledgment that more doctors are needed is great. The worry is where they will come from and how long it will take before they are up and running. Using the word 'GP' in the 48 hour guarantee is giving patients the chance to use the deadly 'I know my rights and you have to see me' card, which won't do much to alleviate stress in the workplace for the poor receptionists on the receiving end!

The relentless workload in general practice has already forced many surgeries to embrace new ways of working. Triage, Nurse Practitioners, email, phone and skype are all being utilised in the battle to keep up with demand. You politician types should not only recognise this, but take it into consideration before promising the impossible because you think it will win votes.

What about 'You can have an appointment with a GP within 48 hours... unless seeing an alternative health care professional..like a nurse or HCA..is more appropriate/beneficial/time efficient for all concerned?'

It would win my vote!

Lastly, I see you also want us to make sure patients can book an appointment in advance with the GP of their choice? Surely those GPs of choice will be the same poor souls struggling to see everyone within 48 hours?