Life as a GP Practice Manager

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MikeyB
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Re: Life as a GP Practice Manager

Post by MikeyB » Sun Jan 07, 2018 12:14 pm

Yup. Happens everywhere once in a while. It isn’t perfect - I didn’t say it was- I was talking in general. Many hospitals are just about coping. In this particular case, whatever was wrong with this lady, she was fit enough to go home the next day, so it would appear the triage system is working fairly accurately. For sure, the husband knows his way around pain relievers. Backstory?

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sun Jan 07, 2018 12:40 pm

We have a new GP who has joined our practice from Scotland and an ex-GP who moved to Scotland several months ago. Neither paint a very rosy picture of NHS Scotland at primary care level.

Apparently the clinical systems are antiquated and the free prescriptions are causing further abuse in a system already abused even when the patients pay for it.

I cant comment on secondary care, but it can’t be worse than here.

I do now of course have a tame local MP! As you are probably aware our local MP is one of our ex-GPs and he is on the parliamentary select committee for health. He still does a few sessions for us to retain his licence and I saw him on Friday so I have already canvassed him regarding PCSE (Primary Care Support England) who are beyond appalling.

He is on to it. It’s not what you know but who you know as ever!

Hugs

Jane 😘

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stuart13
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Re: Life as a GP Practice Manager

Post by stuart13 » Sun Jan 07, 2018 3:09 pm

I know you, Jane. :wink: :wink:

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sat Jan 13, 2018 12:54 pm

I’m not sure how much benefit that could be to you Stuart to be honest :lol: :lol: .

I have asked for a quote for some new door signs for the consulting rooms for the new pharmacist and our new GP.

The signage man asked what we wanted on the Braille for the signs :shock: :shock: . Yes there is Braille on the signs - I think I may be being a little cruel when I question why, as blind people don’t know the Braille is there so have probably never used it. However I digress....

My next question was of course - how the hell do I know what the Braille on the signs says?

One of my proactive members of staff went on Google and found the Braille alphabet. This was then, as an initial experiment, compared to the Braille on my door sign which apparently says PRACTACE MANAG. :roll: :roll: :lol: :lol:

I’m not sure I am brave enough to now check what is on the GP’s door signs :lol: :lol: .

I’m starting to wonder if the person who organised the Braille signs had a strange sense of humour. I am obviously hoping that they are just Braille illiterate.

And more problems again this week with patients on Pregablin. One patient who has already been caught out getting 3 prescriptions in one week was put on weekly post-dated scripts to curb his abuse of the system. This prevents them getting the meds early - the pharmacist can only see the scripts on their system on the day they are due.

The patient managed to last 2 weeks before he found a gap in the system and he managed to get 2 scripts in one week.

So we have had to put more restrictions in place again :roll: :roll: .

The final restriction would have to be daily scripts which he would literally have to collect every day.

One of the problems is the sheer volume of prescriptions we process. The other problem is that we start from a position of trust which the abusers are fully aware of and have no conscience about exploiting. It’s a constant battle and sadly due to their drug-seeking behaviour they are usually a couple of steps ahead of us.

Hugs

Jane 😘

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Foxysally
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Re: Life as a GP Practice Manager

Post by Foxysally » Fri Jan 19, 2018 12:45 am

I once decided to teach myself Braille (mad moment, no good reason). The only things I could find with Braille on were in the medicine cabinet. After half an hour of research and painstaking deciphering, I found out that the paracetamol box, which was absolutely covered in Braille, said.....Paracetamol. :roll:
I then discovered that Teach Yourself Braille books on Amazon were non-existent and extremely expensive. I gave up after that and borrowed a learn French CD from the library instead.

I'd check the Braille on the new signs if I were you. Who knows what debauchery they might be enticing blind people into otherwise?

The pregabalin issue makes it so difficult for everyone else. My repeat scripts are always very smooth running, but the gabapentin seems to get taken off at random intervals for no apparent reason. I have to then phone the surgery who have to get a doctor to reinstate it or, more usually, print off a script for the one month. I'm guessing it's why, when I was getting side effects on gabapentin and queried trying pregabalin with the GP, he wouldn't even really discuss it. I feel I need to come with some kind of disclaimer "I hereby guarantee I only need drugs because I'm in pain". I always assumed it's easy for them to tell who is genuine, but maybe not?
Sarah

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stuart13
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Re: Life as a GP Practice Manager

Post by stuart13 » Fri Jan 19, 2018 10:38 am

The only way any of your prescribed medications should fall off repeat is if your GP is only prescribing it for a limited period or you don't attend a medicines review.

I would take it up with the surgery manager.

Stu :)

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paul.m
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Re: Life as a GP Practice Manager

Post by paul.m » Fri Jan 19, 2018 5:04 pm

Never been to a medicines review thought that was just a reminder for Dr to see if you still need everything .
Paul

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stuart13
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Re: Life as a GP Practice Manager

Post by stuart13 » Fri Jan 19, 2018 9:11 pm

It's not mandatory but it is recommended that all patients on long-term pain medication should have a regular medication review by their GP.

I have an annual one that is instigated by the pharmacy.

This is probably something that Jane will comment on.

Stu :)

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sat Jan 20, 2018 11:36 am

Everyone who is on (I think) 4 meds or more is supposed to have a meds review annually. This is best practice as Stuart says.

However, the sheer volume of patients on polypharmacy (nice word!) is such that is is difficult for GPs to keep up to date with. You may have had a meds review Paul without knowing it - it doesn’t always involve the patient’s input. If the GP thinks the drugs are working and the patient’s condition hasn’t altered then they may well leave your prescriptions as is.

Pharmacies are usually good at med reviews as well as Stuart has commented. It’s one of the reasons we have employed a Practice pharmacist, so we get better at meds reviews in-house. Some patients are on such a complex combination of medication that it is real hard work for the GPs to review them. You really do need a pharmacist.

You are correct Stuart in saying you should always get repeat scripts once they are on repeat and repeat scrips can also be time limited by the GP. I wonder if this is the case with you Sarah? Due to the current discussions on Pregabalin being reclassified as a controlled drug, your GP may be adding an end date to the repeat for reasons of safety. Our GPs sometimes use this as a tool to force patients to attend an appointment if they feel they haven’t seen them in a while and they are on a complex combination of strong meds.

It’s certainly worth asking your poor beleaguered Practice Manager :P :P :P .

Out of interest there is a form of prescribing called Repeat Dispensing. This means that you don't even need to contact your pharmacy on a regular basis for your repeat meds, they are automatically sent to the pharmacy from your GP practice for the timeline that the GP considers is safe.

It involves your GP agreeing that you are eligible for Repeat Dispensing and they can set that up on their clinical system. The pharmacy then receives the scripts electronically for up to a year (dependant on what length of time the GP has allocated).

This is a win-win situation. The patient doesn’t need to remember to order their repeats, the GP has only one script to sign for the whole Repeat Dispensing timeline, the pharmacies are guaranteed the income for prescribing for the Repeat Dispensing timeline.

Many practices are wary of this but for patients who have stable long term conditions it is a no-brainer. It may be worth asking at your practice if this is something they do - I would ask the GP rather than the reception staff.

Hugs

Jane 😘

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sun Jan 21, 2018 11:00 am

I just got called out by the alarm company because the alarm at work had gone off :roll: :roll: .

I am the primary key holder for the main reason that I live the nearest to the practice (2 miles away) so it is sensible for me to pop out if the alarm goes off.

Well it’s not easiest for me obviously! :roll: :roll:

However on pulling up outside the practice there it was, open for business because we rent out the premises for the Federation to use at the weekend for the 7 day access service, which was what I had suspected but had to check just in case...

I was quite relieved because if they hadn’t been there I would have had to enter the building and search the premises for burglars :shock: :shock: and I had forgotten my baseball bat :lol: :lol: .

No seriously, had it been broken into I would have phoned the Police - nobody would expect me to enter the building and take on a group of ne’er-do-wells! Although to be fair I take on my fair share of ne’er-do-wells during the week aka patients :lol: :lol: .

I just hope they never ring me in the middle of the night - they’ll never wake me up - I sleep like the dead :lol: :lol: .

Hugs

Jane 😘

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stuart13
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Re: Life as a GP Practice Manager

Post by stuart13 » Sun Jan 21, 2018 12:22 pm

The threat of you with a baseball bat in your hand would scare off the most hardened criminal.

:wink: :)

I hope you had words with whoever set the alarm off.

:)

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sat Jan 27, 2018 1:33 pm

stuart13 wrote:
Sun Jan 21, 2018 12:22 pm
The threat of you with a baseball bat in your hand would scare off the most hardened criminal.

:wink: :)

I hope you had words with whoever set the alarm off.

:)
It’s a given Stuart! To be fair, I probably didn’t need the baseball bat. I had been sitting reading the paper on Sunday morning when I got the phone call. My hair was post-bed state, no make up. That’s how I went to the ‘scene of the crime’. I think that would be scarier than any baseball bat :lol: :lol:

So more fun with NHS England this week:

Some time ago there was a ‘scandal’ in the papers re patient information getting ‘lost’ between hospitals and GP practices. Jeremy Hunt (Health Secretary) was vilified as he was a board member of the private company that the NHS had paid to transport the information.

To cut a long story short, the NHS then set up an investigation unit to try to ensure that the lost information had not caused patient harm.

As a result I relatively reguarly get correspondence from the investigation unit (SBS) providing me with copies of the (now found) lost information and to report on whether there has been any patient harm as a result of the loss.

I sent a report back to them in December for 3 patients at my practice where the information they sent had not been received at the time.

Yesterday I received an email saying:

Make an appointment with the patient and a GP to explain the situation.
Get a signed consent from the patient that their records can be shared with SBS
Process the patient records from 1 year prior to the incident (on paper)
Let SBS know that you have processed the information and they will collect it on security transport.

Well I nearly blew an internal fuse! :lol: :lol:

For one patient the ‘lost’correspondence was a urine test dated 2001 marked as ‘normal’ :shock: :shock: .

So NHS England aka SBS want me to arrange a GP appointment to get permission from the patient to send 18 years worth of their medical records to check that they haven’t suffered harm from a normal urine test 17 years ago :roll: :roll: :roll: :roll: .

And the estimated cost for the country for this around 6.5 million pounds :twisted: :twisted: :twisted: .

You couldn’t make it up!

I refused by the way and sent an email back saying that they need to have someone clinical to assess the potential level of harm and target the patients who MAY have suffered harm, not every bloody piece of paper that has ever gone missing :twisted: :twisted: .

No wonder I’m grey haired :lol: :lol:

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sun Jan 28, 2018 1:00 pm

On Friday I had a visit from the police at work -no not me this time!

They asked for one of the doctors. I asked what it was in regard to and it was a phone call made by the GP regarding a patient who was suicidal and left the consultation before the GP could get him appropriate treatment.

The policeman asked if I thought they were going to arrest the doctor given my initial reluctance to let them see him.

I replied “Have you met our GPs?” :lol: :lol: .

Anyway it transpires that the patient has mental health problems but has also been radicalised whilst in prison. :shock: :shock: .

The police also asked for a description of the clothes the patient was wearing (although why I have no idea given that apparently he has long ginger hair and a long ginger beard which I would have thought would be more of an identifier than any clothing, but hey! I’m not a policeman :shock: ).

One of our reception staff gave a very good description so I spent the rest of the day calling her a “copper’s nark”!

They also saw the full name of one of our nurses on her door. “Is her husband in the police?’ “Oh yes” I replied , and then to my eternal embarrassment added. “He’s called Bob, I have no idea what his surname is”. :oops: :oops:

In my defence, it had been a particularly difficult day :oops: :oops: .

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stuart13
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Re: Life as a GP Practice Manager

Post by stuart13 » Sun Jan 28, 2018 3:27 pm

Jane's thread is better than tuning in to 'Doctors' on TV, she could become the James Herriot of the NHS and write a series of books.

Everyday life in a GP's practice.

:)

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sun Feb 04, 2018 11:59 am

Oh I intend to Stuart! To be honest you couldn’t make most of it up! :lol: :lol:

So now I hear that Primary Care Support England (PCSE) aka Capita have issued a profit warning. This is an out-sourcing company who deal with Navy pensions, various other government contracts and most importantly for me, registrations of patients, registrations for GPs, GP pensions and basically any legal administration that NHS England primary care require.

This the company that is so unbelievably inefficient that last week I discovered the reason I have battled with them for 3 months to get a GP’s registration changed from salaried to partner is because they have been sending the information for the final checks to an incorrect email address :evil: :evil: .

They also sent patient-identifiable information on two child protection cases to a supermarket which had the same postcode as the GP practice for whom it was intended. I must admit I had to laugh at that one :lol: :lol: .

It reminds me of the situation with ATOS who were doing the health checks for the DWP and all the trouble that caused.

I spoke to our ex-GP/MP last week and he is also very concerned. Typically for the government they give these contracts to the lowest bidder. Sadly cheapest isn’t always best.

The ideal of giving contracts for government administration to private companies is, in my opinion, a bit like Communism: a marvellous idea that simply does not work at all!

I stick with my mantra “strategic decisions that don’t work at operational level” - it should be carved on my gravestone!

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