Life as a GP practice manager

[Janey Dal]

I have to say that, for me personally, the announcement that there was going to be shortage of vaccines in April was greeted with pure joy!

I may get the opportunity to actually do my 'normal' job! We are not sure at the moment what impact this will have on us but my hope is that it will give the GP practices some breathing space to regroup and start to be proactive rather than reactive.

We are really concerned about patients with long term conditions (asthma, diabetes, COPD etc) who have had telephone-only reviews over the last year but no face to face appointments. We are all horribly aware that many patients will have avoided contacting their practice with minor symptoms and when they do contact us the minor issue will have become major. This will be one of the worst unseen outcomes of the pandemic without doubt.

I have tried to advise patients via social media to continue to contact us and 'not allow something minor to become something major' but sadly the older generation will be the victims of this. They are the ones who don't want to bother us because they know we are busy. We have never been too busy to see genuinely poorly patients.

The lifting of the lockdown will force us into some major decisions on how to start to open up gradually. More interesting times ahead. But, Oh my goodness! I cannot wait to start to get some normality back. I know everybody feels the same.

[paul...m]

What's Normal I have forgotten

[Janey Dal]

Indeed Paul!

So instead of the reported shortage of vaccines we are getting delivered of millions of the beggars! Well a slight exaggeration. However this is actually good news for me because I can plan vaccine clinics until the end of April instead of doing them a week at a time. I may even get a week's annual leave in April because of this. I don't normally take annual leave in April but I very well might this year.

Meanwhile we are getting patients ringing to ask us for their second jab because they had their first jab at a mass vaccination clinic 30 miles away because they didn't want to wait for their GP practice to administer it. Now they don't want to travel the 30 miles for their second and want us to do it . Well sadly no! It is not our responsibility. Some patients do take a lend at times.

I had another patient telling us via a written complaint that we have a 'lack of care' at the practice because he is a long distance lorry driver and he can only have his jab on Fridays and we don't do clinics on Fridays. I advised him he could go to another provider (there are several in the area), he doesn't HAVE to come to his GP practice and that we are doing the vaccine clinics AS WELL as our normal day job so can only do them when we have enough staff to cover them .

And then we get other patients who buy gifts when they come to the vaccine clinics just to thank us for our hard work. After the first clinic we ran in December we had so many boxes of biscuits and chocolates you wouldn't believe it. One patient insisted on giving the vaccinator £20 despite her protests. She handed it in and I bought cake for the staff with it.

And one that tickled me: I received an email from a member of staff advising that she had attached her parsnip to the email . Apparently she meant payslip.

[Janey Dal]

So COVID enforced changes that I predict will remain at your GP practice when we get back to 'normality':

The ability for GPs to ask for a picture of minor rashes and skin lesions via patients' mobile phones. This saves massive amounts of time for both GPs and patients.
Patients using something called eConsultation where they complete a questionnaire online and the GP makes a decision on what their care needs are without speaking to the patient first. This allows prescriptions to be issued, appointments to be booked if the GP needs ore information, sick notes to be issued without the patient seeing the GP first and using up an appointment.
More telephone consultations for minor or ongoing issues.
Annual checks for patients who have a stable long term condition being done over the phone.

I suspect there may be many people who will find this worrying. Please don't! There is without doubt the need for doctors to see patients face to face and that will NEVER change. But the changes above will make practices more efficient and therefore allow patients who need to be seen better access to face to face appointments .

I don't know if the changes will be better or just make life faster. But they are with us to stay and have been forced on us by the pandemic.

I genuinely however have no doubt that they will improve access to your GP. The NHS is notoriously slow to make changes, the pandemic has forced them to act quicker and I think this will be of benefit to everybody.

[paul...m]

What's happened to ear syringing mum has always needed them doing every couple of years . Now cannot be done at surgery as no one is qualified so has to be done at Specsavers since when are they more qualified than nurses . Nearest on about 10 miles away and charge £50

[maz]

The only thing I want to know is where did confidentiality go?

[maz]

Oh, and why would the old system not work post pandemic? I so don't want to be critical.

[Janey Dal]

All good questions!

Ear syringing is a controversial one. Increasingly it is now considered to be quite a risky procedure in terms of potentially causing damage to the ear drum during the syringing, particularly with repeated syringing. Equally it is generally not considered to be a necessary medical procedure that requires a clinician to do. There are a lot of things you can buy from the pharmacy that can help clean out ears without an invasive procedure. Some surgeries still do it but many do not. It is a bit like treating corns and verrucae which nurses used to do. Surgeries don't have the resources to deal with minor issues that are not affecting quality of life in a major way and can be dealt with either by self help with over the counter remedies or private treatment. Sorry, that's the way it is. The NHS is not a bottomless pit of resource so many minor issues will have to be dealt with elsewhere.

I'm not sure on your comment on confidentiality Marilyn? We still maintain that VERY rigorously. Happy to answer though if you want further clarification xx.

The 'old' way of treating patients will come back, certainly for older patients and patients who want to see a GP face to face. It will be a system of choice though. Many younger people would prefer to do online consultations and use their mobile phone for minor issues so they have the option to do that. But the hybrid system will be of benefit to everybody and will be more efficient. So hopefully if you prefer to see a GP there will be more appointments available to do so. Like I said, please don't worry! Slowly things will get back to normal and if patients do not want to use the online options they can see a GP like they used to.

The main point is that the GPs don't like the present way of working, ie doing consultations over the phone. They much prefer to see patients face to face so it will be patient choice.

We are also legally not allowed to refuse a patient treatment so if you do not want to take a picture on your phone or send in an online consultation then you will be seen.

As an example of this: we currently suggest to patients who need regular BP checks to buy their own BP machine and ring in with the results. This is to try to reduce footfall into the practice. Some patients prefer this. Some don't want to buy a BP machine so they are given an appointment to have their BP done at the practice.

So the point of this is all about patient choice. As I said, the new system will be better for all because there will be more choice.

[paul...m]

Suppose its better to see a picture of someones piles rather than looking at some unwashed rear end.

[Janey Dal]

Suppose its better to see a picture of someones piles rather than looking at some unwashed rear end.

I don't very often in my job get to see the photos but occasionally I do. Some are not for the squeamish I can assure you! The poor girls have to open the photo in order to attach it to the patient record and on occasion I hear some gipping noises from the office! The GPs don't seem to be fazed by it which is just as well.

So a lovely patient turned up last week. I missed the start of it but watched it on CCTV afterwards. He came into the practice fine but was getting increasingly agitated as he waited. We discovered subsequently he was on Spice. He had a pot on his leg and was on crutches.

To cut a long story short he eventually threw one of his crutches at the receptionists who are luckily protected by a glass screen and then proceeded to bash the glass doors into the surgery with his crutch, swearing and shouting at the same time. I was called and went down to speak to him.

He was, even in my limited experience, obviously 'on something'. He was just shouting and swearing and I couldn't work out what his problem was.

I advised him that he needed to sit in the foyer to calm down and once he had calmed down we would see if we could help him. He did so and we immediately locked the internal door and called the police. He was arrested.

We could see from his record that he had been in prison previously. We have a prison not far from where the practice is and many of the rehabilitation residences are in the town centre right where the practice is so we get many of these patients.

The next day a man (we never found out if he was even our patient) turned up and wanted to see a GP because his toe was sore. He was advised that it wasn't a walk in service and he couldn't just turn up. He told the Receptionist that she was a 'waste of f****** time' and went to sit in the foyer. I was called and went to speak to him. He showed me his toe which looked black and very nasty, but evidently hadn't got like that overnight.

Me: "You need to go to the Urgent Care Service, we are not a walk in centre"
Him: "I can't walk"
Me: "Well how did you get here then?"
Him "I got a taxi"
Me: "Well get a taxi to the urgent care centre"
Him: "I've got no money"
Me: "Sorry but that isn't my problem."

And yes it sounds harsh but he had sworn at the Receptionist and refused to give his name so I doubt he was our patient. Urgent Care is the only place for him.

There's never a boring day!

[maz]

^^ ^^


Wow, you were very brave twice going to take charge of those situations. Well done. What a problem such people are. They are their own worse enemy, but so dangerous out and about.

[Janey Dal]

It's interesting Marilyn that despite many confrontations over the years (I've been there 5 years this June ) I have never felt frightened or intimidated. I am not daft, I don't go too close to these people but for whatever reason I am quite unfazed by it.

I often wonder why some of these people, some who are rather large and almost always men, do what I tell them. I was pondering this with the staff and one of the girls said to "You get a look in your eyes Jane". Maybe it's because I'm not frightened that they back off. Maybe they realise I won't be intimidated which I suspect many of them are used to using a a tool to get their own way.

I am tall as well which I'm sure make some difference. Still I really enjoy it. I must be a bit odd! We have had in the past a male patient who wrestled another patient to the ground when he started kicking off and held him there until he calmed down .

It's like living in the Wild West .

As soon as they start to swear I lose all patience and refuse to help them. The staff should not have to put up with it and there are elderly patients and children (before COVID) sitting waiting. They should be able to come to their GP practice without feeling frightened for goodness' sake.

I still remember with some amusement the guy (drug seeking) who I told to leave because he was swearing and shouting. This was in main Reception. He stood at the front door and shouted at me that I was the "nastiest f****** person he had ever f****** met." I turned and apologised to the patients for the language at which point he also turned to the patients and said "Yes and I apologise for the language but not to f***** HER!"

He still left without his meds which he was trying to get early.

[paul...m]

Nice one

[Janey Dal]

And what a lovely week off I've had! Nobody contacting me from work!

I never mind if they do because no matter how well you plan for time off, when you are dealing with members of the public you never know what will happen. However, apart from the unexpected, I feel I am not doing my job properly if the practice can't manage without me for a week or two.

Thankfully I have not had any contact from work. Of course when I go back on Monday it will take me a week to get through the email correspondence and I will need to have a meeting with the departmental managers to catch up. Still, I go back with a new energy and a clearer mind.

Won't it be wonderful when COVID is just another virus?