Life as a GP Practice Manager

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Thu Nov 30, 2017 11:18 am

Don’t you go telling anyone that Paul! I have my street credibility to consider :shock: :shock: .

Thanks guys - I don’t think I did anything anybody else wouldn’t have done in the circumstances. But it does give me a nice warm feeling and this time it wasn’t my sagging pelvic floor to blame :shock: :shock: :lol: :lol: .

I do hope however that maybe, just maybe, this young lady remembers that the GP practice went above and beyond for her and that there are good people out there despite her experiences as a child.

Fingers crossed. We see some desperate situations and horrific chaotic lifestyles with some patients and sadly mostly all you can do is stop it escalating - you can’t actually DO anything.

Hgs

Jane 😘

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paul.m
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Re: Life as a GP Practice Manager

Post by paul.m » Fri Dec 01, 2017 6:47 am

Well in my book your a hero as are all of those in the front line of the NHS Well Done . :D
Paul

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Fri Dec 01, 2017 10:47 am

I’m all pink with pleasure :D :lol:

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sat Dec 09, 2017 12:15 pm

Another week gone! It’s astonishing how quickly the days at work go -which is a good thing.

I’ve had a disciplinary meeting with the member of staff who is taking the Michael and she is now not talking to me and has given all the other people at work a Christmas card apart from me!

As is my mantra -she is mistaking me for someone who gives a s***!

I attended a seminar from 12.30 until 6.30 on Wednesday that was on the new Data Protection Act and was an utter waste of time. I sneaked out early because I could take no more, it was so utterly boring and useless.

I kicked two patients off our list for not attending appointments. We send out a letter every time they don’t attend to advise them that they are wasting GP time and preventing other patients from getting appointments. They get three of these before they are kicked off - so basically they have failed to attend 4 times in a short period of time.

One patient I’d kicked off rang me to say that she hadn’t received the previous 3 letters, only the final letter. Never heard THAT before! :roll: :roll:

We are in the final stages of organising the recruitment for a practice pharmacist who will start with us in January. I can’t wait! It will be a fantastic addition to the team and will save loads of GP time.

This is definitely the way forward for GP practices but there is limited support from NHS England.

hugs

Jane xx

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stuart13
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Re: Life as a GP Practice Manager

Post by stuart13 » Sun Dec 10, 2017 1:34 pm

A couple of months ago I was booked to on a NICE seminar. 10 days before the date I received instructions as to what I should take with me, the list included a pocket calculator.

I declined to go.

At my age, all I want is to know that it works, not how it works.

:wink:

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sat Dec 16, 2017 1:37 pm

Absolutely Stuart!

One of the presenters at the seminar spent an hour and a half telling us how the data sharing between hospitals and GPs practices had been implemented.

As we have been sharing data via this particular route since April this year it was of no interest at all. We wanted to know how it was going to develop further, not how it had been developed originally. :roll: :roll: .

This week I had an interesting interaction with our local hospital who are renowned for being rubbish.

We regularly receive patient discharge letters that are inaccurate or misleading.

For example we received a discharge letter a few months go that stated on page 1 “Patient died” and on page 2 “Patient discharged home medically stable” :roll: :roll: . Whilst there is an argument that being dead is probably as medically stable as anyone ever gets, it really is not encouraging.

Any way I rang the hospital about yet another example of one of their inaccurate discharge letters.

The letter said that the follow up actions for the hospital were a referral to the breast clinic under the 2 week rule because the patient had a breast lump and also a referral to haematology for a reason not stated.

Anyway,the patient came to see her GP 3 weeks later and said she hadn’t heard from the hospital about the breast clinic appointment. Our GP referred the patient under the 2 week rule just to ensure patient safety and I was asked to investigate re the Haematology referral to make sure that the hospital hadn’t missed that as well.

After being transferred to at least 3 different departments across the hospital in error by the switchboard, I finally got so speak to someone who was very helpful. The conversation was as follows:

Me: “The patient, according to your discharge letter, should have been given an appointment at the breast clinic under the 2 week rule and hasn’t heard anything”
Her: “We did refer her to the breast clinic and we had a telephone appointment booked for her but your GP has now re-referred her so her original appointment has been cancelled”
I decided not to question how the hospital thought that a telephone consultation for a breast lump would work :roll: :roll: and determinedly continued with my quest for the truth.
Me: “Okay that’s fine, but there is also a note to say she needs referring to haematology and her GP can’t do that because we don’t know why. I just wondered if that has been done?”
Her: “Oh we haven’t referred her to haematology-I’ll look into that and sort it out straight away”
Me(feeling weak and confused): “Okay - thanks” :shock: :shock:

Marvellous! :roll: :roll:

Hugs

Jane 😘

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MikeyB
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Re: Life as a GP Practice Manager

Post by MikeyB » Sat Dec 16, 2017 11:20 pm

Keep it up, Jane. Any more and I will change my mind about relocating to a country with an NHS run by idiots.

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sun Dec 17, 2017 12:37 pm

Well there’s a benefit to we English Mike :P :P xx.

This week brings a personal dilemma. I have been on anti-depressants for about 30 years. I have tried to come off them but it just doesn’t work and given that I get no obvious side effects and am evidently functioning perfectly well on them, I have simply learned to accept them.

The length and stability of my medication regime means that I order my prescription from the local pharmacy and get 3 months at a time. This has been the case for years. However, on ordering my last script I was advised by the pharmacy that my GP practice are now only issuing 28 day prescriptions with only a 3 day lead time prior to the order :shock: :shock: . Given that we are approaching a 4 day Bank Holiday the lead time is pretty stupid.

There is no NHS directive on this-it is a GP practice decision.

There is no sense in it - previously my GP only had to sign 4 scripts per year for me -now he/she has to sign 12 scripts per year. It may not sound life-changing but if you have 10,000 patients it kind of escalates the numbers a little.

Obviously I also have to pay 4 times as much for my prescriptions - I am not delighted about that but would take it on the chin given that the financial outlay is hardly life changing.

My personal concern is that I will forget to order the scripts given the tight lead time and that I now have to do it monthly. And I really don’t understand why the practice has done this - there is no benefit to either the patient or the practice.

If I were not a manager at a nearby practice I would contact the manager at my practice and ask why the decision has been made. However, I am. I know her well. I do not want to compromise our professional relationship.

If it is not her decision and she is not happy about it, then any complaint made by me may help. If it is her decision I may cause problems for her.

And yes I can write as a patient and make it clear that that is my only angle. My other consideration is to leave the practice. This may be my solution given that I have been unhappy with my practice for a long time (even prior to becoming a practice manager) and the manager at my practice would probably not even be aware of it.

Hugs

Jane 😘

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MikeyB
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Re: Life as a GP Practice Manager

Post by MikeyB » Mon Dec 18, 2017 7:26 pm

In Scotland you wouldn’t worry, because all prescriptions are free. Would a pre payment cert help? I don’t know how much they are these days.

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paul.m
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Re: Life as a GP Practice Manager

Post by paul.m » Tue Dec 19, 2017 6:50 pm

£104 for 12 months thank you for reminding me mine needs renewing .
Our Drs has been doing my blood pressure tablets monthly for a while but Creon still on 2 months worth . Maybe there is a cunning plan if I run out of blood pressure tablets and drop down dead I wont be a drain on NHS but if I run out of Creon and go to Drs Surgery there could be a sticky mess to clean up . :oops: :oops:
Paul

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sat Dec 23, 2017 12:17 pm

:lol: :lol: thanks Paul for the mental picture I’ve now got :roll: :roll: .

Well this week I have been very busy and important :lol: :lol: . I’ve spoken to the Health Ombudsman, the local MP (the other one not our ex-GP) and the police (twice) :roll: .

The Health Ombudsman rang to say a complaint against the practice that the patient had taken to the Ombudsman had not been upheld (ie the practice was in no way at fault). Which is great news. It was what we expected but it’s good to get official feedback.

The local MP’s office rang me with a complaint from a patient who had waited 2 hours for a doctor to ring him for a telephone appointment. Like you ring your MP for that! Well Apparently yes :roll: :roll: !

I rang the police to report a patient who (and you’ll like this) presented at a nurse appointment for his asthma. On asking him to lift his top up so she could listen to his chest she discovered 2 x 25mcg Fentanyl patches which were not prescribed by the practice.

Apparently he had been given them “down the pub by my mate to help with my bad back”. :shock: :shock:

The nurse gave him a really hard time about the risk of death from such strong opiates. His GP has put a note on his records to remind him to give the patient a hard time when he turns up next for an appointment and I’ve reported it to the police!

I suspect after all that he may think twice before using someone elses’s medication :lol: :lol: . The police were not really interested to be honest unless there had been a theft of Fentanyl reported, but I did advise the police officer on the phone that I suspected that it was just two daft old blokes down the pub who had no idea what they are doing.

I don’t think we’ve uncovered a major crime syndicate. But we also need to cover our backs if there are any repercussions.

And yesterday we had no idea what to expect because on a ‘normal’ Christmas Eve it is busy in the morning and quietens down in the afternoon. Amazingly it was exactly the same!

Apparently people don’t get ill on a Christmas Eve :roll: :roll: .

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Thu Dec 28, 2017 12:19 pm

Well day 2 of my 3 day holiday from work and no phone calls.

This is either because everything is running smoothly (which in GP practice land is unlikely) or it is so chaotic that nobody has had time to ring me :roll: :roll: .

I nearly popped past the surgery this morning to check everything was okay and then had a word with myself!

I have discovered that working in such a relatively small environment is very different. One of the best things is that I do feel a sense of loyalty to the practice. When I started work years ago I did feel loyalty to the company I worked for, but after years of being ‘a number’ and twice being made redundant despite doing a damned good job, my sense of loyalty to my employers waned somewhat.

But now it’s back again and I love that aspect of the job.

Working for corporate NHS was a bit like wetting your pants in a dark suit - you got a nice warm feeling but nobody noticed :lol: :lol: .

And on the 8th January a new pharmacist will be starting work with us. I am really excited about it. I have pushed for this since the day I started 18 months ago and finally the GPs have seen sense. Yes it’s a cost to the practice, but the benefits of the expertise a pharmacist brings are worth more than money.

I am sure Mike will concur that GPs are good at illnesses but not necessarily medication. So the pharmacist will be able to do the prescribing work in half the time the GPs do and with better results.

With the national shortage of GPs many practices are starting to look at alternative ways of working and I suspect you will all start to see more pharmacy input into your practices. NHS England have provided some funding but you have to jump through so many hoops to get it many practices simply won’t be able to access it. One of the criteria is that you have to have a cohort of 30,000 patients to even apply.

The average practice size in England is about 8,000 - my practice has 14,500 which is pretty big but we have applied for the funding and had to go into partnership with another practice to access it.

This, my friends, is the way NHS England are going - they want to see super-practices of between 30,000 -50,000 patients. Economy of scale and all that!

I’m not convinced personally.

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Janey Dal
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Re: Life as a GP Practice Manager

Post by Janey Dal » Sat Jan 06, 2018 12:18 pm

How much better did we all feel then when Theresa May and Jeremy Hunt apologised for the state of the NHS?

I personally felt much better :roll: :roll: .

The whole institution is in crisis including GP practices. We have a policy of creating a Pool when all appointments have been filled because we try not to refuse any urgent same day appointments. The GPs will pick from the Pool if they get a non-attender and basically keep consulting at the end of surgery until the Pool is empty. Most days there is either no Pool or maybe 2 or 3 people in it at most.

The Thursday between Christmas and New Year there were 23 patients in the Pool and we were forced to refuse urgent same day access for safety reasons. Bearing in mind that urgent appointments are 5 minutes that is still 2 hours extra consulting time added to the day.

One of our GPs had to call an ambulance for a patient who was having a heart attack. An ambulance car turned up and the GP was told that every available ambulance in the area was sitting outside the local hospital waiting to admit patients.

At what point exactly will the government realise that they have cut funding too far? I KNOW that most of the funding goes to useless overpaid management,but instead of just cutting funding the government should insist on a structure within each Trust that won’t allow this to happen.

Basically at the moment the NHS is just about managing on a daily basis, but add the ‘Winter pressures’ and there is no wiggle room.

:twisted: :twisted:

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MikeyB
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Re: Life as a GP Practice Manager

Post by MikeyB » Sat Jan 06, 2018 5:07 pm

While those two hypocrites were apologising for the state of the NHS in England, Nicola Sturgeon was sending a message of congratulations to NHS Scotland for the way they were coping with the winter crisis. At the moment, there is no restriction on routine surgery. It’s no good for a hospital if it’s theatres are closed and surgeons and anaesthetists standing idle, it’s a waste of money.


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