Life as a GP practice manager

Chat about anything you like... Fed up with the state of the world today? Tell us!
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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Fri Dec 27, 2019 12:40 pm

Death Marilyn! It's the only way :lol: :lol: .

Hope you had a good break xx

And you know the constant stories about patients not being able to get a GP appointment? Well you could have had three or four on Tuesday (Christmas Eve). The Monday was very busy, but Christmas Eve? The GPs were finished morning surgery at 11.30 and had had loads of gaps in their appointments and several did not attends.

And in the afternoon? We saw one patient :shock:. It never fails to astonish me that people don't get ill on Christmas Eve :shock: :shock: . We contractually have to stay open until 6pm however. One of our GPs was busy hanging pictures round the practice :lol: :lol: . Most staff leave early but the GP on-call stays until the bitter end with a couple of receptionists.

And today, they'll all be back again complaining that they can't get an appointment :roll: :lol: :lol: .

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maz
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Re: Life as a GP practice manager

Post by maz » Sat Dec 28, 2019 9:09 am

Our surgery didn't have normal booked appointments yesterday(Friday) just emergency ones. John needed one, phoned in at 8.02am and was 4th in the phone queue. "Can I see a doctor today please?' 'Yes of course, can you tell me the problem?' He went and had an electrocardiogram and saw a doctor a couple of hours later. 3 doctors and 2 nurses in and very quiet really.

Oh, and John probably has angina, has new tablets, and will have an appointment coming through from the hospital. No complaints here about our surgery here.
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Wed Jan 01, 2020 1:20 pm

I hope he's okay Marilyn xx

We also only book same day appointments at this time of year. If you book routine appointments you get more no-shows because people are too busy.

Believe it or not our surgery was open on Christmas Day and Boxing Day :roll: :roll: . Not our actual practice: we rent our premises to the Federation at evenings and weekends to see any patients for the 7 day access to GP appointments contract. Our local CCG mandated as part of the contract this year that the Federation had to open on both those days and today. There will have been no patients or perhaps one or two and the staff who work will have been paid a premium rate. It's a nonsense! Most patients won't even realise that there are GP appointments so will turn up at the Walk-in service.

There isn't a shortage of volunteers to work because a lot of health service staff are from cultures that don't celebrate Christmas and for the ones who do it's a great excuse to avoid the in-laws :lol: :lol: .

And even if no patients turn up at all, the contract will remain the same for next year! Unless Boris changes things :roll: .

Hugs

Jane xx

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maz
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Re: Life as a GP practice manager

Post by maz » Thu Jan 02, 2020 9:15 am

So it was open for normal GP appointments?
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Jan 04, 2020 10:36 am

Yes it was! And apparently there were a few patients! The appointments were open to 111 bookings so some patients chose to go to the practice rather than urgent care at the hospital which, even if you have an appointment, usually means a longish wait.

On Christmas day I realised we would be short of milk with so many people coming over. I was going to call my mum and ask her to bring some over with her but decided, on a whim, to have a quick drive round to see if any local shops were open. I thought maybe a garage may be open. I was astonished to find our local McColls was open :shock: .

And whilst we may think that this spoils Christmas, my mum, who is 89, advises me that when she first started working she worked for the local bus company and worked Christmas morning because the buses were running.

And back at work this week after a week off was a little bit of a shock to the system! It's 3rd quarter end which means completing a whole raft of pointless statistical returns for NHS England to ignore :roll: . And also preparing for our CQC inspection on 6th February which this time is done over the phone :shock: . Yes of course they can tell how clean and medically safe the practice is via telephone :roll: :roll: .

The laugh is that if you have improved too much since the last physical inspection then they will come out and do a physical inspection. If you have improved slightly or maintained your standards from previously they will leave you alone. What a nonsense!

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Jan 05, 2020 9:18 am

Things are never going to change in the overall NHS structure unless someone is very brave indeed. Maybe Trump :wink: :lol: :lol: Erm joke. But it needs someone.




By the way, I can remember the post being delivered on Christmas Day when I was very young. Hard to believe now.

We went off into town on this New Year's day and i was expecting a myriad of shops to be open, but it was as dead as a dodo. Just a few shops and coffee places(we had a Costa) but NO M&S! I was going to fill my freezer there as it was rather empty. However I was glad the shop workers had the day off.
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Jan 11, 2020 11:55 am

Lovely start to the first full week of the new year with a phone call from a very angry drug seeking patient who, when I refused to give him his prescription early, threatened to come down to the practice and petrol bomb us :shock: .

I of course had to phone the police to report it. I had little doubt that it was a mindless threat but nonetheless I had to report it. As it transpired the surgery is still standing so he didn't carry out his threat.

And then another lady who had been removed from the list for repeated non attendance rang to ask why she had been removed. I explained that she had missed 5 appointments during 2019.

"That's terrible!" she said :roll: :roll: :lol: :lol: And then she said our surgery was brilliant and thanked me. I did feel a bit mean but rules is rules. I do occasionally change my mind and give patients a let off from being removed, but 5 appointments missed in one year is just a step too far. They get plenty of warning letters.

And I've also had to write to a patient who arrived on his bike 2 months ago and was sent straight into hospital so we looked after his bike for him. He was discharged the next day but we are still storing his bike in one of our rooms. I've tried to ring him but there is never an answer so I've written to say if it's not collected in 2 weeks I will donate it to a local charity.

Never a dull moment!

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Jan 18, 2020 12:25 pm

So this week has been about meetings! I had meetings that ended up needing further meetings, and them some more meetings to arrange a meeting and then a meeting that people turned up for that I had forgotten all about due to the number of other meetings that I had attended :shock: .

Sadly as a practice manager, most of these meetings involve the practice manager having to do some more work :roll: . And woah betide if I don't attend a meeting because all the actions will be given to me as a penalty for not attending the meeting :lol: :lol: .

I am meetinged-out!

I remember when I worked at NHS corporate there suddenly became a trend to be invited to a pre-meeting meeting. I kid you not! The idea was to discuss what was going to be discussed at the meeting in order to shorten it :shock: :shock: .

I also remember being asked to sign up to a policy on how to write policies. A policy policy :shock: .

No bloody wonder the NHS is struggling!

And then the politics! All practices have been more or less forced into joining a Primary Care Network - this basically means that we have to get together with a group of other practices to form a network of up to 50,000 patients (to give you an idea of scale the average practice size in England is around 8,000 patients). We have all done this because we couldn't not do it due to the amount of money lost to each practice if we didn't.

We have been offered, at a reduced sum, extra staff provision eg a practice pharmacist, a practice physiotherapist, a mental health nurse. The networked practices have to contribute financially to these extra staff but it all sounded okay and of real benefit to patients. And then NHS England have sent out a new contract for approval which basically uses all these new staff that we are paying for to do extra work mandated by the contract.

It's like giving you a tenner and saying that we want you to do work that will cost you £12.50!

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Jan 25, 2020 12:01 pm

A couple of weeks ago I received a call from the CQC (Care Quality Commission) who oversee the quality of care in GP practices. They notified me of the date of our next inspection which is February 6th. They can remove licence to practice if the surgery is not up to standard so it's a biggy.

Our last inspection was in 2016, three months after I had joined the practice. No pressure! :lol: :lol: They came in for the day and I had to organise a rota with military precision given that they tell you who they want to speak to and for how long but give no idea what they want to speak to them about. They speak to GPs, staff, the manager and patients, and in the meantime we are still running a surgery and seeing patients. A fairly stressful day for me especially given my newness to the post at the time.

This inspection is via telephone :shock: . Of course they can tell how effective you are as a practice over the phone :shock: . We could be sitting in a surgery with no electricity and dreadful doctors and tell them everything is great!

I have seen on the news this week that the CQC did an inspection of a care home for patients with mental health issues and missed the fact that the staff were bullying the patients because the report that highlighted the inspector's concerns was 'lost' :shock: .

I won't mention that in our inspection :lol: :lol: .

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MikeyB
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Re: Life as a GP practice manager

Post by MikeyB » Sun Jan 26, 2020 11:15 pm

As you quite rightly say, such an “inspection” on the telephone isn’t an inspection. The CQC, of course, take money from the NHS that could be used on something meaningful. As do CCGs, and the stupid hospital electronic appointment system.

As a result of these insane “improvements” there are now 50% more managers in NHS England than there were in 2010, all of whom are counting stuff and ticking boxes, and not benefiting patients one iota.

It worries me, Janey, that you accept all this crap as being normal, but it’s only normal in NHS England. Don’t worry, it’s only a short hop to Scotland before the border closes. :D

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Feb 01, 2020 1:25 pm

I absolutely agree with you Mike (apart from the border!) and I cannot comment on NHS Scotland but I suspect you have a rosier view of it than one of my Scottish GP Partners suggests :P .

Having worked in the NHS for many years I have learned that the NHS bureaucracy is not normal in any way, shape or form, but also that fighting it all the time would put me in my grave within 2 weeks!

I have learned to pick my fights. My personal mantra is the Serenity prayer which I actually have on my wall at work:

God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.

I have won some battles but not won any wars with the NHS. However, having worked in NHS corporate, which is a completely profligate and ridiculous place to work, I love being in a GP practice.

Because it is a private business, there is little waste of resource (apart from some mandated payments to the CQC for example) and whilst I can only make a difference to the care of the 15,000 patients who are registered with us, that will do me very nicely thank you.

I don't want to change to the world, but I would like to think I am contributing to improving the tiny bit of the world around me.

And on a lighter note one of our Receptionists took a call from a patient wanting to book an appointment. Mid-conversation he suddenly said:

"Oh hang on!"

Following a silence of several seconds he came back on the phone.

"Sorry! I was in the middle of a sh*t, I've finished now. So what day were you offering?" :shock: :shock: :lol: :lol: :lol:

You really couldn't make this stuff up, but it gets us through the day with lots of laughs. It's a good place to work.

Hugs

Jane xx

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Feb 02, 2020 9:25 am

:shock: :lol: Difficult to know what to say to that last part of your post Jane. It has made me think twice about holding someone's phone for them though :mrgreen:
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Feb 02, 2020 11:42 am

:lol: :lol: :lol: :lol:

I suggested the Receptionist should have said "Oh sorry, I'll give you time to wipe your bottom, you can ring back when you've done" and put the phone down thereby forcing him to go back in the queue!

We've also had two people in the last week threatening to go to the press to report that we wouldn't prescribe them sleeping tablets :roll: .

Surprisingly the local press have not picked up on the story. We get regular threats that the patients will go to their solicitor as well. I always respond to the threat with "That's fine Mr xxxx, you are entitled to do that."

My favourite though is when they threaten to go and join another practice. Like we care really? If they are dissatisfied with us then it's the sensible thing to do, and often we are happy if they do go elsewhere because they are usually the ones who have unrealistic expectations of their health care anyway and will never be satisfied with any surgery.

I take great pleasure in advising them how to join another practice :twisted: .

I really must reiterate here that the stories I share are about a very, very small minority of patients. In all honesty the majority are brilliant.

Sadly, in my job, I don't get to meet those ones :roll: :roll: :lol: .

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maz
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Re: Life as a GP practice manager

Post by maz » Mon Feb 03, 2020 9:09 am

John's reply when I told him about the man on the toilet and phone was to say after he said "Sorry! I was in the middle of a sh*t, I've finished now" was "yes I know, you have facetime on".
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Feb 08, 2020 1:07 pm

:lol: :lol: :lol: :lol: That would have been fantastic! :lol: :lol:

This week we have had a 'Time Out'. This is an event every 3 months when all the practices in the area are closed for the afternoon to enable staff and GPs to attend training or information events. The CCG organises cover for patients via 111 and the urgent care centre for emergency appointments. It goes on across the country in various formats but you wouldn't necessarily notice unless you rang your practice whilst it was shut.

So this week, in this area, GPs and Practice Managers were invited to an event to discuss the new GP contract issued by NHS England which has caused an absolute s**t-storm across the country with practices. It is utterly unachievable and beyond ridiculous.

We spent the whole afternoon discussing this ad infinitum because there was such concern around the amount of extra work practices were expected to do. The next morning we received an email from NHS England saying the contract had been changed completely so therefore all discussions from the event the day before had been a waste of time :shock: :shock: .

We get these events 4 times a year. It is really important that they are used appropriately for GP practices to get together to discuss things that are important. So to waste one is scandalous. To be honest, had I known what a total waste of time it would be, I would have stayed at work, with no phones ringing and got through a whole load of work that got left. :twisted:

Sometimes there are no words .......

Oh and 6 patients kicked off our list this week for repeated 'Did Not Attends'. All have had letters to tell them they are at risk of being kicked off and then they subsequently didn't attend another appointment. Meanwhile we have patients complaining they can't get an appointment! :roll: :roll:

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