Life as a GP practice manager

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Jney
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Re: Life as a GP practice manager

Post by Jney » Sun Sep 06, 2020 5:01 pm

Hi Jane, I hope you don’t mind if I ask you a question as a practise manager. Am I allowed to request that my test results are shown on my Systemonline page? I’ve requested this a couple of times but get different answers as to why they can’t be shown. Thank you 😊

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Sep 12, 2020 11:29 am

Hi Jney

The system allows for it but some practices are reluctant to switch it on in case it is bad news and distresses the patients.

However from the 1st April this year you are allowed access to your full medical record on line - this includes literally everything on the record including letters. They cannot refuse this it is part of the GDPR regulations. Try that request and don't let them say no - they aren't allowed to refuse.

So this week the patient who wouldn't wear a mask last week has put in a formal complaint. We should be okay because we have followed guidelines and offered her a sensible compromise which she refused so that is patient choice. We can only say that a procedure cannot go ahead if the risk of catching COVID is higher than the risk to the patient of not having the treatment or procedure. And we can only say that we cannot offer that treatment 'at this time' - we cannot refuse treatment altogether. We did all of that so she hasn't a leg to stand on, but it will take up my time responding to the complaint.

The nurse who was going to do the ear swab could refuse to see patients because she has severe asthma. But she asked to continue to see them. However there is no way I would ask her to do an ear swab without the patient wearing a mask. This patient obviously doesn't give a stuff about that -she is only thinking of herself.

And the wonderful testing situation - NOT! We have had 4 staff who needed to go for a test this week due to either being symptomatic or a member of their family being symptomatic. 1 got the results back within 24 hours, 1 got them back after 48 hours. The other 2 couldn't get a test either via 119 or online so had to drive round to try to find a testing centre. 1 of them found a testing centre which was open but had no tests and the other had a test and was still waiting for the results 72 hours later despite ringing up to try to get the results.

They cannot come back into work until they have tested negative. It is beyond a farce and the government are blaming people who go for tests who haven't any symptoms. Well it is a known fact that many people don't have any symptoms but still have the virus. This is just a ploy because they know bloody well that there aren't enough tests available.

One of the staff at a testing site said that no tests had been delivered into the country since Monday, hence the availability at the beginning of the week and the lack at the end.

There are no words........................... :evil: :evil: If we have enough staff off waiting for tests then there is a real possibility that the surgery will have to close. We are a big practice but the smaller ones will really struggle.

I did start to feel some empathy with Guy Fawkes this week. And I bet if I did blow up parliament the populace would be on my side :lol: :lol: .

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Sep 19, 2020 12:50 pm

So a nice incident this week: An elderly patient rang to complain that he couldn't get through on the phone. It is a constant complaint at the moment because all the GPs are ringing out so all the 18 lines are constantly busy. This particular patient however is 89, lives alone and is partially sighted and such an utter sweetheart when complaining that I decided to really help him.

We have a dedicated line specially for Care Homes so they can get straight through without going through the queue on the phone. I gave him that number but asked him not to tell anybody else what the number was. He promised he would 'take it to my grave". :D :D :D

It makes me laugh that we have patients complaining by shouting who get nowhere and this particular man who was so gentle and polite whilst complaining he got more than he had expected! Apparently when he visits the doctor he always dresses up in his suit and tie :D .

As I have said, I only get to speak to the patients who are kicking off so I get a very skewed view of them so it is so wonderful for me to speak to a lovely gentleman who deserved some support from us and we were able to give it.

Because the phone lines are so busy patients are trying a variety of methods to try to get what they want. We really do understand their frustration but apart from installing the 4 extra lines into the practice there is literally nothing more we can do.

I have just set up a Facebook page and have had one patient sending a message to us "can I book an appointment?" One who received an electronic link to his sick note and then sent a message via the webpage saying the link had expired and he needed another sick note. He obviously thought the link was like a sick note tree and he could just keep clicking on it and it would provide an updated sick note :lol: :lol: .

It's so difficult for so many patients to get through to the practice but really? We are doing our best like all the other practices in the country.

paul...m
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Re: Life as a GP practice manager

Post by paul...m » Sun Sep 20, 2020 5:01 pm

Son works for a housing association sometimes residents tell him they have a problem and cannot get through on phones . If resident is a nice friendly person he will walk away ring his direct line then goes back and tell them they will be getting a call in a few minutes ,they must think he is the reincarnation of Paul Daniels its magic .

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Sep 26, 2020 12:18 pm

Well a very busy week this week!

We were taken to small claims court by the cleaning company we were using last year. The cleaners were meant to stay until 9pm and we discovered that for months they were leaving at 7.30 every evening . This was proven by the alarm log which showed what time the alarm was set every night. The owner of the company refused to believe the log (I know! but she wasn't the brightest!). I worked out that they owed us over £4,000 in wages we had paid when they weren't there and refused to pay the last two invoices which totalled around £3,500 until they negotiated. They refused and took us to court.

We won! It was via telephone because of COVID and was enormous fun for me. Especially because the judge was proper stroppy with the claimant :lol: :lol: . It was like being on Judge Judy :lol: :lol: .

And then yesterday was manic! I had arguments with 4 patients! All about wearing masks! The infection rate is increasing faster here than elsewhere (probably because of people not wearing bloody masks) and they STILL don't get it. If the surgery closed because all the staff were ill they'd complain about that as well! :lol: :lol:

Then the fire alarm went off and we all had to vacate the building. It was set off by accident by a patient who had pressed the fire button instead of the intercom button - I know the fire button is bright red and says "FIRE" on it but anyway! This is the third time in as many months this has happened. We had even put a notice covering the fire button so patients couldn't see it but this patient was obviously determined :lol: :lol: . And once the furore had died down it transpired the patient who had set the alarm off didn't even have an appointment and shouldn't have even been there :roll: :roll: .

I'll never get fat working there. I spend too much time running up and down the stairs from my office!

paul...m
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Re: Life as a GP practice manager

Post by paul...m » Fri Oct 02, 2020 6:01 am

Easily solved connect fire alarm to a sprinkler above fire button so whoever presses it gets a soaking , at least if there on fire it will have saved their life and Jane can get a medal .
Well done for winning case just hope my previous employer wont find out how much time i spent sleeping on job or may be in debt for next 100 years . :D

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Fri Oct 02, 2020 11:55 am

:lol: :lol:

Just to add to last Friday's madness a patient and her husband turned up at the practice without an appointment or masks. They were asked to wait in the foyer until I came down to speak to them.

The patient was furious with me because she said she had been trying to get through on the phone for 45 minutes. The patient was doubled over in apparent pain and was holding a stainless steel bowl in her hands (but still shouting). I didn't ask about the bowl, and half assumed that she was feeling sick.

I advised we didn't have any appointments and that we weren't a walk in centre so she needed an appointment. We will, in normal times, see patients who just rock up obviously ill - particularly if they are children. However because of COVID we can't just let random people come into the surgery without them being triaged first by a GP on the phone, the risk is just too high.

She shouted "It's my bowels!" I wasn't sure therefore what the bowl was for but decided not to ask :shock: :shock: . I have a fairly strong stomach but that was a step too far.

She and her husband continued to be very angry with me and shouted "What are we supposed to do then?" I advised either A&E or the Urgent Care Centre."That's FINE!" She shouted "The last time this happened I lost 2 pints of blood!".

"Well A&E or urgent care is the best place for you then!" I replied calmly. They left shouting abuse at me :roll: .

It really is hard at the moment for us all. I understand her frustration at not being able to get through on the phone but given her presenting symptoms and her history why didn't she go to urgent care when she struggled to get through to us on the phone? If she had lost 2 pints of blood 'the last time this happened' to her what does she think a GP practice could do?

Common sense seems to have gone out of the window at the moment. It's almost as if some patients think that things are 'normal' when they are far from it. I genuinely feel for the patients at the moment but at the risk of stating the obvious, we are in the middle of a pandemic. We are just as frustrated by the way we are being forced to work but there is nothing more we can do sadly.

We have two of our most experienced GPs really struggling with the phone call aspect of triaging patients. They have worked for 30 years seeing patients face to face and both are very frustrated at not being able to see patients. The younger ones are coping better but still not really enjoying the job.

Awful times!

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maz
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Re: Life as a GP practice manager

Post by maz » Sat Oct 03, 2020 1:03 pm

I imagine phone call appointments have their place, but there is nothing like a face to face appointment for the most part. Doctors can see things they wouldn't on the phone, or even a video appointment. It is completely different and down to more basic technical results without the help of viewing the patient or the human touch. But we are rather stuck with it as part of the future. I am completely hopeless on the phone, always have been. Tongue tied, stutter, forget things, get put off what I am saying.......etc.
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Oct 04, 2020 11:21 am

And that's part of the problem Marilyn! Some people just aren't great on the phone. The doctors also have to rely on the patient telling them everything and just as you say, people forget things that the GP may be able to see if they were sitting in front of them.

There has been an acknowledgement in the NHS that some serious illnesses will be misdiagnosed or missed because of telephone appointments which is very worrying but sadly a sign of the times.

Doctors are prescribing antibiotics more over the phone than they did face to face because they prescribe them 'just in case'. This of course flies in the face of the previous clamp down on antibiotic prescribing but again, what choice do they have? Interestingly though we prescribed fewer in total than at the same time last year so evidently people are not contacting their GP for minor illnesses like they did before.

It will change health care forever without doubt. But I have to reassure you all that the GPs can't wait to get back to face to face appointments! Telephone and video appointments have their place but will never replace the GP and the patient sitting down having a face to face discussion.

And I feel for the student doctors. We have 3 or 4 of them at any one time and they are trying to pass exams and learn their job without seeing patients. It's awful for them.

Hey ho! Onwards and sideways at the moment! Hopefully we will all learn to value our freedom more when we get it back.

Hugs

Jane xx

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Oct 10, 2020 2:09 pm

So my week back at work after a week off. And WHAT a week!

It was just manic. Mainly from the sheer volume of work created by COVID and my week off (240 emails which I still haven't got through a week later). But also from trying to deal with patients who are unhappy about not being able to get through on the phone. Yes still!

In the middle of all this we still have patients refusing to wear masks when visiting the surgery and arguing with us.

The problem is that EVERYBODY is just fed up. And patients' frustrations are taken out on the practice. What some don't seem to realise is that WE are just as fed up as they are. We know we are not providing the level of service we did before. We know that everything is delayed and frustrating. We know that everything is difficult. But all my staff and GPs have the same frustrations and problems that the patients have.

On top of this we have 2 GPs off self-isolating due to poorly family members, they are not ill luckily so are working from home but it still creates extra burden on the ones who are in. Staff who are having real problems with schools sending whole year groups home so we have to accommodate their child care issues. And we are all weary.

On a lighter note we had a patient contact the surgery for an urgent telephone appointment because he was seriously worried there was something wrong with him because he was eating too many crisps :shock: :lol: :lol: :lol: . We were tempted to send him to the hospital via ambulance but he was eating all the same flavour so it wasn't as serious as we had originally thought :lol: :lol:.

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Oct 11, 2020 12:19 pm

And amongst all the general madness last week we had a call from a patient asking for medication. The patient is a man but the caller was evidently a woman trying to put on a deeper voice :shock: :shock: .

The patient has had to ask his pharmacy to only give his prescriptions to him because his sister would phone up and order his medication (she can do that) and then go to the pharmacy and pick it up 'on his behalf'. He would then ring and ask for his medication only to be told that his sister had ordered it. He never saw it again.

The bogus caller was ordering more medication and asking to change their nominated pharmacy. This was obviously because she had been stopped from picking it up at her brother's usual pharmacy, so was changing the pharmacy in order to collect it from a new one who didn't know the situation. Luckily our Receptionist was sufficiently concerned to speak to me.

I advised that she say quite openly that she was concerned regarding the caller's ID and that if 'he' wanted to change the pharmacy and order more meds 'he' would have to come down to the surgery. 'He' said he wasn't well enough but the receptionist stuck to her guns.

Believe it or not 20 minutes later the caller tried again and got a different receptionist. However in that period I had informed all the staff of the situation so the second receptionist was ready for the caller. Again 'he' was advised to come down to the practice to discuss due to concerns over their ID.

Unsurprisingly 'he' never turned up :roll: :roll: . I have tried to contact the patient to advise of the attempted fraud with no success. We think he works away. I have contacted the police and NHS Counter Fraud. Meanwhile if and when we get in touch with the patient I will suggest he puts a password on his account to prevent a repeat.

The laugh is that the bogus caller was phoning from her own mobile phone so we have a record of the number and the calls (I listened to them, it is definitely a woman) so was able to give the police the telephone number of the attempted fraudster.

Can you understand why I love the job? Everyday is a school day!

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Oct 17, 2020 11:33 am

Weary, weary, weary!

I've spoken to two retired GPs this week who are our patients and were complaining -one about the inability to get through on the phone and the other to say that we should have the windows open in reception to encourage airflow. The first one and I became 'best friends' during the phone call as he hadn't realised that the GPs were phoning out thereby clogging up the lines.

The second one (re the windows) had a valid point except that the poor receptionists would be absolutely freezing. I did feel like telling both of them that they were retired and therefore should refrain from offering advice on a situation they have no experience of. In other words :'butt out!".

Our biggest worry at the moment is with staff and GPs with childcare issues. So many children are being sent home from school because someone in their year group has COVID and the working hours of many staff are around school times. Often their back up childcare is not suitable because it is grandparents who are obviously elderly and in a higher risk group. There are grandparents who are more than willing to help but how can you take the risk? If you sent your child to their grandparents' house and they ended up with COVID and died you would never get over it.

The staff and GPs at my practice are bloody fantastic! They are all fed up. They are all weary of the situation but they keep on buggering on. I am finding it tough to keep cheerful but I have to! I am aware that if I start to moan about it, that will be picked up by the staff so I have to remain upbeat. Normally that is my nature anyway, but right now, like everybody else, it is becoming increasingly difficult to find that extra energy it takes to be positive.

And still the patients complain :roll: :roll: :lol: :lol: . They must be getting their energy from somewhere else :lol: :lol: . I have to say though we have had more emails and letters thanking us than we do normally so I guess there is a group of patients who DO value what we are doing.

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Oct 18, 2020 9:47 am

I watch a guy who has been doing medical(and now Covid) YouTube videos for years. He really has been excellent, non political and researches everything. He always says have your windows open to dilute the virus load. Says put another layer of clothing on, go back to wearing a vest, etc. He is always telling us that his pharmacy has their door closed, which really surprises him. Yes, it won't happen everywhere, but a good idea to take some of these things onboard. Maybe if the windows were opened occasionally for a while to clear the air etc? Trouble is these days, newer buildings have non opening windows and aircon. Ripe for virus spread etc. But things will never change now of course, we are too accustomed to the modern day niceties. Oh and I do understand about your office staff feeling cold. Unless they were in agreement it is a nono of course. None of us want to go back to wearing vests and liberty bodices do we :shock:

Back in my day( :lol: ) we always had a bedroom window open a little, all the time, whatever the weather. My dad's idea. He was ahead of his time for sure. A lot of what he did and said we laughed at back then, not literally of course. But poor dad. But over the years, he has been shown to be right on so many things. I actually carried on with the open window thing till after I got married and John wouldn't let me :roll: Of course he was looking at the heating bills. Now I just open as many windows as i can first thing in the morning, and leave them open as long as I can or until John closes them :roll: But I would for sure have the top bedroom window open just a little overnight if I could get away with it :wink:
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Nov 07, 2020 1:36 pm

I'm sure a lot of 'old wive's tales' are proving to be correct. They are based on experience over many years rather than science.

I always have the bedroom window open at night - the only time it gets shut is if it's blowing a gale! I feel claustrophobic if the window is shut :roll: :roll: .

More hindrance from the government this week who are advising that GP practices will be able to give you your COVID vaccine. It still doesn't exist properly although trials so far are positive.

Where we are at the moment: There are 10 vaccines that are proving to have no side effects but equally no reassurance on how effective they are. 2 are considered 'useful'. One has to be stored at minus 70 degrees - unsurprisingly we don't have facilities at the practice to do that. The other one needs 2 vaccines to make it effective.

So we are starting to have to plan to vaccinate 15,000 patients twice :shock: :shock: :shock: . And before you ask - no it's not doable! Hopefully it will be organised in cohorts of patients ie: frontline health workers first and the over 80s. I have no faith that the government will issue any useful practical advice on this. As usual it will be down to GP practices to sort out the mess created by NHS England.

Nevertheless a vaccine is on the horizon. But don't be too hopeful. There is a strong opinion that immunity even via vaccine will be short lived.

Hugs

Jane xx

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maz
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Re: Life as a GP practice manager

Post by maz » Tue Nov 10, 2020 9:11 am

So, this message popped up on our GP Surgery Facebook page and then we received individual texts with the same message. I think something you are dreading Jane.

' xxxx Surgery: We are experiencing a SIGNIFICANT staffing crisis due to Covid-19 & many of our team are unable to work. Please only call the surgery if it is vital. Thank you.'

I wonder if it was a build up of single contacts among staff or one contact at the surgery. Whatever it must be bad at the moment. I do wish them all well.
Marilyn

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