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Re: Life as a GP practice manager

Posted: Fri Apr 17, 2020 1:15 pm
by Janey Dal
paul..m wrote:
Thu Apr 16, 2020 12:21 pm
Never mind some window cleaners are disenfecting knockers the job just got more interesting
Paul's going back to work then! :lol: :lol:

This week is somewhat quieter in terms of patient contact. The nursing team are seeing more patients than the GPs just by the very nature of their job: we still need to do immunisation clinics, INR clinics, wound dressings etc and these are all nurse jobs.

We have 2 nurses who have severe asthma but want to continue working but we have decided that they can't see patients. They have been given a project to contact the patients classed as frail. It is a big list of patients. The idea is to check that they are okay in their social as well as medical situation.

It has been a brilliant project in terms of patient care but very sad. The frail patients are 99% elderly and this is the generation who just soldier on without asking for help.

The nurses have come across patients who are down to their last few tins in the cupboard, who are without medication because they have nobody to get it for them etc etc. Desperate! :(

But we've been able to help them which is fantastic :D .

And then we had a VERY difficult patient on the phone who was not happy that he couldn't get a GP appointment for his corn :shock: :shock: . This would never be a GP consultation pre-COVID but really? Is he going to die from his corn during lockdown?

I can only hope so :oops: :oops: .

Re: Life as a GP practice manager

Posted: Sat Apr 18, 2020 9:27 am
by maz
I'm really happy to hear you have a team contacting your frail patients but isn't it sad to hear how poorly some are doing with not much food etc. You are right in that they are of the generation which doesn't want to be a nuisance. Whilst I am not frail or that elderly( :shock: ), I am the same also not wanting to be a nuisance to others at this time, or any time actually. I think a lot of those who have come to light recently who have died from other conditions at home and didn't go to hospital, were feeling that way. Not just because they were scared of catching Covid-19, but because they didn't want to be a nuisance at this time when hospitals and/or GP's are so busy. Imagine how you would feel if you went and then found out it was nothing and you had wasted everyone's time. Okay very relieved, but you know what I mean.

John got a letter from his cardiologist saying that he will be having a telephone appointment with him at some point. Due to the fact his cardiac surgeon's appointment will be delayed, so most likely to check how things are going etc., and maybe see if he needs to be pushed up to urgent. He doesn't need to be in our eyes thankfully. I was quite impressed really, though as the doctor couldn't talk face to face even, we are highly amused about how it will go over the phone :shock: John is going to make a long list of questions whilst he is out of the hospital environment so not as nervous, and also has the doc. captive :lol: I am still waiting to hear about my referral, but mine isn't as important, or hopefully not.

Re: Life as a GP practice manager

Posted: Sat Apr 18, 2020 1:55 pm
by Janey Dal
It is a very frightening time for people who are awaiting an operation or just an appointment with the specialist.

Hot off the press on Thursday was the news that hospitals will have to take responsibility for GP referrals. This is good news! At the moment the GPs are writing referral letters but they are just sitting in a pile because the hospitals weren't accepting them. However, under the new rules we can send them and it is the specialist's responsibility to assess how urgent the referral is.

Much better for the patients!

2 week rule (ie suspected cancer) referrals are still being accepted. Many specialists are sitting on their bottoms doing very little so they really should be triaging referral letters and seeing patients who would benefit from an earlier appointment.

The hospitals are divided into red and green areas, so there is no reason patients can't be seen by the specialist under strict protection measures. The problem is that nobody has enough protective equipment still!

In direct response to Marilyn's comment, I would again urge you all to speak to your GP if you have a non-COVID related condition. I understand that people don't want to be a nuisance but actually at the moment the GPs are fairly quiet. You will be offered a telephone consultation or, if you have a smartphone, potentially a video consultation.

The GP will only call you down to the surgery if they need to examine you and it will be done under strict safety guidelines to prevent cross infection. Remember that your GP doesn't want to take a risk either!

Re: Life as a GP practice manager

Posted: Sun Apr 19, 2020 9:32 am
by maz
Thank you for all the info Jane. I had in my mind that many hospital specialist were sitting on their bottoms twiddling their thumbs, but then, thinking that was naughty of me I changed that to their being updated/retrained to help with the Covid-19 situation. I am sure right in the beginning of the virus problems and lockdown there was a lot of confusion(and fear) at hospitals in what they could or should be doing, but things should have improved by now. Mind you not many of us would have wanted to visit a hospital by choice back then.

As far as my situation, it is an oral problem, referred by my dentist just a few days prior to lockdown. I am not even sure if my GP knows. It isn't teeth related, my referral is to an oral and maxillofacial surgeon, and I will of course be at the bottom of their urgency list after reading what they do. But I would just like to know something of what is going on. It made me impressed that John's cardiologist has actually contacted him.

Of course dentists have gone into hiding sitting on their regular monthly Dental Plan money, whilst nobody can get treatment for anything. One poor guy ended up pulling his own tooth out and there are other stories too. Of course the dentists blame the NHS for not setting up the regional centres, but I guess now most dentists are private, so don't have to work at these centres if they don't wish. I do love my own dentist by the way, though hate going to see him :lol: .

Re: Life as a GP practice manager

Posted: Sun Apr 19, 2020 12:09 pm
by Janey Dal
Some hospital doctors are retraining but there is only so much training you can do because it takes time away from the more recently skilled staff.

There was a suggestion locally that GPs should consider volunteering for hospital shifts. It really is not that simple as I'm sure you can imagine.

During training all doctors have to do both hospital and general practice work, but if they then go into general practice they quickly lose the minor skills they learnt on rotation at the hospital. I firmly believe that GPs are better staying where they are for the time being.

They are doing a grand job preventing patients from having to go into hospital by continuing to treat them at primary care level.

And as for the hospital doctors - I certainly wouldn't want a gastroenterologist (for example) treating me in A&E. They will have forgotten how to treat patients in emergency situations!

I watched the Andrew Marr programme this morning and it seems increasingly likely that this really is going to be a long term situation. There is not even going to be a chance of a vaccine until September at the very earliest and then somebody has to manufacture the vaccine it needs distributing.

I believe that the lockdown will very slowly be lifted, bit by bit, but that social distancing will continue for many many months.

My biggest fear within the family at the moment is my daughter in law who is due to give birth in August. Currently they are not allowing birth partners in when the mother has the baby. Mum and Dad will be absolutely gutted if that proves to still be the case in August :? . I personally disagree with the decision because if the birth partner is appropriately masked and gowned up and wears gloves there is little risk and I would suggest that the trauma of giving birth without your partner there would outweigh the risk if sensible precautions are taken. I feel sure as well that some mums would rather have the baby at home without help which is even more dangerous.

I also think that being able to sit with your loved ones as they die should be re-considered. Nobody but nobody deserves to die alone. It's just desperately sad.

Re: Life as a GP practice manager

Posted: Mon Apr 20, 2020 9:36 am
by maz
Whilst it is wonderful for fathers to be present at the birth, it never used to be the case, and they all coped, it wasn't a trauma. Yes, it would be nice and the very best thing for dad to be there, and I am sure the decision will be changed by then, particularly if they have found more tests that work. But women have been managing for years without the men there. They had to put these rules into place in the beginning, just imagine the uproar if something awful had happened. They can't do right for doing wrong.

Re: Life as a GP practice manager

Posted: Sat Apr 25, 2020 1:49 pm
by Janey Dal
You are right of course Marilyn! I remember my mum saying that my dad was playing cricket when my brother was born because he wasn't welcome at the event. Can you imagine the uproar now if a dad did that! :lol: :lol:

And to cheer you up a bit we had a report of a person lying down in the street round the corner from the surgery (this isn't the first time this has happened). A GP and a nurse went out in full PPE to see if they could help. It transpired he was completely p****** and when they woke him up he ran away leaving behind 1 shoe and a cardigan which are still lying in the street because nobody is prepared to pick them up :roll: :roll:

We are still getting patients phoning up asking to see a GP! We do wonder if they ever watch the news or speak to anybody.

It has been hard this week to keep the morale up. I think everybody is realising that this is the new normal and it doesn't look very exciting. It's just work, home, sleep, repeat. This doesn't bother me too much because that was pretty much my life before Coronavirus but the youngsters are finding it tough!

I was involved in a conversation with some of the staff who were discussing which they would be willing to give up first, their false nails or their false eyelashes :lol: :lol: :lol: .

There is also a general acknowledgement at work that things are going to get worse from a GP practice perspective. Many people are avoiding the GP because they are either too frightened to attend, or prefer to wait thinking their condition is not urgent. Sadly some of their conditions will be urgent and the delay will have some serious consequences. It is a real worry but we can't do anything about it sadly :( . There is little doubt that the aftereffects of the virus will continue for a long time after it is finally crushed.

Re: Life as a GP practice manager

Posted: Sat Apr 25, 2020 3:28 pm
by maz
Jane, I remember you said you had nurses who had asthma but wanted to work, phoning the very vulnerable. Is there a way some could be phoning the chronic disease patients? Those maybe who should be attending their annual reviews etc? Also maybe phoning some who the GP's were a bit concerned about prior to the lockdown but who have not called in. Patients with depression, other mental issues, serious illnesses. People who cancelled their appointments at the beginning when sent emails/texts etc. I would think a bit of this has been going on, but it has been blowing through my mind on and off. Like you said, some patients are reticent to call. I know practice numbers are large these days but even if only a few are reached, it might help a bit.

By the way, I agree it must be harder on the young ones who are used to going our, socialising etc. Such a good job there is social media and mobile phones. Would have been an absolute nightmare just 30 years ago.

Re: Life as a GP practice manager

Posted: Sun Apr 26, 2020 1:40 pm
by Janey Dal
Hi Marilyn

We are ringing the long term condition patients around the time of their annual review and doing the review over the phone. It is not ideal but better than nothing. If a patient is really struggling we can bring them down to the practice but obviously this is done as little as possible due to trying to keep the practice a ‘green’ zone.

This is to ensure these patients are still being looked after but also from a practical perspective in that if we don’t do it now the workload afterwards is going to be crazy because we will be trying to fit 12 month’s worth of patients into 9? months.

Sadly with mental health patients their numbers are so huge we simply could not cope with phoning them all :( . We have to rely on them contacting us if they are in crisis. You are absolutely right that with a large practice like mine we simply cannot identify individual patients we are concerned about. We have to group them into cohorts like the long term condition patients, frail patients and ones who are on the shielding list. This is in an attempt to reach out to the most vulnerable.

It is not ideal and nobody likes it but we have to deal with what we can. I can really only reiterate that if you need to speak to a doctor PLEASE ring up and ask - that’s not just for you Marilyn but for everybody. The surgeries are quiet at the moment because people are managing conditions on their own and don’t want to bother the GP. When lockdown finishes it will go crazy! Get in there while you can!

The most important thing is that you know that your GP is still there for you the same as before. The only difference is the method of consultation which may be via phone or video link. If you have a condition that requires a face to face consultation that is still available to you. At our practice (and I would suspect all other practices) we give patients a mask when they come in, regardless of whether they are symptomatic, and the doctor or nurse who sees you will be in full PPE so the risks to the patient and the staff are as minimal as we can make them.

Please do not let something that appears to be minor now turn into some major by ignoring it until the end of lockdown.


Jane xx

Re: Life as a GP practice manager

Posted: Mon Apr 27, 2020 11:02 am
by maz
Good points Jane and helpful. I knew you would be being even more proactive at your surgery. To be honest I am glad the surgeries are a bit quiet just now so it gives you all a bit of breathing space. I hope that quietness has reached your office! There might just be another spike as the lockdown is relaxed.

Re: Life as a GP practice manager

Posted: Sat May 02, 2020 3:55 pm
by Janey Dal
We have one nurse who has severe asthma and could be shielding but absolutely refuses to do so. So we have asked her to contact the frail patients by telephone and check that they are okay. She is loving it! It’s proper nursing and she is a proper nurse! She spends ages on the phone with some of them because they often are just glad of someone to chat to. It’s very sad but she really feels as if she’s making a difference to the patients.

As I said - a proper nurse!

Meanwhile I am having ongoing complaints from a patient who is insistent that his wife attends for B12 injections. She has pernicious anaemia and needs the injections but guidance advises that the patient can store the vitamin in their system for 3 -6 months since their last injection. The patient is well within that timeline but her husband insists she is going to die - she really isn’t.

He has been to his MP to complain. The disturbing part for me is that the MP wrote the the CEO of the local hospital about a GP practice complaint - so he understands the NHS obviously! :roll: :roll: I don’t care one bit about MPs being involved. I’ve dealt with them before and they can’t argue against our policy because it is based on clinical evidence.

I am not going to risk a member of staff nor a patient coming into the surgery for an unnecessary procedure. But this guy is not giving in. And he is just the sort of patient who,if his wife contracted Coronavirus from attending the surgery, he would complain about that as well :roll: .

There are times when I really feel like being totally unprofessional and telling people to just bugger off! We are in the middle of a national crisis where people are dying and all he can complain about is a delay in his wife’s B12 injection.

His latest missive to me quotes the advice of the Welsh Government :shock: :shock: . Not sure that is relevant :lol: :lol: .

Re: Life as a GP practice manager

Posted: Sun May 03, 2020 9:39 am
by maz
Oh Jane, wouldn't life be so much easier without these patients? (Well that was a silly question Marilyn :roll:) You have my permission to tell him to do whatever you want him to do :lol:

What a wonderful nurse you have there Jane. Thank her from me for doing what she is doing. I am so glad she is loving it, and so feels rewarded in return for helping these frail patients too. I hope she does not catch the virus with her having the severe asthma. I also hope she is offered to be in one of the first groups in line for the vaccine, whenever it is released.

Re: Life as a GP practice manager

Posted: Sun May 03, 2020 11:20 am
by Janey Dal
I will pass on your regards Marilyn. She just loves patients! She is having no face to face appointments at all so she is as safe as we can make her.

She came into see me last week and said “Can I go to the bank for one of our patients?”

“No!” I said. That’s the kind of person she is but we can’t take the risk. I would love to have said yes but she could get accused of stealing money and we are not insured to deal with that kind of accusation. I advised her to contact the local authority who are providing that sort of support for patients.

As for the pain in the bum B12 man: he has already informed me that ‘other’ practices are still doing the injections (I’ve checked and they aren’t!). I am so tempted to say “well go to them then!”. He is totally passive aggressive and doing my head in! :lol: :lol: But the amount of time it’s taken to deal with him is ridiculous.

B12 injections cause us a great deal of trouble. They were handed out a few years ago to patients who didn’t clinically require them. They have to be done every 12 weeks so take up 4 nurse appointments per patient per year. There are a few patients who have a genuine clinical need but many who really only need to change their diet to get the right quantities of the vitamin or take over the counter supplements.

We did an exercise a few months ago to check all the patients on B12 injections and took the patients off them if there was no clinical need. You would have thought the world had ended!

It has such a placebo effect you wouldn’t believe. We had one lady who insisted her legs stopped working when her B12 injection was due. I would love to be able to inject them with something benign and see what happens because I bet most of them wouldn’t know the difference.

No wonder the NHS is in financial crisis! Some people really do take the proverbial.

We had a similar kick off when we stopped doing travel clinics. Patients were furious! The alternative is to go privately to a specialised travel clinic but they have to pay. Well they didn’t want to do that did they? Despite the fact that they were paying thousands for a holiday exotic enough to require injections, they didn’t want to pay £50 for a private travel vaccine.

When we did the clinics we charged £10 for them (it’s classed as private work so perfectly okay for us to charge). They didn’t like that either! “My wife is at XXXXX practice and they don’t charge!”

I had no sympathy. They are going to a destination that most of us could not afford to visit and then grumble about £10!

And we still get people complaining because we won’t give Northisterone which is for period delay. Many years ago doctors would give it out for women going on holiday who didn’t want to have a period whilst they were away. Now we don’t - it is not an illness. Again they can get if from the pharmacy but they have to pay for it!

What they fail to realise is that the NHS is there to deal with poorly people, not provide a cheap service for the pleasures in life.

Re: Life as a GP practice manager

Posted: Thu May 07, 2020 9:17 pm
by maz
I hope you have sorted all your naughty patients Jane. What is it with everyone? They should all be learning how to cope with their own ailments by now.

By the way, I keep meaning to ask you. Does your practice use the e-consult thingy? If so, how is it working. I keep having a look, but it seems a little difficult to get through me. Well the idea is great great of course, email your practice because you can't get through on the phone. But of course I am old and dumb as far as technology goes. Plus, apart from anything, who exactly sees what you are writing/asking? It looks like something to put off people from getting in touch :lol:

Just to edit, we did look harder and can see how you can get doctors' help, still not as easy as one would like, but at least there are some options.

Re: Life as a GP practice manager

Posted: Sat May 09, 2020 11:42 am
by Janey Dal
We are using econsultations. It is really, as you say, an alternative to a telephone call for things that are not urgent. It is also mandated in this year’s contract that all practices have to offer them.

At my practice we triage them when they come in and then forward them to the relevant member of staff. Some are requests for advice on medication, some are requests for administrative things like access to patient records and some require a GP appointment. They have to be turned around within 48 hours of receipt ie we have to have contacted the patient back within that timeframe.

There is an algorithm when you go onto the econsultation which won’t allow you to go further if you have eg chest pains and it advises you to ring 999 - yes patients would do this believe me.

We had one this week asking for the nurse to ring him to advise on whether he should be self isolating :shock: . I sent him an electronic message via the econsultation and said “No the nurse would NOT ring him and his decision to self isolate was between him and his employer”. They really do try it on!

Econsultations are not brilliant from a practice perspective because certainly at my practice they are just another route for patients to contact us for stupid requests! However they do potentially reduce phone calls although they are not utilised by the patients enough to make an appreciable difference. It is probably different in practices with a different patient demographic than us.

The main reason for them is to allow patients who work full time and struggle to get through on the phone during our opening hours to contact the GP, or in rural areas where travelling to see your GP is difficult.

We have had one patient who completed an econsultation over the weekend and we booked him into an appointment. He then rang the surgery on the Monday to book an appointment and got another appointment - amazingly then he ended up with two back to back appointments :lol: :roll: :roll: . Another patient sent a message to us asking if the GP could ring her back - she was on holiday in the US! And another who had cut their foot whilst walking on the beach in Spain. :shock:

The worst one was a man who contacted us weekly via eConsult with ridiculous requests. This went on for 10 weeks. His 11th and final eConsultation submission was to complain about the eConsult service :lol: :lol: .

So as you can see they have their place but I would suggest, as you are retired, you could just as easily ring the practice and speak to someone.