Life as a GP practice manager

Chat about anything you like... Fed up with the state of the world today? Tell us!
User avatar
maz
Posts: 7645
Joined: Fri Jan 01, 2010 11:29 am
Location: Harrogate, UK.

Re: Life as a GP practice manager

Post by maz » Sun May 10, 2020 9:29 am

Thank you for the helpful explanation Jane. I really am not surprised you get issues with people using it though.

I used to love our GP practice, but I don't think they are any where close to the way you run yours at this time. Truly.
Marilyn

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Sun May 10, 2020 11:04 am

Thank you. We do try hard to do it right and I am keen on new technology as well so we are quite forward thinking. Practices however, like any business, go through changes. The one I work at has had a good reputation for many years and it is something we work hard to maintain.

A lot depends on the senior GP partner and his/her standards. The one we have is a really good senior partner. He is very fair and measured. He is great at praising you if you have done well and also more than capable of explaining if you have done something wrong. This works for me because it’s how I also treat the staff.

And yes we were open for the Bank Holiday again on Friday! It’s a nonsense because hardly anybody knew we were open so hardly anybody rang. In the afternoon the GPs and nurses had 12 patient contacts and the NHS is paying all the staff who went in time and a half - it makes my blood boil! But despite me practically begging the CCG to say we didn’t have to open, they insisted.

I went in because I believe if the staff have to go in so do I. I have to say it was a canny little earner for me which helps but that genuinely wasn't the reason I did it. I actually got loads of work done because we were on absolute bare minimum staffing so I wasn’t interrupted all the time.

We observed the 2 minute silence at 11 am, shut the surgery for an hour so we could all have lunch together (not contractually allowed actually but who was checking?), and then bought some Prosecco and Nosecco :lol: so we could raise a glass to the fallen at 3 pm.

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Sat May 16, 2020 1:03 pm

So this week the NHS in its wisdom have said we don’t need to open on the 25th May Bank Holiday.

We have been telling them that the need to open on the Bank Holidays is nonsense since the Easter break. And now I will shock you! We paid staff time and a half on top of their normal salary for coming in at Easter and also VE Day - this was pretty standard for all practices. We were also allowed to claim that back from NHS England via the CCG (although we didn’t know that when we offered the time and half pay to the staff coming in). This included all employer pension payments and NI contributions.

For my practice we have claimed (completely genuinely I hasten to add) £14,000 for the 3 days opening :shock: :shock: :shock:. Multiply THAT by all the practices in the country! And the stupid part was that we didn’t WANT to open even with the enhanced pay! We kept saying it would be a waste of time but nobody listened :twisted: .

On VE Day afternoon the GPs and nurses (absolute bare minimum staffing here) had 12 phone calls with patients - so basically 2 each. Don’t even go there with how much this stupidity has cost per patient!

Many of the phone calls into the practice to the reception staff were to ask when the pharmacy next door would be open :roll: :lol: :lol: .

I had some hope with Boris initially but at the moment I feel like the lunatics are running the asylum :lol: .

We are also now advised to do risk assessments on all ethnic minority staff due to the evidence that they are more affected by the virus than everyone else. We only have 3 who are affected by this but we need to check with them about whether they are prepared to do face to face appointments with patients. Best practice advises that they should be able to refuse face to face due to the very real extra risk.

I also had to laugh at myself because apparently my risk of dying from COVID doubled on Wednesday last week when I turned 60! It’s still very low mind!

Hugs

Jane xx

User avatar
MikeyB
Posts: 2976
Joined: Sat Apr 30, 2016 6:48 pm
Location: Ribble Valley, Lancashire

Re: Life as a GP practice manager

Post by MikeyB » Thu May 21, 2020 12:13 am

Don’t know about your risk doubling, Jane, if I were a coronavirus I wouldn’t dare infect you for fear of reprisals and scorn. :D

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Fri May 22, 2020 2:02 pm

:lol: :lol:

If only it were that simple to avoid the nasty little ........ virus :lol:.

I know I am being critical, however I must add that it is more criticism of NHS England than the government per se. I know they are intrinsically linked but if only NHSE listened to the front line staff their ‘informed’ decisions would be more informed. And then the information the government were handing out would be more accurate.

I kind of feel sorry for the government at the moment. Boris is completely new in office with a huge majority that would allow him to really make some much needed changes, whether you were in favour of them or not, and then Coronavirus hit. Basically they are damned if they do and damned if they don’t.

This has been a perfect storm! 10 years of austerity that meant all the public services were on their bare bones regarding staff and then an overnight need for every organisation to put more resources in.

I just want to say that I still blame David Cameron for a lot of this. Not the Coronavirus obviously 🙄. But the austerity which, from my understanding, achieved very little, and right now, means bot all!

Hugs

Jane xx

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Sun May 24, 2020 12:06 pm

I am back at work on Tuesday after my week off.

I will lose the first three days just answering emails that came in whilst I was off and catching up on what’s been happening! I also need to organise a meeting to decide which bits of the new processes we will adopt post-virus.

There is little doubt that this will change the way GP practices work for ever. We have been encouraged to adopt new, more technological, ways of working for some time, but this crisis has moved things on exponentially. We were simply discussing video consultations before. Within a week we had adopted them as a useful way to consult with patients because we couldn’t physically see them.

We are using photos more than we ever did. This works really well for things like skin rashes and lesions and saves both GP and patient time.

There will always be the need for GPs to see patients face to face as the norm, but alternative methods of consultation will be very helpful particularly for the younger generation who use their smartphones for everything! Our GPs have had to adapt quickly. They have been trained to assess a patient holistically when they walk into the consulting room. They obviously look for general demeanour, eye contact, the patient’s overall appearance to help them assess the condition.

This will never change for certain patients and conditions, but I can envisage more telephone or video triaging before the patients are asked to visit the surgery. This could be carried out by trained staff rather than GPs.

Patient safety will always be paramount and if a GP has any doubts at all the patients will be asked to come to the surgery. I suspect the number of contacts will not reduce but their will be a variety of types of contact which will be better for everybody.

Why would anybody want to visit their GP practice to be told that they don’t need antibiotics because their condition is viral? Or to be told that they can get the medication they need over the counter at the pharmacy?

Interesting times ahead.

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Sat May 30, 2020 12:00 pm

So now after a pretty hectic week the government have added MORE pointless issues!

The ‘track and trace’ initiative has caused us even more problems. Previously if a member of staff was ill they stayed at home to self isolate under the guidelines. We were coping with that.

Now however with the track and trace nonsense, if a member of staff tests positive and gives the names of all the people they have been in contact with, and they all have to self isolate for 14 days, then the whole bloody surgery could close :evil: . It’s just nonsense in my opinion.

We have a low and slow rate of infection at the practice which is very manageable.

And from all the reports I’ve read the track and trace system isn’t working properly because none of the ‘trained’ track and trace staff have been trained adequately and some haven’t even got a log on to the system they haven’t even been trained to use. Bloody government initiatives!

There is no doubt that the situation is causing massive stress for some people at work. EVERYTHING is different and it is really hard to keep an eye on everyone’s stress issues. I have to try to do this whilst dealing with my own which I have noticed is a total lack of reliable memory from the last 11 weeks. We’re all on information overload.

The number of patients attending the practice is slowly, slowly increasing and we have to manage that. Previously we had one clinical room which was stripped of any fabric (curtains, blinds etc) and we used that room to see patients. The doctor went to the patient rather than the other way round.

Now the numbers are increasing we need to find another clinical room we can strip. We don’t have a spare.

Nevertheless the message is the same. Contact your GP if you need to! We are still working as near to normal as we can whilst protecting both staff and patients from the virus.

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Sat Jun 06, 2020 12:31 pm

So good news this week. In our area the hospitals are intending to be ‘back to normal’ with referrals to secondary care by 22nd June. This may be different in your area but it will be a similar timescale and is a significant improvement.

Currently our GPs are referring patients and the referrals are just sitting waiting until we can send them (the hospitals were always accepting 2 week rule referrals by the way ie suspected cancer). The hospitals in our area are being really Teflon about the other referrals which is really annoying because most of the clinical staff must be sitting round doing nothing.

My argument is that as the hospitals have no idea how many referrals are waiting to be sent, how can they manage them? Only they know their staffing levels and how many patients they can see in a day given social distancing rules. It is way past time that they should be looking at the referrals and making a forward plan.

I have been in touch with the CCG to express my dissatisfaction. I am Chair of the practice managers’ group so asked for comments from all the other managers and sent them on to the CCG (up the revolution! :lol: ). This seems to have at least helped move things on a bit.

The hospitals have come up with a radical solution :roll: . We start off by sending them a week’s worth of referrals to see if their new system works. Their new system is to triage the referrals into patients they can consult with via video consultations, patients they can have a telephone consultation with and patients who require a face to face consultation.

Radical! :roll: :roll: The GPs practices have been doing this for 12 weeks and implemented it within a week! It has taken the hospital 12 weeks to work it out.

The waiting times are going to be horrendous for some time to come I’m afraid.

And a dreadful sign of the times: we have one patient who had a cough but didn’t meet the 2 week rule criteria so the GP referred her as an urgent referral. This was just as the lockdown started. The hospital rejected it because of the lockdown.

The patient rang again and her symptoms were no better so the GP decided to send her for a chest x-ray mainly because the GP felt the patient needed to think something was happening. The x-ray results prove she has lung cancer :? .

There will be more I am very sad to say.

User avatar
maz
Posts: 7645
Joined: Fri Jan 01, 2010 11:29 am
Location: Harrogate, UK.

Re: Life as a GP practice manager

Post by maz » Sun Jun 07, 2020 9:43 am

Oh Jane, that is just so sad, I felt so upset reading about your patient. That poor person. I fear there will be many more such cases. Plus even the more less urgent cases will be suffering more of course, and worrying of course. I know the first couple of months were awful for the hospitals, but they have had quite a while now to be thinking ahead. I'm not sure thinking ahead is something parts of the NHS are good at.

Same with dentists. All these weeks doing nothing much apart from advising a few emergency patients and telling them where to go(if they were lucky enough to have an emergency dental clinic open in their area that is), and now they have had a week or so to be ready to open, they are moaning a bundle that they haven't had enough time to get ready. I do know about their PPE situation and aerosol producing procedures. It is all 'don't expect things to be back to normal', 'there won't be any fillings or other aerosol procedures yet', 'you will be waiting outside', you will have to pay for your PPE, which incidentally have gone up in price up to 200%", ' we have to get the staff back in', 'we have to train the staff' etc. (Today's grumble over with :lol: )

I have said it before and I will say it again, you are one amazing practice manager Jane. They should be so grateful to you for what you have done and are doing. I wish you were our surgery's practice manager. I hope soon things do settle to some semblance of new workable normal and that patients have learnt some things throughout the lockdown, such as they don't need to see the doctor for every time they have dandruff.
Marilyn

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Sun Jun 07, 2020 11:36 am

Why thank you Marilyn! I have a great team at the practice and very supportive GPs I hasten to add.

There is no doubt that many of the hospital staff are sitting round kicking their heels at the moment. They’ve had more than enough time to plan. It won’t surprise you to learn that the CCG had meetings with the hospital managers EVERY DAY last week :shock: . How many meetings does it take to decide that they need to start seeing patients asap?

And to add even more frustration to the situation, we are supposed to be tested for the antibody as NHS staff. Our Pathology lab hasn’t got the capacity to do that at the moment so none are getting done :roll: :roll: . How long have they known there was going to be an antibody test?

There is no benefit to the test I hasten to add. It is purely to provide the government with statistics. If you test positive to the antibodies there is no guarantee that you are immune from catching the virus so you still have to social distance. It seems increasingly clear that you can catch it more than once and nobody knows how long the immunity will last.

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Sat Jun 13, 2020 11:49 am

Typical NHS inefficiency this week:

I am a member of the local Practice Managers’ WhatsApp group. One of them posted on Friday about 11ish to say that the antibody tests were available for GP practice staff on the hospital IT system. Within 20 minutes in my practice we had sorted out the process and by 2.30 when the blood results are collected from the practice by the hospital we had 15 results from staff to be tested.

I received an email from the CCG about 4pm saying that the process was still being discussed and we should wait until next week to test staff :lol: :lol: .

The only process is that in order to test our own staff they have to be registered at our practice as a temporary patient. Obviously that means they can view their own record and any other staff member in the practice. To access your own record or somebody else’s without a clinical need to do so is a sackable offence so I advised the staff as such. It is also easily auditable.

It is entirely the staff member’s choice and if they don’t want to be registered as a temporary patient then that is absolutely their decision and is respected as such.

So the CCG are still mulling this over whilst we, and most of the other practices in the area, have just gone ahead. The CCG will no doubt send out advice next week regarding registering as a temporary patient and how to deal with it :roll: :roll: .

And will also have had to have 24 meetings to discuss :evil: .

User avatar
maz
Posts: 7645
Joined: Fri Jan 01, 2010 11:29 am
Location: Harrogate, UK.

Re: Life as a GP practice manager

Post by maz » Sun Jun 14, 2020 9:29 am

I have had it up to :evil: with NHS inefficiency, slowness and general inactivity. Please Jane go and organise them. I know you could do it.
Marilyn

User avatar
MikeyB
Posts: 2976
Joined: Sat Apr 30, 2016 6:48 pm
Location: Ribble Valley, Lancashire

Re: Life as a GP practice manager

Post by MikeyB » Fri Jun 19, 2020 11:47 pm

Don’t know about NHS inefficiency. I had a diabetic consultant appointment over the phone a couple of weeks ago which was very productive.

I’ve just received a letter for a neurology appointment at the Walton Centre in Liverpool. That’s a video appointment - I’ll use my computer to access that, I’ve got an HD camera and microphone. I’ve been given instruction how to access the clinic, and how I should be in the virtual waiting room 15 minutes before the appointment. At least I’ll be able to have a vape in the waiting room :D I’ve been told to dress appropriately, so no slobbing around in PJs, or a shirt and tie with no breeks on.

Again, that will be productive because I’ve had all the tests I need and she gave me a thorough examination last time I was there, so it’s just a progress report.

I’m sure that this will be the future of hospital appointments, particularly follow ups, which clog up clinics left right and centre. If this lockdown, bring it on. It’ll save the NHS thousands in transporting me to and from appointments.

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Sat Jun 20, 2020 11:59 am

There is no doubt Mike that the NHS will change beyond recognition as a result of the virus. We are already looking at different ways to triage patients in primary care. Photos sent in by patients of rashes and skin lesions are now the norm and that will not change because it is so efficient.

Virtual ward rounds via video consultation at nursing homes will also become the norm. Again very efficient and in this area the nursing home patients are overseen by the Community Matrons who can prescribe. These patients generally don’t need a doctor, just a nurse and if the nurse feels that they need extra advice then the doctor can get involved.

Interestingly though the local medical committee (CLMC) advised us that it was illegal for us to take blood from our own staff and send the results into the path lab. OOOOps!

Meanwhile in an email from the CCG they have set up a rota for practices to take blood from their own staff and send them into the path lab. So completely conflicting advice! This is the kind of stuff I deal with on a regular basis.

COVID has, without doubt, changed and will continue to change a lot of processes that have been in place for years without question.

I do genuinely think though that it will change healthcare for the better. We have been forced to find more efficient ways of working and the CCG and NHSE have been forced to move quickly which has never been seen before!

Strange times for us all!

User avatar
Janey Dal
Posts: 9931
Joined: Mon Jul 26, 2010 10:34 am
Location: Stockton on Tees, NE UK.

Re: Life as a GP practice manager

Post by Janey Dal » Sat Jun 27, 2020 11:42 am

We have recently appointed a new GP to the practice. She is an extra rather than a replacement so we will have 9 GPs.

We run personal lists at my practice - so each GP only sees their own patients for routine appointments unless it is an urgent same day appointment, or the GP is on annual leave. It is unusual In primary care but we prefer it. The patients get total continuity of care, which for patients who attend regularly is great and the GPs get to know their own patients really well.

However, one of the very minor downsides of this is that I now have to move patients from each of the 8 GPs’ lists over to the new GP’s list. Not a problem technologically but I also had to write to all the moving patients to tell them. Oh dear! What a storm in a teacup that has caused!

I have had letters from patients begging me to leave them with their current GP because they are the only ones who understand their condition :roll: , one patient flatly refusing to move and one who told me it was very unprofessional that he hadn’t been told. How did he know then? :shock: The GPs actually checked their lists and decided which patients they felt they needed to keep due to either the complexity of their condition or that they knew the patient and their whole family for years. But we can’t tell the moving patients that! They will get offended.

The thing is though that 2 of our incumbent GPs will be retiring in a couple of years so what do the patients think they will do then?

We will look at all the requests and make a decision. But I will have to be firm or else the process could continue ad infinitum!

Post Reply

Who is online

Users browsing this forum: No registered users and 22 guests