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 » Sat Aug 17, 2019 11:47 am

So first week back at work has been a corker! Firstly I walked into death by email - 187 of the beggars! :shock:

And then really I believe the full moon does make a difference! What a load of difficult patients I have had to deal with!

One patient who is in the process of transgendering into a female was really annoyed when he told us he had moved house and we advised his new address was out of our catchment area and therefore he would have to register elsewhere. A slight overreaction occurred when he came into the practice shouting, swearing and threatening to head butt anything that didn’t move. The problem was exacerbated by his appearance which is still extremely male but he was dressed as a female and had a moustache and long pink hair :shock: :shock: . We have had to remove him anyway for his behaviour but the situation was much like a Bennie Hill sketch it was so farcical :lol: :lol: .

And then another patient who I stopped from ordering his prescriptions online because he was abusing the system. He had found a loophole and was ordering a week’s worth of strong opiates every 3 days. We removed him from the list for fraud and he rang me up to complain :shock: . I refused to budge and he then said he would kill himself and put the phone down.

I checked with his GP but this was apparently his standard response whenever things don’t go his way so we dismissed it. Imagine my horror when a consultant from A&E rang to say he had been admitted after an overdose :shock: . However the consultant did say it was an “unambitious overdose” - I love the way doctors speak at times!

The consultant didn’t want to give him what he wanted and we agreed that that was correct. Apparently after taking the ‘overdose’ his partner (who according to his records he had reported as committing suicide 2 weeks previously :shock: ) had got so cross she had flushed all his medication down the toilet :roll: .

Really? :roll: :roll:

We agreed that he should be sent to his usual pharmacy who could give him an emergency supply over the weekend and the consultant said he was going to discharge him. The patient then rang to try to get more meds from us completely unaware that my conversation with the consultant was documented on his notes.

God these people suck the life out of you!

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Aug 24, 2019 11:47 am

So another week at the madhouse :lol: .

This week we had a patient walk in to the surgery and ask for a home visit. When asked who it was for he said “Me”.

The Receptionist rightly asked why he needed a home visit. He replied “Because I’m housebound!” I kid you not :lol: :lol: :lol: . The craziness of some people never fails to astonish me :lol: :lol: .

And then the guy who caused me all the problems last week wasn't kicked off our list until Wednesday and boy did he make his presence felt in those three days :evil: . On Friday evening the GP had put him on daily scripts to stop his abuse of the system. I had an urgent phone call from Adult Safeguarding on Monday saying he was on the phone and we had refused him prescriptions. So I explained the situation and off they went.

I then had a phone call from a very panicked NHS England representative saying he was on the phone and if he didn’t get his meds (which he again alleged we had refused him) he would kill himself.

The poor lady at NHS England must have thought I was a right old bag when I said to her “No he isn’t going to commit suicide, he's just after more medication. He’s on daily scripts and his next script will drop down onto the pharmacy system today”.

She said “Well he says he’s run out and he's rung the pharmacy and it’s not there!”

Me: “It’s 20 past 8 in the morning! It will be there some time today and he got a script yesterday.”

His wife/partner then rang the GP to say it was my fault he’d tried to commit suicide on Friday - well a) he didn’t try very hard and b) if he was upset it was only because I had stopped him abusing the system.

Face? Bovvered? :lol: :lol: I am actually astonished that he has a wife! He is apparently morbidly obese regardless of his opiate abuse!

So now he has been put on the Special Allocation Scheme which deals with patients who are too difficult to manage in general practice and which is 20 miles away from where he lives and just imagine everybody’s joy that the NHS will pay for his taxis to and from his new surgery :evil: .

This is because the NHS has a legal duty to provide health care to everybody. Personally I would be saying to patients like this “Off you go! You are abusing and defrauding the NHS so you don’t get a GP”.

You watch them all come into line if that were the case! :evil:

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Mon Aug 26, 2019 11:37 am

Oh and I forgot -how I don’t know - but we had a patient rang last week for an emergency same day appointment.

The girls ask what the condition is for the try to stop people sneaking in with non-urgent conditions.

“My clitoris is exploding”. She said :shock: :shock:

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maz
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Re: Life as a GP practice manager

Post by maz » Tue Aug 27, 2019 9:03 am

:shock: Oh my goodness. I hope she went to hospital straight away :shock: :lol: GP surgeries are not the place for exploding clitorises :? That is a new one for me. Shame you won't be able to tell us more but the imagination is running riot. :lol:
Marilyn

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

Post by paul..m » Thu Aug 29, 2019 7:29 pm

I will say nothing but check tube they have everything else :shock: :shock: :?
Paul

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Aug 31, 2019 11:23 am

So this week another wonderfully polite and happy patient emerged. I have had a run-in with him before but this one was the best! He had been trying to get more dihydrocodiene because he couldn’t go back to his flat because the police had told him it wasn’t safe for him and all his meds were in the flat.

I refused him because he had managed to get 2 weeks supply 4 weeks ago by telling our pharmacist that he was going on holiday to Spain for 2 weeks and needed a double supply (he is on weekly scripts because of his constant demand for more opiates). Whilst “on holiday’ he had been into the surgery for an appointment :roll: :roll: .

Well he wasn’t best pleased (we are pretty sure he is selling them rather than taking them). So he left the surgery shouting in Reception at me that I was a “f******* nob” and a “f****** waste of space” :shock: .

Another one for the violent patients’ register then :roll: :roll: . It’s just as well I find this amusing (which I do). One of the GPs was laughing with me about it and said “What other job could you do where you get such fulsome abuse on a daily basis?” :lol: :lol:

At the moment I feel like I need a hotline to the police in order to get incident numbers to kick violent patients off our list! It is definitely getting worse and mainly we think because we have subsumed 48 patients from the, now closed, drug and alcohol practice. NHS England saving money and putting practice staff in a situation where being sworn at and threatened is the norm.

And you wonder why I have no time for NHS England? They are too far removed from patient contact and only look at financial outcomes. The front line staff therefore bear the brunt of their idiocy!

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Sep 08, 2019 11:47 am

This week was total chaos!

The new RPOS (Repeat Prescribing Ordering System :roll: the NHS loves an acronym! :roll: ) came into force on Monday.

The rationale behind it is to prevent pharmacies from continuing to order medication for patients that they no longer need. A great idea indeed as there is absolutely no doubt that the pharmacies are making money out of ordering medication for patients that they are no longer taking. However the contract between the pharmacies and the NHS has actively encouraged this behaviour.

So instead of ordering meds from the pharmacy patients have been told they need to order from the GP practice (as we did many years ago). However, the GP practices simply cannot deal with the number of calls for repeat meds so we have had a campaign to encourage patients to sign up for the new NHS app where they can order repeat meds online.

But ‘vulnerable’ patients can still order form their pharmacy as before. Define vulnerable! We have to make that judgement call.

So now at our surgery:

Patients over 75, housebound or on the palliative care register can ring the practice to order their repeat meds
Vulnerable patients can order as before by ringing their pharmacy
Everybody else has to either sign up for the NHS App or post their repeat prescription requests into the box in the foyer or request repeat dispensing which means the GP orders a year’s worth of meds from the pharmacy which are handed out monthly.

Confusing? Yep! And they were confused! We had hundreds of phone calls from patients who had no bloody idea what was going on.

Again a typical strategic decision that doesn’t work at operational level (I want that on my gravestone!). So some bloody stupid Herbert at NHS England is patting himself on the back for saving the NHS money whilst we are left fielding the chaos because it wasn’t planned properly as per!

I had planned this like a military operation so that everybody at the practice knew exactly what was happening. Sadly - and I know you won’t believe this but it’s true - nobody had bothered to tell the pharmacies what was happening.

Some days there are just no words..............

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maz
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Re: Life as a GP practice manager

Post by maz » Mon Sep 09, 2019 9:23 am

We haven't been able to phone up for repeat prescriptions for quite a few years now. I guess like your practice some must still be allowed to phone in. We have done ours online for I guess 5 years 'ish. Now I believe they have introduced an App, but as you know, my phone is only a little used PAYG and has a hissy fit if it hears the... erm.. ?word App! I would have no idea what to do with an App of course. I am all for stopping pharmacies over dispensing completely. One of the reasons we have never gone for that system as I want control. Well as much control as they allow :roll:

I do wonder what the next fun project the NHS will think up. I am sure there lots of ridiculously over paid humans sitting in expensively appointed offices just thinking. Thinking of what else they can mess with.
Marilyn

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MikeyB
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Re: Life as a GP practice manager

Post by MikeyB » Thu Sep 12, 2019 10:59 am

When I phone the surgery, the response is “Press 1 for medication requests, Press 2 for all else”. I’ve never used online requests, not because I’m a Luddite, I don't see a reason to change. For sure, I’m under no pressure to do so. It is possible at the surgery, and I’m sure a lot of people use it.

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Sep 14, 2019 11:25 am

We simply have not enough man power to deal with the sheer volume of phone calls if all patients were able to order over the phone via the practice.

Patients can regularly wait 10 minutes on the phone now to make an appointment so we cannot allow an increase in calls. I would argue that making an appointment is more immediately important than ordering your prescriptions so we have to try to divert the patients ordering repeat prescriptions via another route.

The NHS App is actually very good and will improve. You can also make appointments via it which again is saving incoming phone calls.

The trouble is of course it depends on your surgery. Every single surgery has different processes.

We are currently having a campaign to refuse patients ordering repeat medication urgently. We have a 48 hour turn around from receipt of a request for repeat meds to issuing the prescription. But there are the repeat offenders who order late every month, insist that it is urgent and therefore put increasing pressure on the service.

We have a list of medication that MUST be ordered urgently because it is vital for the patients: epilepsy meds, diabetic meds, heart meds etc. But these patients tend to be more organised and rarely ask for urgent prescriptions.

It is, as ever, the scallies, who cause the problem. They can go to the pharmacy and ask for short term meds or they can simply do without for a couple of days. It will take some time for the message to sink in but it will.

We have one patient who is on weekly scripts (therefore an abuser of pain meds!) who every week would try to get her weekly script a day early. On one occasion she rang the surgery 6 times in one day trying to get her meds early. It’s usually because her sister who lives in Scotland is ill so she has to visit her :roll: :roll: . So I have written to her and told her that she must never ask for her meds early again because she will be refused. It is her responsibility to manage her medication.

There is a note on her record so that when she tries again (and she will!) the Reception staff are able to simply refuse.

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Sep 21, 2019 11:20 am

This week we had an upgrade to the IT system. Utter chaos ensued as usual! The IT guys are great but simply don't get that we cannot just stop working just so they can do their job. It has to be carefully planned so the GPs are not without a computer during the day at all. The computers which are used in Reception have to be done during a ‘quiet’ time. There isn’t one! The staff are fantastic and just get on with things despite chaos all around them.

Regardless of minute by minute planning prior to the upgrade, it never works out as planned. However we prevailed as ever.

We defenestrated a patient a few weeks ago for repeated did not attends (DNAs). She was a character and permanently drunk but pushed her luck too far and we got rid of her. However her husband is still at the practice. She rang up demanding to speak to a GP about her husband Harry. Harry is apparently having an affair (he is 92, 3 stone wet through and walks with a Zimmer frame) and we have heard this story about 300 times before.

It is not a medical issue and she is no longer a patient so we are not obliged to do anything. And even if we were what can we do? I ended up with her on the phone and she said Harry had left home (who can blame him?) and was in a hostel ‘somewhere’. She told me we needed to DO something.

“What do you want me to do Mrs Smith?”

“You must visit him, he is mentally ill”.

“How can we visit him Mrs Smith if we don’t know where he is?”

“You DO know where he is”

“Mrs Smith, YOU don't know where he is, so how can we know?”

She put the phone down on me.

Never a dull moment!

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Sep 22, 2019 9:37 am

Oh my. I don't know how you do it Jane.
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Sep 22, 2019 11:47 am

I laugh Marilyn! That’s how I do it! :lol: :lol: :lol:

This is the same patient who I spoke to a few months ago on the phone and she was telling me that Harry was suicidal and she needed to make an appointment for him.

Harry was in the background very clearly shouting:

“I’m not going down that f****** surgery, I don’t want any f****** help. They can all f*** off!”

“I don’t think Mr Smith is on board with your suggestion Mrs Smith.” I advised her :lol: :lol: . The thing is she is terribly posh which somehow makes it even funnier :lol: :lol: .

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maz
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Re: Life as a GP practice manager

Post by maz » Mon Sep 23, 2019 9:41 am

I thought I remembered her. She is one of a kind. Well I hope she is for your sake :lol:
Marilyn

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MikeyB
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Re: Life as a GP practice manager

Post by MikeyB » Wed Sep 25, 2019 1:03 am

Is Stockton really full of psychos, drug addicts and alcoholics? Not a very pleasant place to live? We didn’t get such cases even when I worked in Maidstone with one of our surgeries on the biggest council estate in the UK. Is it the water in the North East?

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