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 Jan 02, 2021 2:03 pm

And so it changes again! No wonder I'm grey!

Apparently the BMA and some GP practices have kicked off about cancelling the booster jab. The GPs are saying that patients have consented to the treatment (ie 2 x jabs, 3 weeks apart) and it is not ethical to cancel a course of treatment before it is completed. A very valid point! There is also a mindset amongst practices that we have promised the patients something and we should deliver it. And I think your point about the 12 weeks is very valid Marilyn and I suspect Pfizer's comments have set the ball rolling with GP practices to protest.

The BMA has said it will support any practices that decide to go ahead with the booster. My practice has decided to do this. So next week we WILL be delivering the booster to the first set of patients as originally agreed :roll: :roll: . DO try to keep up there :lol: :lol: .

I had decided that we would ring the patients again next week to remind them anyway (ringing Tuesday's patients on Monday, Wednesday's on Tuesday etc) because I think that given their age and the time of year, many will have the days mixed up and some will be confused about whether to come or not given the news.

I can see both sides to be honest: the government may have a point that SOME immunity is better than none, but they don't think things through or ASK for advice from anyone who works on the front line. There is an opinion that younger, working age people should have the jab first to help get the economy moving rather than the most vulnerable who can stay at home and take extra care.

I don't know the answer to that. But I just wish the government would think things through before moving the goalposts on to a bloody rugby pitch and then back again :lol: :lol: :roll: :roll: .

Let's see what next week brings! I dare not even speculate at the moment :lol: :lol: .

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Jan 03, 2021 9:55 am

Well done on making that decision Jane(and practice) I hope things continue to go well. I was wondering if one of the reasons for spreading the vaccine round more people was to get the younger ones done. To be honest that is a good idea really. Not only to get more back to work(including some government workers who have been off going on 10 months on full pay), but also to get those 'don't care' idiots who are spreading the virus covered to stop them spreading it as much. I agree we oldies can stay inside and away from others a while longer. I do think front line medical staff and extremely vulnerable need the 2 doses though.
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Jan 09, 2021 2:42 pm

Well! Things move on apace! We administered the booster to our 80 plus patients this week. They were so grateful bless them :D .

We also vaccinated most of our care home patients and staff this week. We have another vaccine clinic on Thursday and Friday next week to vaccinate the remaining 80 plus patients with their first jab but this is with the Astra Zeneca (Oxford) vaccine.

I was with 3 doctors on Thursday at one of our care homes to help manage the administration of the vaccine. We had a fantastic moment when one of the doctors was about to vaccinate a patient who, God bless her, was severely demented. He told her he was going to give her an injection and she told him to "stick his injection up his a***". :shock: :lol: :lol: :lol: :lol:

It made our day! :lol: :lol: :lol:

Everybody is working their socks off at the moment to get this vaccine out there. We are all pretty spooked about the new variant but we keep on buggering on and fighting the fight.

The Astra Zeneca vaccine is more portable and much like the flu jab in terms of storage so will make our lives a bit easier.

I also had my first jab this week -the Pfizer one. Some of our staff also had the second Pfizer jab this week and all have been unwell for 24 hours afterwards with headaches and high temperature in varying degrees of severity. Some managed to come into work and some didn't.

So you can imagine just how much I am looking forward to my second jab :roll: :roll: .

The current guidance is that you need your second jab between 3 - 12 weeks after your first.

It's controlled mayhem!

Meanwhile we are still doing our day to day work at the practice. Don't ask me how! So please bear with your GP practice at the moment. We have never worked harder.

Keep safe guys xx

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Jan 10, 2021 9:33 am

I'm so impressed with your practice Jane(and down much to your organisation) We have absolutely no idea what is happening in Harrogate. They began with great fanfare before Christmas, on the local news and online media, and then stopped 3 days later - apparently - as nobody could find out what was happening. The Showground vaccination entrance was all locked up and people could find no information anywhere, and the local Commissioning Group weren't answering questions from local media about it. Google is no help as it gives you the place where the vaccinations will be given(Showground) but when you click on the link(NHS site) the page has gone. We can only guess what has happened, but it wasn't vaccinations :lol: I heard a rumour they had started up again this week so hopefully they will get moving when the Oxford vaccine becomes more available. They were vaccinating hospital staff though which is good. I guess that is where the team disappeared to :| as if there is no one at the hospital to administer the vaccines :roll:

John and I aren't going anywhere so it doesn't matter over much when they get to our age range, but we do have a huge elderly(more elderly than us :wink: ) population which needs to get vaccinated and numbers are increasing rapidly. I'm hoping they have the GP practices doing them soon, that can only be better for more rural areas.

Even with all that, I am glad you are getting both vaccines, just as it should be. Well done on your week's work.
Marilyn

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Re: Life as a GP practice manager

Post by refandy » Fri Jan 15, 2021 9:10 pm

Well done Jane and her team!

I've got a couple of friends who are nurses. One in a hospital dealing with patients who have Covid - she was ill from her first injection (not sure which flavour). Another is a nurse in a GP surgery and they have received the first batch of vaccines. She's been working 12 hour days the past few days - 2 of them her days off. I can only imagine how busy you've been.

Take care
Andy

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Re: Life as a GP practice manager

Post by paul...m » Sat Jan 16, 2021 6:49 am

East Anglia worst in country for stabbing people in arm but hopefully starting next week .

Hope all those in health care get some reconition at the end of this . If footballers can get MBEs then so should NHS Apart from Hancock

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Jan 16, 2021 3:09 pm

Thanks guys! And yes the NHS in general needs some kind of recognition. The front line nurses who are dealing with COVID patients are heroes! We are pretty well protected in GP practice but the hospital front line staff are not.

We had an unbelievable incident on Tuesday last week. We got an email saying we were being delivered of 1400 oxford vaccines (which we were expecting) and 975 Pfizer vaccines (which we were not expecting) sometime on Wednesday :shock: :shock: . The Pfizer vaccine needs to be given to patients within 3 days of delivery. So in order to avoid working on Saturday (which we are trying to avoid if possible - we all need our weekends at the moment) we had 2 days to deliver the Pfizer vaccine. The calculations were that we needed 10 vaccinators working alongside each other for 2 full days and we were going to have to take over the ground floor of next door's GP practice and move all their GPs into our premises.

We were half way through a very manic meeting to sort out the details when we received an email to say "Sorry! But we made a mistake. You are only getting the Oxford vaccine :shock: :shock: ." Luckily we all have a sense of humour :roll: :roll: :lol: :lol: .

To be fair Marilyn the supply chain is still not up to full capacity so it may well be that your CCG doesn't know when it is getting any vaccines. We have a delivery next week of another 1400 Oxfords but we have no idea when we are getting any more after that. The Pfizer vaccine is being slightly delayed due to one of the main manufacturing plants being upgraded to increase their capacity.

From next week we will be delivering the vaccine from our own premises which is much easier. The rules are changing on a daily basis. The Oxford vaccine is so much easier to deal with as it is portable and doesn't require a 15 minute wait after the vaccine (unless and until some selfish git has an anaphylactic episode after the vaccine :lol: :lol: ). It also stores in a normal fridge for up to 4 months.

And we are also starting next week on the 75 - 79 year olds! We have delivered vaccines to 1100 of our patients at the moment which is pretty incredible. This has been with the help of retired GPs and a retired policeman who all came in to help us out. It's really fantastic.

I don't think I'll forget this year in a hurry!

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Jan 17, 2021 9:44 am

Is that this year or last year...or both :wink: ?

Yes, I did get to understand the difficulties with the vaccinations. I guess knowing how you are doing doesn't help :lol: :lol: Truly, I am happy to wait indoors for my turn. I would rather all the front line healthcare workers got theirs. If only they weren't so secretive here about it all, but sometimes that is a good thing. They are up and running again here, and apparently doing a great job safely and quickly. The snow didn't help things though.

John's sister and husband had their first vaccinations at the beginning of January and they are both 76. That is near Kings Lynn so they are going great guns. His other sister and husband had theirs on 4th January, though the husband is just over 80, and if they are going alphabetically, their surname begins with A :D So whilst it is still a little bit annoying that things are so different around the country, it is great to know things are really moving. And with the news of another vaccine, we should get through the population quicker :D .

Keep on keeping on Jane. There is light at the end of the tunnel.
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Jan 23, 2021 3:30 pm

I will do my best Marilyn :lol: :lol: .

A madly busy week this week with delivering the vaccines on Thursday and Friday at our own practice. I did a 10 hour day on both days :roll: :roll: so was pretty shot when in got in last night. And no I don't get overtime pay. It is accepted that it is part of the job for Practice Managers.

We were all set to do a mass vaccine clinic on Tuesday 2nd and Wednesday 3rd of February with 4 vaccinators working over 2 days. It takes some organising with staff and rooms etc but we were well on with it and then - they cut the number of vaccines we were getting because apparently the north is ahead of the south of the country :evil: :evil: . God forbid we should be ahead of the south! That would never do! :evil: :evil: So some of our vaccines have been sent elsewhere.

And I had a very cross patient on the phone complaining that he had been waiting for his skin tags to be removed for over a year and when was his appointment going to be. We do minor surgery at our practice but funnily enough it's been cancelled due to the pandemic :roll: .

I was so tempted to tell him that as people are dying from COVID I didn't give a flying doodah about his bloody skin tags :roll: :roll: :lol: :lol: . He explained they were at the site of the waistband of his trousers so get sore. I told him to put an elastoplast over them. He said I was rude. I think he was mistaking me for someone who gives a s*** :lol: :lol: .

We have not had a full staff in since the beginning of the pandemic. We always either have someone off with COVID (surprisingly few as it happens) or someone off because a family member has tested positive and they have to isolate (quite a lot, particularly with staff with school age children). We are in a state of permanent overwork and this guy is unhappy about a couple of skin tags :roll: :roll: .

And the highlight of the week: We now get patients to send in photos of minor rashes and skin lesions. It is an accredited IT system so very safe from hackers. It is a revelation and is one of the COVID solutions we will continue with post-pandemic. This patient had warts around her nethers and was asked to send in photos. She did so and helpfully labelled them "bum" and "virgina". :lol: :lol:

It cheered us all up :lol: :lol: .

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Jan 24, 2021 9:46 am

It is all your fault the vaccines were sent elsewhere Jane, you have done such a great job you have ruined it for the rest of the region :lol: All I could think of was 'typical, put London first' :roll: I was very suspicious about it all, and I have a theory :evil: :lol:

As far as locally, Harrogate seems to be struggling to get all our many over 80's done, and whilst numbers of cases in regions around us are going down, our North Yorkshire numbers are rising. We will see what happens now the vaccine numbers have been cut. I just wish people would stop bragging on Facebook that they have received their vaccines though, particularly when they are younger than us :lol:
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Mon Jan 25, 2021 12:31 pm

It is really very rude to brag about it Marilyn! As I said we have to phone people at the end of every vaccine session to get them down to the practice in 20 minutes maximum to ensure no vaccines are wasted.

Some of these are younger than the current cohort of patients but we always make sure we can justify the decision if challenged. They are not all patients at our practice but always front line workers. So we have vaccinated a policeman and 3 teachers - but in my opinion, they SHOULD be in the first cohort anyway. There are no immediate plans to vaccinate teachers or police officers any sooner than their age group which is VERY wrong. They are the ones in a very high risk group who have no choice but to go to work.

They are in a higher risk group than many GP practice staff due to their necessary close contact with people. We can manage our contact, they can't.

My sister in law, who is a retired nurse, has volunteered to vaccinate people in Harrogate where she lives. So that's one person doing vaccines at least :lol: . Let's hope there's a few more!

It really seems to be a lottery on who gets vaccines across the country. And I am furious that down south is getting more vaccines because up north is ahead of the game. We are ahead of the game because we volunteered to do the first vaccines. So now we get punished for doing the right thing :evil: .

It's all about votes with politicians! :evil:

On an encouraging note, we vaccinated a whole care home 2 weeks ago with their first jab. The vaccine is supposed to be at maximum effectiveness after 3 weeks. The care home residents are now all suffering from a COVID outbreak BUT! They all have very mild symptoms and none of them need to be admitted to hospital - so basically it's working.

Cheering! :D

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maz
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Re: Life as a GP practice manager

Post by maz » Tue Jan 26, 2021 9:46 am

That is encouraging news about the care home Jane. It is what they said that the first vaccine helps you stop getting a more serious illness, and of course that helps the hospital situation. Of course there might be the odd care home resident who still has a more severe case, but it should be nothing like it was in the first wave for them.

Please thank your sister for me in helping my area get moving with the vaccinations. The workers and volunteers are doing a fantastic job for sure, here and everywhere, including you and your practice too Jane. Don't ever think you aren't appreciated.

One thing with them sending half the north's vaccines down south is that people who should have been in the know weren't. Firstly it was reported on the early evening local news that they were transferring half the North's vaccines down south as almost as a good thing. Then next morning came all the local complaints :lol:. Our MP put out a message saying it was wrong and NO vaccines were being transferred from our area. On the local news the head vaccine admin. guy, I can't remember his name, said exactly the same, it was not true. Then a snooty NHS lady who also seemed to be in charge was interviewed and she said it was indeed the case and was the only fair thing to do(with a sly smile on her face). So the main government appointed vaccine guy didn't even know of the decision, as well as local MP's apparently. Typical NHS management mess sigh :roll: I would have thought the London area were given more vaccines in the first place being as at that time they were the most affected with the newer UK variant. I still have my theories about London's apparent slowness in vaccinating the over 80's though, meaning they get rewarded with more vaccines :?
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Jan 30, 2021 1:57 pm

Isn't it sad that we have so little faith in the establishment? They deserve it mind, but sad all the same.

So again interesting news! We have to use an IT system called Pinnacle to record the administration of the vaccines. When it was announced I KNEW it would end in tears, having had experience of NHS IT systems in the past.

Imagine my joy then on Friday to discover that they are reporting a 2% error rate in Pinnacle across the country. 2% may not sound much but if you accept that we will be vaccinating millions of patients 2% doesn't sound so low does it?

The impact is that for some patients who have been vaccinated this does not appear in their GP clinical record and for some patients it is not even appearing in Pinnacle despite the fact that we KNOW they have been vaccinated. Some patients, according to Pinnacle, have been vaccinated twice on the same day at the same time. The numbers are too high for it to be user error.

Guess who is picking this up to try to reconcile the numbers? YES! You've guessed it, your local GP practice :roll: :roll: .

And, as if this weren't bad enough, we are mandated to submit figures to NHS England for the number of vaccines we have given by midnight on 31st January. Which, if you hadn't realised, is a Sunday. As the information updates overnight in Pinnacle, any vaccines given on Friday or Saturday would mean somebody working the weekend. Any given on Sunday - forget it!

And even better! The reporting system needs a username and password to access and, despite having to submit the data by Sunday, by close of play on Friday, nobody had their username and password :shock: :shock: .

If only the government had let GP practices organise this! It would have been brilliant. As soon as the government becomes involved they create chaos.

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Jan 31, 2021 11:58 am

Also this week in a non-COVID related situation _ yes there still are some! - we had a patient complaining bitterly about a GP who had refused to refer her 3 year old son to ENT. Her son had had one diagnosis of tonsillitis and mum insisted on a referral.

The national rules are that GPs cannot refer a child to ENT for tonsillitis until they have had 8 episodes in a 12 month period. The NHS has its challenges at times, but rules like this are based on years of research and that most children will simply 'grow out' of episodes of tonsillitis. Equally the only real remedy is a tonsillectomy, which again have proven to be largely ineffective after years of research.

If the GP were to refer the child the referral would be rejected by the hospital. There are obviously situations where this can be overridden after clinical assessment, but it is rare.

The interesting part is that the family are Latvian. Latvian and Romanian patients are notoriously demanding because their health services are private so provided they can pay for it the doctors will refer to the hospital for anything if the patient so wishes. This causes us problems because the patients' expectations of the NHS are completely unrealistic.

We have had two similar families who have left our practice in fit of pique. It won't do them any good because the next practice they go to has the same rules.

We had one Romanian patient who simply could not understand why we wouldn't send her for a cervical smear test and refer her to Gynae when she had a diagnosis of thrush because that's what they did in Romania :shock: :shock: . When she was advised it could be treated over the counter she was horrified :roll: :roll: .

As stated, the NHS has it challenges but I have every faith that because it is not private, the treatment you get is necessary and in the best interests of the patient, not necessarily just what the patient wants and to help line the pockets of the doctors.

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maz
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Re: Life as a GP practice manager

Post by maz » Mon Feb 01, 2021 12:59 pm

I guess they could pay here for the services they feel they are being denied. I'm not sure even then the specialists would do the procedures privately that they are wanting, but money does go a long way in persuasion :lol:

By the way, we are having our vaccinations on Friday :D . Harrogate has really begun getting through them now. So many over 70's we know are having them this week. A good thing is that they have opened the Ripon racecourse now so Ripon dwellers don't have to make that journey down here, plus of course it frees up spaces for more local folk. That and the York mass centre opening a couple of weeks ago must have made a big difference. Our Covid numbers are dropping well too. We ALL just need to keep doing what we have to for a few months longer.
Marilyn

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