Life as a GP practice manager

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

Post by paul...m » Mon Feb 24, 2020 6:43 am

Your patients are lucky our surgery closes most Thursday afternoons .

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maz
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Re: Life as a GP practice manager

Post by maz » Mon Feb 24, 2020 9:06 am

Ours was closed last Wednesday afternoon, so maybe the same kind of meeting you had the other week Jane. Lets hope it was all worthwhile :roll: I'm off to see my favourite doctor tomorrow(appointment made 5 weeks ago) so I might ask him :lol:
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Mar 01, 2020 10:34 am

I don't know how some surgeries get away with it Paul! Contractually we have to open certain hours. It's a mystery to me.

And booking an appointment 5 weeks away Marilyn? That's crazy! We actually don't book appointments further off than 2 weeks. We found that any further off than this and we got more no shows.

So we've had a staff meeting re Coronavirus this week with nurses and GPs present as well. There is a plethora of useless high level advice from Public Health but nothing that actually tells you what to do at operational level ie if a patient walks into the surgery and it sounds like they may have the virus.

We have identified an isolation room at the practice (the Reception girls are used to this anyway with other contagious, notifiable diseases, measles, mumps etc). Apparently though with Coronavirus we have to decontaminate the room after the patient has left. And who is supposed to do that? Well the practice staff obviously! :roll: :roll: We can't ask the cleaners to do it they can barely cope with dusting and mopping :shock: .

Mostly the advice is that if the patient appears to be in a high risk group then they should ring 111. But of course now that service is becoming overwhelmed. And then we had a local practice report that a patient walked into the practice to advise them that her daughter had returned from Italy and was being tested for the virus. Yes, she walked in to tell them :roll: :roll: . We have heard no more so it is likely the daughter has had a negative result. However it just goes to show that you can't legislate for idiocy :lol: :roll: :roll: .

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maz
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Re: Life as a GP practice manager

Post by maz » Mon Mar 02, 2020 9:38 am

Not that we go to see our GP's often, well until our more recent issues anyway. I was quite proud of my infrequency of visits :wink: . But we do quite like being able to book up to 6 weeks in advance, particularly as we like to see the same GP. We are old and remember the good old days of having a GP who knew you, so we like to give ourselves the thought that our favourite one at least remembers us from when we were last there a year ago or whenever :lol: :lol: We have had so many different 'named GP's' since registering 19+ years ago that I decided to get my own named one :lol:

Obviously booking so far ahead is not for more urgent problems so I can see how there could be a issues with no shows. You have to remember to cancel your appointment if you don't end up needing it :roll: . I guess it mustn't be too much of an issue though as we have been able to do this for quite a few years now. We have one of those electronic notice boards that dings your name up when it is time for your appointment(when it works). It has public service announcements the rest of the time such as, don't come in and bother the doctors for this or that reason :roll: , but occasionally they put the numbers of missed appointments up for the month, or year so far. Maybe the main reason is being able to book so far ahead.

I was there last week and there are notices outside about NOT stepping inside the surgery if you have just returned from China(a bit out of date now I think :roll: ) Then others in various places in the reception and waiting area. Some are in Chinese but I couldn't read those! GP waiting rooms are not the healthiest places to sit at the best of times. Back in the day the reception staff used to be behind glass partitions. Maybe they should be now again as they are in the front line aren't they? We will just have to see how things go with Coronovirus. I don't think anyone really knows at the moment
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Mar 07, 2020 12:24 pm

What a lovely, interesting post Marilyn!

I am interested in the comment on the glass screens at reception. We don't have them. I have considered it but feel that it is impersonal and also patients cough and sneeze at reception and the results will end up on the glass screens :mrgreen: :mrgreen: . Not something I want to think about!

All GP practice staff, but particularly receptionists, build up a pretty robust immune system within the first year of working in a practice. It is a known phenomenon that someone coming to work in a GP practice for the first time will fall victim to various viruses within the first year. After that they are pretty well bomb-proof!

Regarding your appointment system, I think the point here is that every practice works completely differently to each other. This is often dictated by the demographic of the patients. My practice is in an area of high deprivation (although I would add that at least half of our patients are from an affluent area, but they don't cause a problem) therefore we have to appreciate that these patients often have chaotic lifestyles, so booking appointments weeks in advance doesn't work. They simply aren't organised enough to remember to attend. We don't even send out booked appointments for patients. The resultant no-shows are not worth it.

I had to laugh at the latest advice from the government on Coronavirus. We apparently have to offer an isolation room with negative pressure (no! I have no idea either) and ideally with en suite facilities :shock: :shock: . If we can't offer en suite facilities then we need to provide a commode :shock: :roll: :shock: :shock: :shock: .

My practice is a new build with fantastic facilities but we can't offer en suite for goodness' sake, nor a commode. The best I can offer for isolation then is a consulting room with a bucket :shock: :lol: :lol: :lol: . And from reading the newspapers today I am not confident on the provision of toilet paper :lol: :lol: .

And then this advised self-isolation? Obviously nobody can self-isolate for 14 days! You need to go to the shop to buy, at the very least, bread and milk. Apparently the government have advised that the supermarkets will have to deliver. :roll:

How many delivery drivers do they think the supermarkets have? Do you sometimes despair at the complete idiocy of the people who are supposed to be in charge?

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MikeyB
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Re: Life as a GP practice manager

Post by MikeyB » Wed Mar 11, 2020 1:43 pm

I had a Tesco delivery yesterday, including two large packs of toilet roll. It would have been interesting to see if they’d substituted for something else :D I don’t know why folk are stockpiling toilet roll. It’s an outbreak of coronavirus, not rotavirus.

Mind you, I’m going to switch to Ocado, because their selection and packing is done entirely by robots. Robots don’t get coronavirus, but Tesco packers are low paid, so would probably struggle into work with Ebola. :D

paul 28
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Re: Life as a GP practice manager

Post by paul 28 » Fri Mar 13, 2020 7:01 am

Could use cabbage leaves at least it would be better than izal tracing paper .

If receptionist get that many viruses maybe patients should get screens to be protected from staff .

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Mar 14, 2020 11:09 am

:lol: :lol: We were talking about Izal yesterday at work. The younger members of staff had never heard of it! One of the older ones and I could remember putting it over a hair comb and playing tunes with it :lol: :lol:.

And oh my! What a week at work. Obviously everything is now kicking off and we have had to make all our morning appointments telephone only for the doctors and nurses to triage and only bring patients down if necessary in the afternoon. It's been pretty full on because it meant contacting all the patients who already had face to face appointments and telling them it was going to be by telephone. :roll:

We are making decisions on the hoof because none of us have been in this position before. The most worrying thing for me is if the schools close. About 60% of my staff (including GPs) have school age children and not all have alternative child care. Thankfully the government have realised this and although the current 'delay' phase originally said the schools would close they have changed their minds. We really would have struggled to keep the practice open if the schools closed.

If they do (which is very likely) we have an agreement with 2 local practices to potentially share one surgery thereby cutting down on the number of Reception staff required.

The main thrust at the moment is to try to prevent patients visiting the practice unnecessarily. But people need to pick up prescriptions and sick notes for example. We have decided to email sick notes where possible. For prescriptions we are encouraging patients to nominate a pharmacy so the prescription can go straight there. The patients need to visit the pharmacy to collect the script but it is one less contact.

ACAS have advised employers to be pragmatic about their sick note policy to prevent extra pressure on GP practices asking for sick notes for patients who have the virus.

We are issuing up to 3 months of medication for patients who are stable but obviously we have already had someone who is on weekly prescriptions (thereby being a medication abuser) asking for 3 months medication. They never miss a trick!

We are trying to get through to patients that we need to protect the staff at the practice in order for it to stay open for people who are genuinely ill, but many patients are notoriously selfish and don't consider anybody but themselves.

We have to look after vulnerable patients who are more susceptible to the virus (asthmatics, patients with COPD for example) but need to be seen. We intend to bring them down in the morning when the medical staff are mainly doing telephone calls, therefore there should be almost no patients on the premises for them to pass on the virus.

Every patient who is asked to come down to the surgery is being triaged for symptoms of the virus prior to being given an appointment, if we suspect they have it they can't come and the local hospital has set up a service to do home visits with staff wearing the necessary protective clothing and masks. Some of our practice nurses may be asked to help man that service during the pandemic.

I left work on Friday almost on my knees with tiredness! But it has been fascinating! :oops: :oops:

I was also due to take my last week's annual leave next week but have cancelled it :? . I have two deputy managers but it isn't fair to leave them at the moment to deal with the workload and decision-making which is phenomenal.

Very worrying but interesting times!

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

Post by paul...m » Sat Mar 14, 2020 11:30 pm

Hope it was unused izal that you put over comb then up to lips .

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Mar 15, 2020 9:37 am

I was wondering how things were going for you Jane. John went online on Thursday to cancel his appointment for next week(it was picked up straight away by another patient :lol: ) and then Friday he was on the site again(he is always on to see what has been added to his patient record :roll: ) and lo and behold, the online appointment system is closed down. It took me quite a while to find out they ins and outs of it all, but of course they are doing what you are. I have an appointment booked for a week Tuesday, a follow up one my GP asked me to book, so not from my end. I guess I will get a text to say it will be by phone. But I can't see that being much use in my case, but needs must I know. I guess it is difficult when some of what doctors rely on are the visual signs too, even the way patients look or act. Bit of a worry for patients with normal illnesses. Eh deary me. I feel so sorry for the doctors and ALL the frontline staff. Keep going Jane and don't dare get sick!!
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Mar 15, 2020 11:36 am

As for Paul's comment about the unused Izal - it hardly mattered - everything slides off it anyway :roll: :roll: .

Marilyn! I daren't get sick! Although I would probably have to work from home if I do.

Just to reassure you all because obviously you have serious health conditions: If you need to be seen by a GP, you WILL be. What we are trying to do is stop unnecessary visits to the surgery. That is the general day to day stuff: suspected UTIs, chest infections etc. The GPs can prescribe antibiotics without seeing the patient. Normally this would be frowned upon because we are trying to reduce antibiotic prescribing but at the moment, if you don't need the antibiotics they won't kill you and if you do then you are being treated.

Things that won't be provided are routine annual health checks and smear tests etc, they can be postponed. So the face to face contacts will be for conditions where the patient needs a physical examination.

We are still contractually and morally obliged to offer a service to our patients but we have to do it with caution.

Marilyn there is no reason why your surgery can't offer online booking of telephone appointments. They may have panicked on Friday - many did - and may rethink it.

You will receive a service that is radically different for the time being but seriously don't worry that you will receive a lesser service. You will still be looked after. If you have no symptoms of Coronavirus there is no reason that you can't be seen by a GP or nurse as needed.

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Mar 21, 2020 11:01 am

So more general madness this week! The message is getting out slowly here.

Stories from this week:

A patient rang to say she wasn't a patient at our surgery but she couldn't get through to her surgery on the phone so could one of our doctors ring her?
No!

I overheard a conversation from one of my staff to a patient:

Staff member: "Yes you can go out in your garden" ......"Yes you can do your gardening"......."No it's people not soil" :shock: :shock:

One 17 year old rang to say she had a persistent cough and a high temperature (classic symptoms). She was told she must self-isolate by the doctor. "I can't self-isolate today I have to go to college. I can self-isolate tomorrow."

A patient came down to the surgery to book a telephone appointment.

Some surgeries are closing their doors (not the surgery, just the doors) and only letting in patients who are pre-booked. Everyone else will be triaged at the door. I am reluctant to do this at the moment because somebody has to be the person on the door and will be immediately put at risk as a result.

At the moment surgeries are remaining open and I can't see that changing. Pharmacies will have to stay open. We are forcing our patients to sign up to a pharmacy for their meds to be sent electronically. Some are not happy.

We are not issuing sick notes for patients who are self isolating or socially isolating. Many are saying that their employer is insisting on a sick note. We have had to say to them all that their employer has the same information as everybody else and that they need to make a policy to deal with this. If we issued sick notes for all these people then we would be issuing hundreds per day.

Chins up guys! We will get through this, bloodied but unbowed :lol: :lol:

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Mar 22, 2020 9:17 am

Yes, I believe our surgery door is locked. But now I know what they are doing behind them! Thank you Jane and all working in such situations.
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Mar 22, 2020 12:00 pm

We still have to see certain patients!

INR clinic (patients on Warfarin), wound dressings, childhood immunisation clinics, patients who are acutely unwell with something other than Coronavirus. Telephone appointments only work up to a point. There are certain conditions where the GP or nurse HAS to physically examine the patient. These patients are triaged for Coronavirus prior to being asked to come down to the surgery.

Every appointment that can be done via telephone is being done that way. We now have video consultations set up which allow GPs/nurses to see rashes or lesions without the patient coming down. You do need a Smartphone for this however.

We are allowing patients to send in photographs of wounds/lesions/rashes for the doctor to triage that way.

We are overprescribing antibiotics (soooo frustrating given the hard work to stop this!) rather than risk a patient coming into the surgery.

If it takes longer to get through to your practice on the phone it is because all the clinical staff are making phone calls out and there are only so many available lines (thanks Marilyn for pointing out this particular frustration xx). Where possible try to sign up for on-line ordering of prescriptions and booking appointments - every surgery has switched off online booking of appointments but this should only be face to face appointments, not telephone appointments - and they can differentiate.

PLEASE do not ring your surgery for social advice (ie self isolating, work related issues including sick notes). Remember that we only have the same information as you do and it is your employer's responsibility to make a decision, NOT your GP.

Believe me guys, your GP practice is working its socks off! We cannot just let the hospitals pick up everything we don't want to because they would be overrun. And we genuinely do care about the patients.

If you need help, for genuine health issues, contact your practice. They will continue to treat you.

There is a suggestion in situations like this that more patients die of non-virus related conditions because they didn't contact their GP when they should have done.

Hugs

Jane xx

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maz
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Re: Life as a GP practice manager

Post by maz » Mon Mar 23, 2020 8:30 pm

Big hugs Jane.
Marilyn

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