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 » Fri Mar 27, 2020 12:43 pm

Thanks Marilyn - gratefully accepted :D

So - where do I start? We have had to MALWARE an intercom in the foyer to stop patients just wandering in :roll: :roll: . Yes! Believe it or not they were still doing it even after the lock down. If they don't have an appointment they are sent away to ring. They only get an appointment if they have spoken to the GP via phone and the GP says they need to be seen. Some of them get very cross about this :roll: :roll: . I'm not sure what part of 'lock down' they struggle with?

One patient who needed a wound dressing was annoyed with the nurse who was wearing a face mask. "I won't catch it love! You don't need to worry about me!" he said. She very firmly advised him that actually she was protecting herself :evil: :evil:.

And I have to express my absolute disgust for the news that Prince Charles has tested positive for the virus :twisted: :twisted: . I am SO bloody angry about this. NHS front line staff in hospitals cannot get the test. But bloody Charles gets one (and no doubt all his staff)! :evil: :evil: Why could he not do what everybody else has to do who suspects they have the virus and self isolate for 2 weeks and save the tests for really important people? It would hardly be a challenge for him would it? And personally in the scheme of things I don't think he's particularly important.

Selfish, self-important *******. :twisted:

Phew! I feel better for THAT rant :lol: :lol: .

I am spending a lot of time reassuring staff. They of course can send their children to school because they are NHS. But 2 staff have small children with asthma so they don't really want to send them to school. But they have and they are coming into work with a wobbly smile on their faces. Apparently one parent had sent their child to school even though she was at home :evil: .

I think this has brought out the very best and, very sadly, the very worst in people. Another of my staff reported going to a local supermarket at 'NHS time' and was hurried in through the side door. Apparently the queue of non-NHS people outside were attacking the NHS staff and the police had had to be called :shock: .

Our brand new, shiny video consultations aren't working because the phone networks are so overwhelmed that they are not possible :roll: :roll: .

We were trying to get patients on Warfarin onto alternative meds because they don't have to attend the surgery for blood tests if they are switched. Only to discover that the supply of the alternative meds is not reliable.

We cannot get hold of Personal Protective Equipment for a King's ransom.

We have one GP now self isolating because his wife is symptomatic. I have had to beat the local CCG to a pulp to get him a laptop so he can work from home.

I currently have 5 admin staff and 3 nurses self isolating for 2 weeks, none of them are likely COVID, they have small children with a cough (what small child does NOT have a cough at this time of year?) but we have to adhere to the rules. This is part of the anger at Charles. If we had sufficient tests, many of these self isolators would test negative and could come back to work. They could easily come back to work after 2 weeks and end up going off again for another 2 weeks until we have tests. None of them (God love them) want to be off.

These are the day to day challenges in practices - we are not alone in this, yours will have very similar challenges.

I was very moved last night when I went outside my front door at 8pm to clap the NHS staff (not me, the front line workers who are in very serious danger but keep going). There were fireworks going off and loads of people clapping.

I felt so moved and uplifted :D :D . I needed that!

Keep well, keep safe xx

Jane xx

26.12.11
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Re: Life as a GP practice manager

Post by 26.12.11 » Fri Mar 27, 2020 11:52 pm

There is no helping some people, rude and stubborn.
It seems to me the people with the most to give are trodden over by the don’t care.
There is an interesting situation across the road. I can truly understand the reasoning but it still seems like madness to me.
Irene has her 2 great? grandchildren staying with her. A sibling had just been diagnosed with cancer and chemo has done their immune system. So yes I get it. Although the children are out every day playing with some other kids from the far end of the street, their parents are visiting every day for a few hours. Parents are out and about, kids out. Irene is 81, why are they there?
Sharon

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maz
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Re: Life as a GP practice manager

Post by maz » Sat Mar 28, 2020 9:19 am

Maybe soon we will be able to report such situations. But would we?

We have a chiropractor who lives almost opposite us. Only mention his profession as shows he is not dumb :roll:. Not the friendliest family at all, and not too thoughtful of others, even prior to the virus. They have 2 children, boy about 8 and a cute 1 year old girl. Dad's parents live next door and I had thought they were self isolating as I am sure they are older than me and granddad not too well, plus I hadn't seen them around as normal. Grandma usually takes their dog out and helps with the children. Anyway, two days ago I saw Grandma in the front garden hand in hand with baby girl, walking her on the garden wall. Grandson comes from around the side of her house, most likely been inside with granddad. Dad is sitting his side of the fence, but just 2 feet away whilst they sat for a chat for quite a while. I was astounded. Seems lack of common sense is everywhere Jane.
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Mar 28, 2020 12:25 pm

It is absolutely gobsmacking isn't it? I went to Tesco this morning to do some shopping. We were queueing outside as they were only letting a few people in at a time. I pulled my jumper down over my hands and held the handle of the trolley that way (the virus can last for up to 72 hours on hard surfaces). The Tesco staff were walking down the queue and offering wet wipes for the handles to everybody. Some refused :shock: :shock: :roll: :roll: .

We also had a 30 year old male patient on Friday who rang up 3 times to ask for his sick note to be issued. He was abusive and sarky with the 3 staff he spoke to and then had the cheek to demand to speak to me to complain. I listened to the phone calls he had made and then rang him with great joy in my heart, I was ready for him! It was a fantastic phone call! :lol: :lol:

I told him in no uncertain terms that his attitude was appalling, he was taking up time on the phones for genuinely ill patients, he had been rude and condescending to the staff and if it happened again I would remove him from the practice list. I told him he would get his sick note when we had time, because we have more pressing issues to deal with. He behaved like a small boy who'd had his bottom smacked and agreed with everything I said. :lol: :lol:

We have found at work that patients are either brilliant and very appreciative or downright stupid. There doesn't seem to be a middle ground.

And I was due to be off Friday and Monday. I wasn't sure about it but was actively encouraged by the GPs to do it. I've managed Friday but I can't do Monday. I need to be there directing operations! (Not actual medical operations obviously - we are not at that stage as yet!).

If I'm not there all the decision-making goes to my two deputy managers and whilst they are brilliant, it isn't fair on them. As I always say - they don't pay you more as a manager because they like you, they pay you more as a manager because you have to deal with more s***.

Keep well, keep safe.

Hugs

Jane xx

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Mar 29, 2020 11:28 am

Your staff must love you Jane, you are amazing.
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Mar 29, 2020 12:06 pm

Thanks Marilyn - they are a great team. They come in to work when they aren't well enough, they help each other out and there is no bitching - which is pretty amazing given they are all women!

Not sure they love me but if they respect me that will do very nicely!

Watching the news again today they are suggesting that all GP practices have sufficient PPE. We don't. There was some delivered about 2 weeks ago but it is inadequate in terms of safety and there is not sufficient. We think that every practice has been delivered the same amount so my practice with 8 doctors and 10 nurses got the same as a practice with 1 doctor and half a nurse :roll: :roll: .

You cannot buy it. I managed to order some online but it won't be delivered until May. Apparently the ambulance crews are fully kitted up in proper full PPE and then handing the patients over to nurses on the ward who are wearing a paper mask and a plastic apron. It's not good enough but little we can do. The nurses on the wards must be terrified but they are still turning in for work.

There is an emergency help line for PPE so I rang it. I was on the phone for 35 minutes because they guy I spoke to had been moved over that day and didn't know what he was doing. He then sent me an email with a form to fill in asking for exactly the same information I had spent 35 minutes telling him. I dutifully filled in the form and emailed it to the address on the form, only for it to bounce back saying it was an incorrect email address :roll: :roll: . So there's an hour of my life that I won't get back again :lol: :lol: .

On Monday I was advised by NHS England to run a search of our patients to see if there was anybody who had less than 6 months to live. We were told that the GP may want to ring them to say they may not wish to self-isolate but spend the time with their families. That was a horrible thing to have to do. Thank the Lord we haven't got any that fit that category, although I have no doubt that some of the terminally ill patients will die away from their loved ones.

And at the risk of being controversial - never bothered me before! - China really does need to get a grip. If they want to be a global power they cannot keep dumping new viruses on the world because of their lifestyle.

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Apr 04, 2020 12:47 pm

Thankfully this week has been somewhat calmer. The utterly amazing thing is that we are doing telephone consultations and only seeing patients who absolutely need an examination - suspicious lumps etc - suddenly there are hardly any telephone consultations either! So from not being able to offer sufficient consultations 1 month ago the GPs are practically fighting over patients :roll: :roll: .

It just shows how much GP time is wasted by people who really don't need an appointment :roll: :roll: .

We were promised a free practice laptop by NHS England 18 months ago. The delivery kept getting delayed for a variety of reasons (including lack of supplies) but yesterday, without even asking, we were delivered of 5 brand spanking new, top of the range laptops :roll: :roll: . It's great because any member of staff who is self-isolating due to a family member being unwell can now work from home. It only took a virus to get NHS England to move their sorry asses!

My role continues to be demanding as with every other practice manager in the country. All external bodies use practice managers as their conduit into GP practices, and part of my role is to ensure that everybody is up to date with everything that is going on outside. I have to sift through the nonsense and advise on things that are relevant.

As this is changing on a daily (sometimes hourly) basis at the moment this is at times overwhelming. I tend to get information in triplicate because everybody takes the view of better to get it 3 times than not at all, but that just adds to the madness and I really am suffering information overload.

Locally here, and I suspect in all your areas as well, a central 'hot' clinic has been set up. This is specifically for patients who either have COVID or are symptomatic but need to be examined for an unrelated condition. The clinical staff are fully kitted with protective clothing (PPE), masks, goggles etc and the room is deep cleaned after every consultation.

This has taken the pressure off GP practices to do this individually without proper PPE and we can pool what little PPE we have and donate it to the clinic.

We are also now expected to open on Good Friday and Easter Monday. This was a blow to everybody because we have all worked so hard it would have been great to have a 4 day break. Nevertheless that is where we are.

I have organised a rota of skeleton staff (I doubt many patients will realise we are open and we certainly are not going to advertise it!) and ensured that everybody gets at least 1 day off. They deserve it.

They are so fantastic! Nobody complained, they just took it on the chin. I am so proud of the staff I can't tell you! We are however paying them time and a half for the ex-bank holiday day they work (we don't have to as it is now officially a normal day) and the GPs are buying them all lunch.

I actually consider myself lucky that my life has changed only marginally compared to other people. I am still going to work every day and coming home every night. Shopping is an irritation but not massively so.

My saddest bit is that I can't see my gorgeous daughter-in-law gradually blooming through her pregnancy. But if that is all I have to worry about then am very lucky indeed.

Keep well, keep safe

Hugs

Jane xx

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sat Apr 11, 2020 1:16 pm

In response to a comment from Paul in a different thread regarding his telephone appointment: There is little doubt that this crisis will change the way GPs consult for ever.

There are always patients who absolutely need to be seen for an examination, but many, many conditions can be managed over the phone and more specifically via video consultation. This was being trialled in a couple of practices in my area for the last 4 months and then stalled for some reason - the NHS takes ages to agree anything :roll: .

Suddenly within a week we all have access to video consultations!

However, whilst this is great, you have to remember that we are in a crisis situation. The GP indemnity insurers (the insurance that pays out for clinical errors by doctors) have advised that they will cover any GP who misdiagnoses something over the phone or via video at the moment due to the situation. But they can't do this forever! And typically, you would get some doctors jumping on the bandwagon and almost never seeing a patient if there aren't strict guidelines.

So afterwards there will have to be some middle ground.

Also we are overprescribing antibiotics. After all these years of saying no to patients when they have a virus and don't need antibiotics, the GPs are issuing them 'just in case' because without an examination they can't always tell if it's viral or an infection especially with throats and chests. If it's viral the antibiotics won't actually improve anything, but won't do any harm, but if it is an infection it will help and saves the patient coming into the surgery. Obviously this can't continue but it's the lesser of two evils at the moment.

We have at last managed to get some PPE. Not a massive amount and it's still being eked out as far as possible whilst ensuring staff safety, but at least gives me some breathing space, it has been my biggest concern since the start of the virus. The advice is that if there is no PPE then doctors and nurses CANNOT see patients at all.

We probably have enough to last maybe 2 - 3 weeks at the moment. And if that sounds pathetic, it's a hell of a lot better than the position we were in on Wednesday of last week when we had about 25 paper face masks in total. If we do a Warfarin clinic we could use 15 of those in one day :shock: .

We decided for Warfarin patients, who often need to come down every week for a blood test, that we would switch them to the new anticoagulant meds which are now considered better than Warfarin. This would prevent their need to come for a regular blood test. Only to discover that there is a global shortage of the alternative meds so we can't do it for fear if we switch them, they then have to be switched back to Warfarin which requires a visit to hospital :roll: :roll: .

Sorry for the long post. I hope some of you find it interesting. If you've got this far, you obviously do!

And on a lighter(?) note. We had 4 phone calls on Friday morning asking for advice on pregnancy terminations :shock: :shock: . Well they haven't been practicing social distancing have they? :lol: :lol: :lol:

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Apr 12, 2020 9:17 am

There will definitely be a baby boom at the end of the year. A new generation of baby boomers to replace those from the last post war boom who are being lost right now :(
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Sun Apr 12, 2020 11:34 am

I know :? :? .

I try not to listen to the figures, it doesn't help. I have to keep positive for everyone at work because we all have someone we love who we are worried about. Keeping positive is made more difficult if I listen to the death toll. Despite doing my best to avoid it, Alan takes great pleasure in apprising me of the daily total when I get in from work. I switch it off mentally, which is pretty standard I suspect for most wives when their husbands are talking :lol: :lol:.

So I genuinely don't know the figures but I know they are far too high :( :( .

The interesting thing about the virus is how it affects different people. Some people barely notice they have it, some have really severe symptoms and as I am sure you are aware we are confident that some people are either immune or don't feel ill at all. Children seem to be largely unaffected. There is a suggestion that people who have had the BCG (TB) vaccine may display milder symptoms but this is still being investigated. Interestingly Italy and the US have never had a BCG vaccine programme and they are being hit hard.

Well if that's the case I will be okay because I had two by mistake! :roll: :roll:

And on the sticky subject of testing for NHS staff. We have been advised here that there is a drive through testing station in Gateshead which is about 35 miles away. It is only for NHS staff with symptoms. Isn't that just great? :evil:

So you feel really ill and have to drive a 70 mile round trip to find out if you are positive or you get a relative or friend to drive you there and infect them whilst doing so :twisted: :twisted: .

:D

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maz
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Re: Life as a GP practice manager

Post by maz » Sun Apr 12, 2020 7:39 pm

I had 2 BCG vaccinations also. One at the normal early teen time and then when I started nurse training. Very annoying that was. We also had to had diphtheria vaccination. That was strange, they injected just under the skin and made a little bubble with the liquid. I really hope it turns out that having the BCG vaccine makes this virus not as severe, though I don't want to be a test case :shock:
Marilyn

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Janey Dal
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Re: Life as a GP practice manager

Post by Janey Dal » Mon Apr 13, 2020 12:07 pm

:lol: :lol:

Apparently the BCG boosts the immune system which makes sense if it does have an effect on COVID.

I am off today but the practice is open. NHS England changed the contracts to mandate Easter Bank Holiday opening for GP practices. We did our bit as it was intended to take pressure off secondary care but nobody bothered to advertise that we were open so both days it has been really quiet!

What was the point really if nobody bothered to tell anybody that the practices were open? And the pharmacies were open reduced hours so the whole thing has been a waste of time because the very few patients we spoke to couldn't get a prescription anyway :roll: :roll:.

Apparently a patient rang today and expressed surprise that we were open. Why then did they ring :roll: :lol: :lol:?

There are times when there are no words...... :lol: :lol:

I have been copied into a going-viral text today: The first text asks: 'Are Asda letting NHS staff jump the queue?'

The responder says: 'Yes you just need to show your vadge and they'll let you in' :shock: :shock: :shock: :shock: :lol: :lol: :lol:

I think I'll queue....... :lol:

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maz
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Re: Life as a GP practice manager

Post by maz » Tue Apr 14, 2020 9:13 am

I had no idea ours was open until I went to the website to check due to you saying yours was open Jane. But the pharmacy in the building was not open according to their posted hours online. Now I do think they deserved a day off of course, but it isn't very helpful for any patients who might have received a prescription that day.
Marilyn

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Re: Life as a GP practice manager

Post by paul..m » Thu Apr 16, 2020 12:21 pm

Never mind some window cleaners are disenfecting knockers the job just got more interesting
Paul

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maz
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Re: Life as a GP practice manager

Post by maz » Thu Apr 16, 2020 2:01 pm

:shock: :shock:
Marilyn

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