Life as a GP practice manager

[Janey Dal]

No Mike - not Stockton - just my surgery . It’s right in the town centre so flat-land and cheap run-down rental housing and don’t forget we have a local prison and many of the half-way houses for ex-prisoners are in the town centre.

So this week I had to fill in an urgent questionnaire from NHS England about the flu jabs. I read the questions and felt moved to answer them honestly. I don’t think you will believe the questions:

NHSE “Have you ordered enough flu jabs for your patients?”

Me: “Well obviously. It would be pretty stupid not to wouldn’t it?”

NHSE: “Are you receiving your delivery as agreed with the supplier?”

Me: “No they are delayed as you well know because you sent out the communication that the WHO had changed their minds about the strains of flu needed in the jabs this year, hence creating a delay for everybody for the jabs for patients under 65.”

NHSE: “If your delivery is delayed and you had booked patients in for flu jabs, what have you done to address this?”

Me: “Strangely enough we have contacted the patients who were booked in - all 73 of them - and advised that there is a delay. We are hardly going to let them turn up are we?”

NHSE: “Are you getting all your under 65 flu jabs from the same supplier? If the answer is yes, do you have a contingency plan?”

Me: “Yes we are. What contingency plan to you suggest? I must point out that NHSE has only one supplier for the whole of the country for the over 65s jabs. So backatcha. What is YOUR contingency plan? Maybe I can borrow it? I am unsure what exactly this questionnaire is hoping to achieve apart from winding me up!”

And if you think I am exaggerating - I am really not! I didn’t receive an answer by the way. And the email came from a Senior Medicines Optimisation Manager. So she’s earning her over-inflated salary!

You watch! In a couple of months when all the under 65 patients are complaining about the delay in their flu jabs, NHSE will send out a message via the BBC to say they had contacted all practice managers in the country regarding the delay but only 25% responded.

Yes because most couldn’t be bloody bothered! The lunatics are running the asylum - that’s NHS England for you!

[Janey Dal]

So also this week we had a patient who turned up in reception with chest pains. “You must ring 999” said the Receptionist, “I will do it for you.”

The patient was absolutely adamant that she would not go into hospital so the poor Receptionist had to book her in with a GP urgently. The patient then suddenly collapsed on the floor and the Receptionist pressed the panic button so everyone ran to Reception.

2 GPs were already there and a nurse, so I directed the patients into one of the other waiting rooms to give the patient some privacy and we called an ambulance.

She was discharged from the hospital with anxiety only. It transpired that she was absolutely fine and has a history of doing this kind of thing. Her own GP said afterwards that it would have been attention seeking and indeed one of the GPs who treated her whilst she was on the floor suspected she wasn’t as ill as she was making out.

Meanwhile one of the Receptionists who tried to catch her as she ‘collapsed’ has hurt her back. Another one was properly shaken up because she said that when the patient fell she actually thought she was dead. Other patients’ appointments were delayed because the GPs and the nurse were dealing with the scammer.

She will no doubt turn up again with no conscience as to the amount of money she has cost the NHS because she is off her trolley.

[Janey Dal]

A fairly quiet week this week.

I dealt with a feisty solicitor who was too full of her own importance and tried to bully me into divulging information I wasn't prepared, nor legally obliged, to divulge. Any situations like this are run past the GP indemnity insurers, that is what they are paid for. They provide legal advice and support in situations of this kind. The solicitor is from a firm who are notorious ambulance chasers and are very aggressive.

We know about the complaint which has no substance. The solicitors are getting stroppy with me without having seen the patient notes. When they do they will immediately back off. There is no claim and they are after a quick win, which they won't get.

Patients occasionally go to a solicitors and make fantastic claims about their GP and their allegedly horrendous treatment. When it is investigated it is invariably because they are after compensation. So far we have never had to pay out a penny but it is a sad legacy from the US legal system that has made its way over here.

There is no doubt that people are entitled to compensation if they genuinely have been badly treated but we once had a claim against us for a patient who had earache for a week. I think some patients genuinely believe that the NHS is a cash cow that will pay for their next holiday to Benidorm if they make enough fuss.

I had one patient on the phone in a complete strop because she had run out of her medication. She had missed her last 2 appointments at the surgery and her last 2 specialist appointments for the condition she needed the medication for. She had been told she could not order from the practice as per the news rules. Well that wasn't good enough and she spent most of the phone call shouting at me despite my attempts to give her solutions. She couldn't register for the NHS App because she didn't have a Smartphone - she's 32! I didn't believe her. She couldn't get down to the surgery to put her prescription request in because she had 2 kids. I asked her where she got her medication from. She said the pharmacy next door to our practice and her mum and dad picked it up for her. So I told her her mum and dad could come down and put her prescription request into the practice for her.

She finally called me a "f****** a******" so I simply put the phone down on her. So she has been sent a strongly worded letter advising that her medication ordering is her responsibility, she cannot swear and shout at staff and she is on her final warning. Should she behave like that again she will be removed. Of course when she finally got to speak to a GP she was sweetness itself. That is even more annoying because she can obviously control her temper but thinks that the staff will respond to shouting.

The staff are genuinely caring and will go the extra mile for genuine patients, but as soon as the patients start shouting they get nowhere!

[Janey Dal]

So a typical NHS situation this week.

There is a new provider for analysing smear tests. It used to be our local hospital but one further away has won the contract. There is a slightly different process and all the nurses who do smears had to attend the training.

The 'old' process was electronically switched off on Friday and the new one switched on. We were all ready to go except: We had not been provided with the smear pots nor the labels to print patient details onto.

Myself and the nurse manager spent the whole week nagging and emailing and ringing people to try to find out what was happening. I resorted in the end to an email in capitals. This may not sound much but it is classed as shouting.

I received an email back from some eejit who said we may have to 'defer' the smear tests we had booked in for Monday. DEFER! Bloody DEFER! She meant cancelled and I advised her that she could call it whatever name she wanted but it still meant cancelling patients. To make matters worse we had loads of smears booked in for one particular nurse so she could be observed taking smears in order to complete her sexual health qualification.

Then we had to provide the smear takers' code to the new organisation. Every GP has one but did they know them? Well obviously not!

After a week of stress the pots and paper arrived, I managed to get all the smear takers' codes from the smear takers database (oh the giddy heights of being a practice manager) however this all came to fruition on Friday at 4pm .

Talk about last minute! It is always the same when the NHS change things. They couldn't organise a p*** up in a brewery! GP practices always seem to weather these crises but it is only through sheer determination and bloody-mindedness.

[maz]

Please someone, overhaul the NHS management. Why on earth can't the powers that be just see what is happening? There must be millions of £'s being wasted one way or another, and lives lost, or patients unnecessarily suffering, as a result of incompetence or the money not going to the right places.

[MikeyB]

I’m sure that this is not “NHS” management in general, it’s the Tory government telling NHS folk that ALL contracts have to be put out to tender, including private companies. This is supposed to increase efficiency and value for money. This has not been thoroughly policed, I have to say, it all depends on the area you live in.

It doesn’t increase efficiency. Never has, because a cheaper service is cheaper for a reason. And the infrastructure to apply the regulations costs money as well.

A change of government might help, but reversing the changes made will take a long time. Doesn’t happen in Scotland, of course. I suspect it doesn’t happen in Wales or NI either.

Don’t forget, Janey lives in the North East, which runs low on common sense. They voted for Brexit up there, so that they could lose their livelihoods when Nissan closes their factory.

[Janey Dal]

North East low in common sense? . And as for Nissan? I am sick of their posturing! They have invested a huge amount of money into that factory with an equally huge amount of money contributed by the government aka us! I genuinely don't believe they will pull out. They are just after extra government subsidies.

I was speaking to my local MP on Friday. As the regulars know he is also a part-time GP at our practice. There has been a sea-change in the rules that every NHS service should be available for private commissioning and he has been at the bottom of it. He has campaigned hard to get this change so hopefully we may see some more intelligent decisions. But don't hang by your thumbs!

Sadly Marilyn, NHS corporate will never ever see sense. They make the stupidest decisions and don't even realise that they are stupid! See my earlier post regarding the urgent questionnaire about flu jabs.

NHS corporate are busy looking at stats to decide where the money needs to go for patient welfare. But the stats are skewed because they don't ask the right questions and the people making the decisions have never spent time at the sharp end of the NHS. It is a farce! Don't despair though because your GP practice genuinely cares about patients and will make decisions that are appropriate despite the eejits above!

I honestly have no time at all for NHS England who are totally and utterly incompetent. But they are the decision makers!

[Janey Dal]

So this week we had an unwelcome phone call from a patient we had kicked off our list about 4 weeks ago for being abusive. He is still ringing us and trying to get more medication (pregabalin the local drug of choice) despite being no longer registered with us.

In amongst all this I have been encouraging staff to be less accepting of abuse from patients. So patient MM rang up and asked for more medication. One of my lovely receptionists, who under normal circumstances is too nice, took the call.

She advised him that he was no longer registered (which he well knew) and she couldn't do a script for him.

"That practice wants to get a grip" he said "It's your fault I'm a d***-head!"

"Oh" said my lovely receptionist in the sweetest of tones "So you are admitting to being a d***-head then?"

"D***-head!" said the patient so she put the phone down on him .

A round of applause for that lady!

And I was astonished by an article in the newspaper this week with the news about GP practices using electronic prescribing which means that they send the prescription request to the pharmacy electronically. This is apparently going to save the NHS millions of pounds.

GP practices have been doing this for 10 years . I have little time for the press when it comes to the NHS. They get it so wrong so often that it is tantamount to fake news. Sadly people read it and believe it.

Today in the newspaper there is another ludicrous article about women on HRT who are going to write to their GP Practices and threaten to sue them because there is a shortage . Where's the logic in that then? Did the GPs create the shortage?

Sometimes I just despair .

[maz]

John read something in the paper about paper prescriptions being stopped and if you are at the GP and need a prescription you get a bar code to take to the pharmacy. I guess on your smart phone or they print one out for those of us who don't have one. Presumably for regular prescriptions we order online and then get sent a bar code(on to the smart phone) or to print out. I imagine they have something in place for those who have neither a smart phone or printer until that generation dies out. But by then there will have been another 10 changes one way or another

[Janey Dal]

It's already in place Marilyn. The GP can give you what is called a token which looks like a prescription but with a bar code on it. You just take than into the pharmacy.

If you order on-line the prescription will be sent electronically from the GP to the pharmacy with no paper required. That's if you have a usual pharmacy set up. If not you have to collect from the GP.

It makes sense for everyone to have a usual pharmacy set up at the GPs then everything just goes through electronically. I suspect that will be the next national push.

NHS England are always nagging us about something.

We are being encouraged to encourage patients who have not had their MMR jab to have it. There is something called 'herd immunity' where if 95% of the population are vaccinated it is very unlikely that the other 5% will catch the virus. However in the UK for measles, mumps and rubella the current herd immunity is at 70% which means even people who have been vaccinated could catch them. We have had a patient with mumps this week which is really rare but will become increasingly common if people don't have their jabs.

Interestingly in France they won't let children attend school if they haven't had their jabs and in Australia the parents don't get child benefit if their children don't have their jabs. I wholeheartedly agree with it. It is irresponsible to not have your child vaccinated and the scare around the MMR jab has been proven to be spurious.

[maz]

We would have riots here if the NHS/government said that either no school until children are vaccinated, or no child benefits. I don't know how they managed to bring that in in Australia and France. France love revolting and blocking roads etc. Here we would say it is a breach of human rights and head to the streets and cause mayhem.

I wish they would bring it in though as uptake of child vaccinations is reducing, often due to social media influence, and of course we know the incidence of measles is increasing. I don't know about other illnesses, but you did mention mumps. In the USA it is becoming very bad. Essential oils are better than vaccinations, that kind of thing. The antivaccers brigade.

[MikeyB]

Not in Scotland, Jane. You talk about the “UK”. In Scotland the vaccination rate is safely around the 95% level. No coercion, just common sense. Enforcement would make no difference in Scotland

[Janey Dal]

My apologies Mike. Good for Scotland!

I suspect some of the problem is irresponsible parents who can't be bothered to have their children vaccinated and use the spurious belief that it is dangerous to not bother having them done at all. I agree with you Marilyn but I also suspect that the government are going to have to come up with something pretty radical very soon as the effects of non-vaccination are starting to cause serious problems. One of our GPs had a case of mumps in a male patient aged 23 the other day. He hasn't seen a case of mumps for years. And a 23 year old male with mumps is not good.

Meanwhile I have to tell you my story regarding our cleaners who are the bane of my life .

We had a whole new set of paper towel dispensers, toilet roll dispensers and hand soap dispensers fixed in the practice about 2 months ago. The old ones were stored in a storage room in the practice. We have about 22 clinical rooms and about 10 toilets so there were a lot of them. I had to get rid of them so decided to put out about 2 or 3 of them 2 or 3 times per week for the cleaners to put in the industrial bin store every night.

I bumped into the cleaners on Tuesday evening and they asked "Oh Jane! Did you want those plastics things putting in the bin?"

"Oh yes!" I said enthusiastically.

"Well we weren't sure so we've been putting them back in the storage room"

It's like a Benny Hill sketch! There I was putting out the dispensers to be thrown out and the silly beggars were putting them straight back .

I thought the stack wasn't reducing! I didn't know whether to laugh or cry .

[maz]

That situation could have gone on for a long long time

[Janey Dal]

We have weeks where I swear there is a full moon! Patients will complain and whinge about anything and everything.

I have had 3 patients complaining they couldn't get an appointment. We have had 2 GPs off this week so that has a knock on effect obviously. One patient said it had never happened to her before in 22 years at the practice. So why complain the first time it has happened? What do they want me to do? I can't magic up appointments when there aren't any. Patients will be seen but not necessarily at a time or day that suits them.

We are not a hotel! We cannot say "and what time and day would you like your appointment?". If you need to see a doctor then you will find the time to do so. It may not be convenient but if you are ill then you make it. This may sound harsh but honestly the number of patients who are offered appointments and say they can't make that one. We offer up to three and if they have refused three then tough.

We also offer same day urgent appointments. The Receptionists have to ask questions on the reason why it is urgent for today. Some patients will lie. They get caught out though because the reason for the appointment is clear to the GP and the GPs will often tell patients off if they misuse the urgent appointment system.

We get people asking for an urgent same day appointment for a pain they've had for three weeks. If they've had it for three weeks it's not urgent, it's just that they have decided to panic about it today! We had one patient book an urgent same day appointment for erectile dysfunction . Not sure if he had a new girlfriend and tonight was THE NIGHT!

What frustrates me is that I can't get an appointment at my GP practice but patients seem to think that it is only happening to them.

And then Boris Johnson is offering more GP appointments if he gets elected. Where oh where is he going to get the GPs from? The reason there aren't enough appointments is because there aren't enough GPs. Sigh.