Managing and reducing stress

Written by: Georgia Dossis

Stress serves the purpose of reacting and avoiding danger, which is great but too much can have a negative effect on you. Life is full of major and minor challenges and it’s completely normal to sometimes feel inundated with these issues.

According to Champion Health, one in 14 UK adults feel stressed daily and I guarantee if you ask your neighbour, your work colleague, a friend, or a family how they are, at least one of them will use the word ‘stress’ in their response.

Below are some suggestions on how to relieve and control symptoms when everything is getting a little bit too much:

-          Leave work at work. With the most common cause of stress being work related, I think one of the most important things is to leave work at work. I’m aware that not all job roles have this perk, but where you can you most definitely should leave work at the office. You psychologically associate your surrounding with your feelings. If you’re taking your work home you’re more likely to feel stress in your home and find it more difficult to switch off when you need to.

-          Be active. I can guarantee that this is the first thing you hear when you say that you’re stressed, and it often is the first question too “are you getting any exercise?” but they aren’t wrong. Exercise increases endorphins, which numbs pain receptors, allowing you to feel better and happier. Even if it’s a walk around your estate, getting movement in will reduce your stresses.

-          Take some time for you. Work holidays are given to be used. It would be unhealthy to work every single day of the year, no matter how much someone loves their job. Taking time off to catch up on you is not a bad thing. You can use this to get some of the life admin that you put off during the week done, take a holiday or even take a day to put your feet up.

-          Getting organised. By getting organised, you instantly feel better about the tasks that you need to do. Creating a to do list helps by having everything out of your mind, alongside being able to visually see what you’ve got to do.

-          Breathing and meditating. There are hundreds of apps and thousands of YouTube tutorials that can help with this. By focusing your attention on breathing it clears your mind of all the tangled thoughts. Meditating not only strengthens areas of your brain responsible for learning, attention and memory but also helps calm down your sympathetic nervous system. This improves your heart rate by slowing it down and causes you to feel more relaxed.

-          Activities. Whether it be apple picking, going shopping or using an adult colouring book, doing something you enjoy will allow you to take your mind away from what you’re focussing on that’s causing you stress. Colouring or reading for example help relax the fear centre of your brain which is what cause you to become calm.

-          Keep a journal. Journalling can allow you a safe space to express how you feel without fear of judgement. Here you don’t have to worry about grammar, punctuation, or spelling, just write whatever comes to mind.

-          Healthy Diet. There’s nothing more tempting when your stressed to eat badly, which is normal, and variety is good. But a healthy diet is key to keeping your body regulated and happy. We’ve all heard the term ‘hangry’, eating good healthy foods will help eliminate the ‘angry’ part.

Although stress is unavoidable it is definitely controllable, you just need to find what is right for you. Keeping stress at a manageable level is key to your overall well-being.

Extreme weather warnings and your Practices pharmaceuticals

Written by: Craig Arnott

On Monday the 25^th of July this year I took a call from a Nurse that I’ve known for over 15 years! The call transcript was as follows:

The Nurse - ‘Hi Craig, I’m hoping you can help – a nurse at the Practice has gone mad and is insisting that we throw away all our pharmaceuticals because temperatures have gone above 35°C. Can you help? I think they may have already thrown away all the B12 at our branch site!’

Me – ‘Thanks for getting in touch.  The pharmaceuticals in question, do you mind me asking where you keep them?’

The Nurse – ‘They are kept in metal cabinets.’

I’ll be honest with you; I hadn’t thought about this before I received the call…. 

Me – ‘I’m not sure I’ll be able to give you a simple answer (or one you’ll want to hear) but I’ll do my best.’

‘The first point to note is that we are not regulated/inspected by the CQC as you are.  We are regulated/inspected directly by the MHRA and have to follow the rules and guidance for pharmaceutical distributors (Green Guide 2022).’

The Nurse – ‘You are boring me, Craig!’

Me – ‘Fair enough, apologies, what I’m trying to say is that; we have to store all pharmaceuticals (including ambient temperature products) in pre-mapped, inspected, temperature-controlled rooms at all times except dispatch and even then, we have to monitor the products route and journey to ensure suitable delivery times are achieved.  We chose not to dispatch any pharmaceuticals last week (18^th and 19^th July) because of the likelihood of the active pharmaceutical ingredients (API) temperature guidelines exceeding the upper limits (and we do the same during extreme conditions in the winter). ‘     

‘So, there are differences (there would have to be practically) but ultimately, both the CQC and MHRA’s priority lies with patient safety.  I am not clinically trained and don’t know the details or the severity of risk to the patient of the temperature breach so in our case, we would have to either destroy the products or quarantine them while we contacted the manufacturers to seek advice (as well as evidence the fact we had).’

‘My experience is that the CQC and Manufacturers will always fall on the side of caution (as you’d expect/hope? with patient safety) and it can also be difficult to get worthwhile responses from them in a suitable timeframe.’

‘I’m not sure if you have a GP or clinical pharmacist at the Practice who would be better placed to look at the risk to the patient? If the decision falls on you, I’d at least quarantine the products until you know more.’

‘I’ve started boring myself now!’

The Nurse – ‘Thanks Craig, you may be boring but I’m glad I called you.  I’ll speak to the PM!’

Me - ‘Sorry I can’t give you a more definitive answer.  If it helps, I’ll do my best to raise awareness with other Practices.’

The Nurse – ‘Thanks Craig – Don’t use my name! or the Practice name’

Me – ‘Deal.’ 

I’m relaying this transcript as temperatures are yet again expected to rise above 35°C in parts of the UK.   I’m not going to start talking about this year’s extreme weather warnings and the (hopefully obvious) link to the climate emergency in this blog. 

I also understand General Practice has more on the ‘to do’ or even ‘to consider’ list than possible right now, but patient safety has and always should take priority. 

Just food for thought. 

To PPG or not to PPG... That is the question

Written by: C. Burke

When it comes to the PPG there seems to be three separate schools of thought:

1.       Don’t have one, don’t want one

2.       Have one, don’t want one

3.       Have one, and it actually works!

Until recent years I was inclined (like most of my PM colleagues) to attach myself to the second philosophy. We didn’t need to have a PPG according to our contract, however we had one and we would do the minimum amount of work required to keep it going. It’s a hassle, isn’t it? Members of the group thinking that they know better than the people working on the ground, with some members even using the meetings as a platform to discuss their own medical problems with one of the GPs! What a waste of our time, which is already precious…right?

As I say, I used to subscribe to the second school of thought, however about five years ago something changed. I realised that instead of fighting against the PPG, we could work with the group for the benefit of the practice, which is after all, the whole point isn’t it?

Instead of fighting them, or correcting them, we work with our PPG to help them better understand the challenges we face as a team. This work paid off, as during the pandemic we were able to voice our frustrations about patient abuse to the group and have them effectively filter out that message to our wider patient list. The message started to get through, and we found an overwhelming majority of our patients supporting the practice, and I even noticed members of the PPG correcting the assumptions and insults of other, less well-informed patients on social media.

Instead of fighting against and resisting the PPG, they have become an asset to our practice. They have consistently (covid aside) undertaken an annual in-house patient satisfaction survey for our practice, promoted new avenues for contact by our patients and have been instrumental in getting the majority of our patients signed up to online services.

Our practice currently holds one of the highest percentages of patients signed up for online access in our area, and this was extremely helpful when the pandemic hit us and suddenly traffic was being driven online to decrease the footfall in the surgery. Without the work our PPG had done in previous years, the pandemic would have looked a little different for our patients, at least initially.

During the worst moments of Covid, when GP practices were receiving higher levels of abuse than ever before, our PPG organised a meeting with our local MP to ask why the government weren’t doing more to support NHS staff who continued to work and put themselves at risk for the good of the public.

Our PPG fought our corner and led the meeting, explaining to our MP that the way in which our team were being treated was unacceptable, and that perhaps the staff in his own offices could try supporting us rather than slating us all to the public when they called to complain about our surgery being ‘closed’ - which of course it never was.

Whether or not the meeting with the MP resulted in anything tangible or not (big surprise it didn’t) the point remains that our PPG were on our side, they called the meeting and they gave the MP what for.

It was a moment that made me really see and understand that we can work alongside our Patient Participation Groups for the greater good, rather than viewing them as an annoyance or a tick box exercise as so many practices seem to do. It takes time to get to know your group, but if you build a good relationship with them, and take the time to listen to their ideas (which are sometimes very good) you may just find yourself with allies you never knew existed.

Long live the PPG!

Learning Not To Take Complaints Personally

Written by: R.A Black

This is a tough one, as even now several years into working in general practice, there are times when I read a complaint and it touches a nerve. The flippant way a patient will publicly state that the service you provide, the service you work your backside off for, is below standard can really grind one’s gears upon opening Outlook in the morning.

Recently, no thanks to the Daily Mail, there has been strongly worded GP bashing everywhere, and it pains me to see when I know full well how hard they work, sometimes losing out in their personal lives in the pursuit of their profession. I’ve known several GPs who have sacrificed family life and missed out on key moments because they were dedicated to their patients, and to see them so relentlessly criticised feels unjust to me.

I find myself at times wanting to respond honestly to NHS choices comments, to tell patients that they have absolutely no idea how difficult life in General Practice really is, and then I remind myself that until I came to work in GP land, I had no idea either.

We walk a lonely path as PMs, and we work in an environment that anyone outside of it cannot really understand. In my previous job I thought I got it, but I absolutely did not. The relentless and continually changing nature of the beast is so different from other working environments that unless you have work within it you simply wouldn’t believe it to be true - and we have to make our peace with that.

Patients, suppliers, cleaning companies, contractors, and anyone else who has anything to do with the practice don’t understand and they never will. People will always complain because it’s within our nature as human beings to do so, and they will certainly complain if they’re unhappy about something relating to their health.

Trying to explain primary care to an outsider is like trying to explain colour to someone born sightless – it can’t be done.

So, how do we handle the situation? Well aside from privately referring to anyone on the outside as ‘muggles’ I have a solution, and a way to approach the kind of complaint that makes your blood boil.

Remember that in most cases it’s not personal. Not matter how furious a tirade has been received, most of the time it really isn’t anything personal. Often in my experience, complaints come from a place of frustration, fear, or misinformation. People complain when they’re worried about their own health or the health of someone they love, they complain when they can’t get exactly what they want when they want it, and finally they complain when they’ve read in the Daily Mail that GPs are refusing to see patients face to face and are refusing to work 100 hours a week etc.

A lot of the time, a complaint can be dealt with over the phone using gentle reasoning rather than it becoming part of a formal complaint process. Call the patient, talk their complaint through, see if you can resolve it over the phone and reduce your own workload. Sometimes you find that they just need someone to talk to.

Think of the patient as a customer. Having worked in customer service I find this way of approaching complaints to be what works best. Remember that in some ways, they are customers really, and that their satisfaction does matter. We are told often enough to put the patient at the centre of everything you do and this is no less true of responding to and dealing with complaints. Put yourself in their shoes, no matter how unreasonable you think they are being, and try to see the situation from their perspective. Even better, you may be able to find a solution to their problem together, which in itself can be a major victory.

I try to look at all complaints and patient feedback as a way for us to learn and grow as an organisation. I now have a matrix of patient feedback, and within it I include learning points and actions; anything positive that has come from a complaint will be documented in that matrix. Why? Because not only will it be a useful resource when CQC come knocking, but also because it means that on the days when I receive an email of complaint, or the dreaded handwritten envelope that signals patient feedback, I can open the matrix and remind myself that some good does come of patient feedback.

We have improved our service and identified problems that wouldn’t have come to light had a patient not complained. We all know that you get the odd patient who seems to love an argument and will not listen to anything you say in defence of the service, but that’s ok, because they’re muggles, and they’re never going to understand.

We just have to learn to be ok with that.