Nice little job in a GP Practice

Written by: S.Black

I’ve read a lot in recent years from practice managers who want to form their own professional body, it’s an interesting one as whilst I agree that we are a group of professionals and we should have some form of representation, I think that we will always come up against the same problem…a total lack of understanding of what a GP Practice actually is, and even less comprehension about what a Practice Manager does.

A good example of this is something that happened to me recently, when I (for my faults) attended an informal school reunion. At first it was all hugs and recognition, then came the standard questions;
Are you married?
Do you have children?
Where do you live etc. etc. until finally, we came to what could be the most boring question of all time…what do you do?
I cringe at this question as I don’t think the sole measure of a person is their occupation, and so when I was asked this recently, I began, ‘I work in a GP practice.’
 To which came the response (and not for the first time)
 ‘Oh are you a receptionist?’

The person I was speaking to knows that I’m not a doctor, they know I didn’t attend medical school, and therefore it’s interesting to me that the first place their mind went was reception. Now, before I continue let me state categorically that I was not offended by this question, and that I have more respect for our reception team than any other team in the practice. As far as I’m concerned, they have the most difficult job in GP land; it’s thankless, relentless, and woefully underpaid across the country. The reason I found it interesting, is that public perception of GP practices seems to be this; that if you work in a GP practice, you’re either a doctor, a nurse, or a receptionist…and nothing else.

GP land is like a hidden world that outsiders don’t understand; filled with challenges and triumphs that simply do not occur in other industries, even in other parts of the NHS. Forget anyone in the private sector if you’re looking for understanding because the fact of the matter is, practices exist on their own plains, and we must accept that the public simply cannot comprehend what we are dealing with on a day-to-day basis.

I remember, several years ago, a rep from a company coming out to our practice and making an offhand comment about practice managers never working full time, the implication from her tone being that PMs don’t really do that much. I was furious but being a relative newbie myself I kept my own counsel. I’ve often thought back to that day, and the fact that the rep professed to understand how practices work and to recognise the pressures we face, whilst at the same time openly criticising the fact that a practice manager didn’t work 5 days per week. I never told her that the reason the PM only worked 4 days a week was because she worked consistent 12 hour days, well over standard full time hours, doing most of her admin at home on her ‘day off’.

Which brings me back to my opening point. People, and by people, I mean anyone who has never worked in general practice simply cannot understand, comprehend or believe the work that we do. They do not understand the vast complexities of our targets, the way that we are paid, the structure of staffing or even the fact that we are essentially independent businesses and what we need to learn to accept is that they never will.

I know that people on the outside think I’m being dramatic when I explain my role, that it is business manager, HR manager, contracts manager, finance manager, IT manager, complaints manager, maintenance man, snow shoveler, staff counsellor and more all rolled into one. But it’s the truth, and other PMs will read this and nod their heads because undoubtably you too have seen someone glaze over when you try to explain exactly what it is you do.

So what can we, as PMs do about this?
Honestly?
Well, nothing really. Other than alter our way of thinking about it.

I refer to two characters from fiction to illustrate my point. Clark Kent and Harry Potter.

Let’s start with Harry Potter, it’s a nice easy analogy that we can all relate to. We work in a world that outsiders (let’s go the whole hog and call them ‘muggles’) simply do not understand. They don’t believe in it, they think it’s as simple as just hiring more doctors or just getting more receptionist and they have no idea that there is a whole world of practice staff working away unseen in the background; clinical coders, reports administrators, clinical administrators, medical secretaries to name a few. Until you become part of the mystical world of general practice you just don’t get it, you’re not in the club, because you’re a muggle, and we are magic.

In case you’re not a fan of the wizarding world, let’s take a look at the classic caped crusader instead, Clark Kent, who worked a normal job, and looked, from the outside, like a normal bloke with nothing special or interesting about him, until things went wrong and suddenly, he was ripping off his shirt, throwing off his specs and saving the day as Superman. As Clark Kent, he took none of the glory, and just did what he had to do until it was time to be his true self and save the day. He couldn’t tell his colleagues in the office how much he was doing behind the scenes, and although we as PMs can, it is pointless, so we don’t.

Why have I leapt to Superman you might be thinking?
Well, consider this…

When the pandemic hit all hell broke loose, and GP practices were being slated left right and centre. The government were chastising us for closing our doors…which was a load of rubbish in most cases, and criticising GPs and medics for taking government mandated precautions like reducing unnecessary F2F appointments to lower the risk of spreading the virus. We were openly criticised by our patients and received record numbers of complaints across the industry simply because we were trying to keep our patients and our staff safe. We were Clark Kent, beavering away in the background, working from home when suffering with covid ourselves and receiving no real thanks once the public became sick of clapping for the NHS.

But who was it who got the nation vaccinated? The mass vaccination sites? No. It was GP Practices. Like Superman emerging from the toilet cubical Clark Kent formerly occupied, we rose up as a group and facilitated the mass vaccination of the most vulnerable and at-risk groups in the country. Don’t get me wrong, vaccine sites did their share, but it was GP practices who ensured that the people who were at most risk were protected from the effects of Covid. And no one can ever take that away from us. We did it without fanfare, and then we did it again, and again, and we’re about to do it once more and no doubt there will be those who criticise our management of the vaccine programme this time round but who cares? They don’t get it. They’re muggles, and we are magic folk. They aren’t in the club and so they’ll never understand.

So the next time I tell someone where I work, and they ask if I’m a receptionist, or they make the classic comment ‘Oh, a nice little job in a GP practice’, I won’t flinch, or lose my temper, or even attempt to explain why they’re talking out of their rear.

Instead, I will simply smile and nod, and as they walk away, I’ll mutter to myself with a sigh and a shake of the head…’Muggles’

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!

Lionesses have brought it home!

Written by: Georgia Dossis

I’m sure that everyone can agree that history was well and truly made last night in the most spectacular way!

Not only was the 2-1 win from the Lionesses their first time winning the Euro’s since it’s begun, but it was also the first big time win for the England teams for 56 years. An absolutely stunning victory.

The extra time goal scored by Chloe Kelly, will forever change football and adds to the timeline that hasn’t exactly been straight forward.

Did you know that women’s football was banned in 1921? It was actually considered unsuitable for women to play football. This changed by the end of the 1960’s when they formed the WFA (Women’s Football Association) but imagine if this hadn’t been the case? There’d have been no representation of women in the sport and last night would’ve just been an ordinary Sunday night.

The players within the whole of the association should be proud, not only to represent England, but for inspiring younger generations everyday as they represent change and inclusion which is so very much important.

Celebrations are being held in London today between 11:00 – 14:00 for all fans and is well deserved after the efforts put in. A huge congratulations to bringing it home!

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.