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Fire breathing dragons

Hard-wired GP

Luke Koupparis

Thursday, 22 March 2018

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AdobeStock_65696445_receptionist.jpgIn years gone by, reception staff in general practice have been viewed as the dreaded gatekeepers of the doctor’s appointments. Some view them as fire breathing dragons, whom require taming to get anywhere near a GP appointment. Now, obviously, times have changed, and many practices now work hard to provide a professional and polite service to their patients. A great receptionist will also have an in-depth knowledge of the patient and will provide that interface between those wanting care and the doctor who provides care.

We have also moved on in recent years to recognising that receptionists are excellent signposters and many practices have invested much time and money in this. Indeed, even NHS England has recognised them as a group who can be invaluable and, as part of the Five Year Forward View, has provided funding for active signposting training. They realised that doing this may free up GP time thereby reducing demand on scarce GP appointments. It also ensures that patients are directed to the right service at the start with all roads not necessarily leading directly to the GP. As an aside, reception staff feel empowered with these roles and have increased job satisfaction.

The reason I mention this is that I am concerned about the plans suggested to open up appointment booking to the NHS 111 call handlers as part of contract changes in 2019/20.

Every time I go through the list of clinical reports from NHS 111 they shock me at how they manage to write copious reams of utter rubbish completely unrelated to the presenting complaint. Not only that, having gone through their standard protocol of inane, irrelevant questions, they then advise the patient to seek further help. If the patient happens to mention the word 'chest pain', even if they point out it is related to a mild throaty cough, a 999 ambulance is sent racing out to them.

The other common outcome I see is that the patient should seek primary care advice in X hours. It seems that X seems to be as low as possible to ensure that their risk-adverse software is placated. Many patients then end up coming via reception and usually getting sensible advice from a clinician.

So, having spent lots of time and energy training our great reception staff to work on signposting patients to the most appropriate service, we are now faced with a whole load of appointments being booked by 111 staff who have no knowledge of the patient and with software that will be only too glad to overrun our appointment systems. It is also possible that patients will start to then use 111 to bypass the normal routes for booking a GP appointment.

I cannot see that a move to allow external organisations to directly book will help to direct patients to the most appropriate service and it will inevitably mean our appointments are filled with inappropriate complaints. The knock-on effect will be to increase A&E attendances for those patients who then cannot get an appointment thereby increasing demand on hospital services.

Therefore, if you ask me I would favour using our fire breathing dragon receptionists pointed directly at NHS 111, rather than them coming anywhere near our practice appointment system.

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Luke Koupparis

Luke is a general practitioner in the Bristol area with interests in men's health, child health, minor surgery, online education and medical information technology. He is the IT lead for Bristol clinical commissioning group. He also works as the medical editor to OnMedica helping to deliver high quality, peer reviewed information to the wider medical community. In his spare time he is a keen road cyclist.
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