The news this week that you may have to phone a call centre to make an appointment with your GP needs a little more explanation than it’s so far received.
At my practice we have nearly 11000 patients, 9 doctors and 6 receptionists. We offer about 600-700 appointments a week not including about the same number of phone calls from doctors to patients for advice.
Approximately 30% of our practice population changes every year, which is typical for an urban practice. Our most vulnerable patients, the elderly, illiterate, learning disabled and mentally ill tend to be less mobile than the younger professionals.
Early last week a new patient came in to make an appointment, she wanted to be seen the following afternoon at around 5pm. When the receptionists told her that there were no appointments then, she started screaming at them, “I’m a professional! I pay my taxes! Don’t you people know how busy I am!”
Our receptionists have a high threshold for abuse. They are shouted at and sworn at on the phone and face to face several times a day. Occasionally they are spat at and patients throw things at them. We look after patients who are excluded from normal society, including about 100 registered heroin addicts, at least as many alcoholics, wife-beaters and child abusers. Many of our patients never go out, except to come to the surgery because they are crippled by anxiety, paranoia and inability to cope with normal social interactions. The movie Mary and Max offers a wonderful sensitive insight into the life of someone who suffers problems like many of our patients.
Because we have a very low staff turnover, our receptionists know what to do when Brian starts banging his fists on the desk, when Shirley collapses drunk on the floor in the middle of reception, when Joyce starts undressing and when Sandra rings up screaming that the devil has stolen her tea bags again. They know that when Sidney who has schizophrenia and serious complications from his diabetes comes in looking anxious that they can call one of the doctors or nurses to review him opportunistically because he rarely ever comes in for an appointment. They know that when Fatima calls to say she has chest pain she doesn’t need an urgent appointment, but when Arthur says he feels breathless he needs urgent medical attention.
When young professionals scream at the receptionists it upsets us all because they are there to help. It offends and upsets us because we know how vulnerable our other patients are and how hard it is for them to get anything. It upsets us because we know that when the angry professional sees the doctor they won’t treat the doctor like the receptionists. It upsets us and it is offensive because healthcare should be distributed according to clinical need, not according to how much tax people pay. It offends our other patients who cannot work and don’t pay tax. It offends patients with mental illnesses that I am seeing every week because their Employment Support Allowance (ESA) has been cut after a 10-20 minute assessment that is hopelessly inadequate at judging the functional disability of their illness, and consequently their lives are filled with endless paperwork, appointments and anxiety-inducing beaurocracy trying to appeal or cope without the money. They are also busy.
Another patient, dismayed at the difficulty getting an appointment with her GP at another practice and at what she thought was unprofessional behaviour, said, “Give me a headset monkey any day.”
I’ll leave aside the reference to someone in a (likely Indian) call centre being a ‘monkey’, it’s offensive, but it’s off subject. Unprofessional behaviour needs to be brought to the attention of the practice manager, and though it’s also off-subject, I strongly support the National Association for Patient Participation Groups as a way for patients, doctors and receptionists to work together to improve the service in GP surgeries.
The underlying problem with the angry professional is one of social inequality. She cannot cope with a system that tries to treat everyone equally at the same time as prioritising the most vulnerable. As I cycled past a surgery in Kensington yesterday I wondered if a patient there would shout out loud in the waiting room, “I pay my taxes!” or would it loose its effect in a room full of tax-payers?
The point I am emphasising here is that GP receptionists have to face the most challenging people, under the most stressful circumstances every day. They are part of the team that looks after our patients and their insights are vital.
They cannot and should not be replaced with call centres.
A Better NHS 
Agree about the call centres. Medical receptionists can give as good / bad as they get and can contribute massively to the stress endured by patients. How many practices get genuine assessments of how their patients are treated?
I disagree with a lot in this post. First I am not sure why you have rolled up an issue with a ‘young professional’ with that of call centres to handle booking appointments for GPs. So I am going to treat them separately.
There are (having met them I am certain there are) some people who feel ‘more entitled than others’ due to the level of taxes they pay. These people are idiots. However I see no substantial reason to think your ‘young professional’ is one of them. Isn’t more likely that this woman was very frustrated, possible due to whatever medical condition she wished to be seen about (which she may not have wished to discuss in a busy reception with the receptionist), possibly due to the pressures of being a ‘young professional’ (which, as for GP’s or even GP’s receptionists who are young professionals, can be a stressful and pressured experience requiring long hours and, perhaps, a culture of presenteeism that can prevent ease of access to the GP depending on the hours they operate). There seems to be an assumption in your post about the nature of young professionals and the medical conditions they may or may not have, their availability (which, in a world where far too many surgeries operate a 9-5 Mon to Fri ‘service’ is going to be problematic for many) and so they urgency with which they need to be seen and accomodated.
The second issue of a call centre also seems to me to be misleading. Personally I would find it quite helpful to be able to make a appointment booking or order a repeat prescription via a call centre. Indeed if, at anyone time, one of your six receptionists is dedicated to answering such calls, perhaps in a little room at the back of the recepetion, what is this but a minicall centre?) My view may be due to issues with my particular surgery; it usually takes them 10 mins to answer the phone, they close for lunch (really, they *close* for lunch! Not just there is a lunch break built into the appointments day, the reception *actually* closes for lunch. And they don’t turn the phones off or change the answering message, you just hang on the phone till you twig…) However just because you have a call centre handling appointments and perhaps repeat prescriptions does not mean that there has to be no route to speak to your surgery’s reception. All you need is your surgery number to immediately present the caller with 3 options 1. Appointments, 2. repeats. 3. speak to a receptionist at your surgery. There is also no need to prevent your own receptionist from making appointments or taking requests for repeats if that is what you wish to do at your surgery. (And I would think this would be the best approach). Indeed if you are wishing to ‘professionalism’ your receptionist in the way you appear to be doing so such division of labour would reinforce such an approach and free up their time.
Perhaps then they, and you, would not need to make snap judgements about ‘young professionals’ and their needs.
Thanks for your comment. I think you assume too much though, about my judgements and the young professional. I’m aware of the nuances and range of reasons for people’s frustration with reception. I could have written a post about that, and I might do in the future, but it would have detracted from the point I was trying to make. In my example i deliberately stated that the patient said, “I pay my taxes!” and yet you assume she ‘isn’t one of them’ [people who think they are more entitled] You might be interested in a previous post, Who is the NHS for? Not me! which explores the effect of blame, self blame and self loathing in a culture that treats vulnerablity as a personal failing; the young professional’s exclamation was clearly meant to deliniate her from the other patients quietly waiting and there is an important consideration of the effect that comments like this have on other patients in the waiting room. It is sometimes necessary to close reception in order to have meetings to discuss, amongst other things, how to improve access and what to do about abusive patients. These issues come up all the time and we’re continually trying to improve access and reduce unnecesary appointments; I don’t know of any surgery anywhere that doesn’t struggle with this, indeed, especially in an urban practice with a high patient turnover, it is particularly difficult. Your surgery could clearly improve, why don’t you make suggestions in writing or offer to join a patient participation group?
Your second point, We allow patients to book appointments by email, by automated phone service, by personal call or face to face. There’s no particular reason why another method might not be useful (text/tweet?!) but I suspect it would add costs to the NHS and do little to improve the situation. If you call my surgery and cannot get an appointment at your convenience you can always ask me to call you back and we can work something out.
Also related. We are running a ‘GP led health centre’ (sometimes referred to as a walk-in centre or a Darzi centre) as well as our regular surgery. Part of the payment depends on us having x number of ‘walk in, non-registered’ patients coming in every day. Too few and we loose money. It we make the target we’re ok. In our regular surgery we spend years training our anxious patients not to come in every time they have a new symptom and teaching people how to care for themselves. But in the walk in centre we’re stuggling to attract the ‘walk-ins’ so we have to encourage people who don’t need to see a GP to come in to see us, from 8am to 8pm, 7 days a week. There’s unlimited access, but it’s no way to run a rational health service.
A few years back, my own GP offered same day appointments for everyone that called before 9 or turn up at the practice. Yes, everyone as waiting list is in a sense a rationing tool: if you have one, it can only grow.
Well after a few months it was abandoned.
“We have the single most compLaints!”
“Same day appointment and the most complaints???”
“Why?” I asked.
“People cannot plan as they have other commitments like Royal Ascot, Wimbledon, Oval, Henley & Epsom!”
“Wow! See the doctor first, then go.”
It upsets us because we know that when the angry professional sees the doctor they won’t treat the doctor like the receptionists
for “professional” substitute “patient, and I’ll agree. I really dislike that and do my level best to be *nicer* to receptionists etc. than to doctors. But I dislike “young professionals” (I’m not one) not only because it singles out professionals but because of its crazed assumption that young doctors are somehow free from “entitlement syndrome”; an assumption devastatingly disproved by the weeping and wailing of doctors who had to *move city to get a job in their specialism at the level they wanted*.
(I loathe the “I pay my taxes” lot.)
And I agree with Nathan Emmerich that call centres are fine for some things — the 1,2,3 option sounds fine. Email and web contact would be helpful too.
— actually, I’m not sure what your argument is.
Thanks for your comment. I try to write some posts with ’10 things … ‘ but in other cases it’s more difficult. The main point here is that making appointments work for patients is complicated and involves knowing patients, particularly the most vulnerable and managing appointments according to clinical need. In primary care when a lot of the time patients struggle to define their level of need it can be very difficult. I think it would be expensive and dangerous to outsource a complicated, responsible job to someone in a call centre.
Receptionists and secretaries doing triage? That explains the mistakes. I naively used to think someone with a medical qualification made these decisions on access to treatment.
As a medical receptionist myself we do not triage but we do have to use some common sense otherwise the doctors would have a surgery full of cold sores, cut fingers, runny noses etc and the receptionists would have even more patients screaming at them that they cannot get an appointment because there are none left and the doctors asking us why we have given an appointment away on something that could be dealt with by a nurse or with a prescription via a message to him/her.
I need some advice, how many receptionists should be there in an urban practice of 11000 patients.
Good question. I think there may be some guidance if you check the RCGP website. It depends of course on whether they are full or part time, how long the practice is open, how much access is by phone or face to face and how many administrative duties they have, so it cannot be fixed and will quite reasonably vary. We have 6 for an urban practice with 13000 patients, but they are not all full time and we have changed their administrative duties quite a lot, even in the last year.