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.