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Friday 30 September 2016
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Receptionists 'have complex prescribing role'

Receptionists should "step out of the shadows" and make their contributions to repeat prescribing "explicitly" known to GPs, it is argued.

A study, published in the British Medical Journal, found receptionists and administrative staff in general practices across the UK often make "important 'hidden' contributions and judgments" to repeat prescribing.

Such judgements serve to bridge the gap between the "assumed" reality of the technology and the often "far messier" reality of day-to-day general practice, said Deborah Swinglehurst, lead author and Doctoral Fellow at the Centre for Primary Care and Public Health at Barts.

Yet GPs are often unaware of this input, she claimed.

Swinglehurst and her colleagues found repeat prescribing to be a "complex, technology-supported social practice" that requires collaboration between clinicians and administrative staff.

She told MiP training in the area should not just focus on technology but assist receptionists in the "complex judgments they have to make and the emotional pressure that goes along with it".

While the study found no evidence any of the contributions made by receptionists or administrative staff were putting patients at harm, Dr Anthony Avery, Professor of Primary Healthcare at Nottingham University, has concerns.

"At the moment it doesn't seem sensible for people to be making decisions that have not had the correct training to do so," he told MiP.

"While I'm sure the majority of receptionists are mindful of not stepping outside of their competencies, they could be engaging in risky behaviour and causing undue harm to patients."

Swinglehurst said a lot of receptionists attach post-it notes to query prescriptions and make potential problems known to a GP.

But post-it notes are "not the most reliable form of communicating", argued Dr Avery, as they can "easily" come unstuck.

"The concern for GPs is there is a very real risk that if a prescription is presented and falls between the rules, it will get signed off with a very quick glance," he said.

"Any communication made highlighting concerns must be made more explicit."

Dr Avery told MiP there is a strong culture in general practice that "doesn't necessarily recognise the value" of training receptionist staff.

He argued it is difficult for receptionists to make demands for training as it all depends on where they are in the "pecking order".

"We have to work out whether we want to continue to have such wide variations of how practices operate with regards to how they engage with collaborative repeat prescribing or set core principles that all practices should adhere to," he said.

Yet, in research submitted to the General Medical Council on the monitoring of repeat prescribing, Dr Avery found there was a general culture in GP surgeries whereby receptionists and administrative staff felt they could raise issues with GPs and not feel as if they were "treading on eggshells".

However, he did acknowledge that some GPs can be "difficult" and receptionists are forced to "tiptoe around so as not to upset them".

Swinglehurst told MiP this hierarchical structure was found in one of the practices studied. She argued the culture gave way to a greater chance of more complex repeat prescriptions, leaving receptionists "more prone to error".

Do you agree that receptionists and administrative staff should make their contributions to repeat prescribing more explicit to GPs?

Your comments (terms and conditions apply):

"Surely the buck stops with the GP signing off the prescription?  A practice protocol covering repeat prescriptions is the most practical way to deal with this issue. A one-size-fits-all approach is only going to complicate the issue - there are too many variables in how practices are run for that." - Alison Nicholls, South Devon

"In our practice I feel we do. We will send a patient note to the doctor or speak direct if we have a query. Only items on a repeat is ever issued, no acutes. No patient is issued with more than 1 repeat if they have not had a medication review with the doctor either face to face or via telephone consultation." - Tracy Kenny

"This very much depends on what the role of the receptionist is. Clearly they are not in a position to authorise the repeat of a prescription this is a GP's responsibility, nor issue prescriptions that are acutely prescribed. These are clear safety mechanisms put in place. However, I as Practice Manager and my reception staff have questioned over use of medication and asked for advice from a clinician as to whether an appointment should be booked?" - Christine, Birmingham

"Yes, there is a time factor involved. It takes time to ask the GP if X or Y can be issued: so patient calls for script or goes to Pharmacy and script not ready.  Results in 'gripes' or 'moans'" - Sue Lynskey, Staffs