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Friday 28 October 2016
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Patients' demands

Prior to working in general practice, I had little experience of what went on behind the scenes.  Therefore, it is fair to say we shouldn’t expect our patients to understand it either. The general practice team spend a lot of time explaining procedures, policies and why we do the things we do at work. This, however, can come across as being dismissive to our patients. At times, our patients may feel we are being unhelpful or restrictive. This is when patient education and good communication becomes invaluable.
As a practice manager I take a considerable amount of time carefully constructing responses to each complaint and/or concern. This is where the unrealistic expectations of our patients start to emerge and no matter how hard you try to help them understand, it sometimes doesn’t achieve complete satisfaction. It is not that I am unsympathetic to their reasons to get an urgent appointment: prescription, test results, documents signed or anything else they may require. However, given the available resources, they have to realise there
are limitations to what we can reasonably deliver. Appointments are the biggest issue for most practices. No matter how diligent we are with managing, on the days (OTD), pre-bookable, urgent slots, home visits and telephone slots we simply cannot satisfy the demand and/or expectations. Most practices have a variety of options to book, yet again we are regularly criticised for not individually catering to our patients’ needs. This is very frustrating for all, including the GPs.

Out of Area
Our practice lies in semi-rural Surrey and currently has a patient count of more than 15,500. Many of our patients have been with the practice for years and at times moved outside our catchment area and have been allowed to stay at the practice. Now we are seeing an increase in new housing development within our catchment area, therfore increasing our patient size. We are currently able to accommodate the new registrations and the leavers but we do have to manage this carefully. Many of our patients moving out of the area want to continue to stay with us due to the continuity of care and trust in their GP. This does cause us problems when patients need regular home visits, which takes the GPs out of surgery for longer periods of time. There have also been times when we have sent one doctor out on a visit only to have the patient request their usual doctor to come out later that week. This is not due to incomplete care but insistence on seeing their own doctor.

Unrealistic requests
Some of the daily requests from patients can be unreasonable and they find it difficult to understand why, for example, the doctor can’t speak to them when they call during the morning surgery or why the doctor can’t ring them at a certain time of their choosing. If they drop off paper work at 8am they often wonder why it isn’t it ready for them to pick up at 9am. Many patients don’t manage their repeat prescriptions effectively and make demands because they forgot to put them in. Last minute travel injections, no matter how you try to prepare patients, they will insist they need to have them not realising the impact of time needed by our nurses. Patients who know the system will use urgent appointments for inappropriate means or for routine visits.
We sometimes accept why these situations occur but the patient does not realise the impact they have on the surgery. We have procedures and policies for a reason, particularly in healthcare for the safety of our patients. Sometimes we are put at risk by patients expecting us to compromise on situations. This is when it is vital to educate our patients and give them a clear understanding of why we do what we do. Sometimes, no matter how many times we reiterate the rules, patients want us to bend them.

Unsung heroes
Since joining the practice three years ago, I feel I have been very lucky with the staff I have inherited and the new members I have since hired. Among the cohort of a mostly female team, we have a male receptionist who has changed the dynamics not only with staff but our patients. By having a strong and cohesive team who work well together, it makes a huge difference in providing a good service. It is important to get the right people in place, focusing them on customer service and positively motivate. We have fewer complaints about our team and hopefully diminished the stereotype associated with receptionists. Receptionists are really the unsung heroes of general practice and for years have been given a bad reputation. They need to know a tremendous amount of information in a diverse and ever-changing environment. Not only is the reception team, the face and reputation of the practice but they are also the ones who get the most grief and abuse. This makes their role even more important in patient education and communication.

Patient engagement
Our patients’ expectations are high and I can only assume this is the same for other practices. At times the patients feel we do not listen to their comments and feedback. We do take them on board and we will investigate possible system failures, invest in new and better systems, track down and discuss communication errors and make it a learning point at our staff meetings. However, unrealistic requests and demands are common. Sometimes the patient is frustrated by our systems and feel they are unjustified. They feel we should be able to bend the rules for them and at times we have. We do our best to make the right and informed decision for patients.
The demands on general practice are evident and we hear about it in the news. We are living longer with more chronic illnesses but there also seems to be a higher demand for basic care. The public seem to need more reassurance from GPs and specialists. There seems to be more need for quick fixes and miracle cures for colds, coughs and stomach bugs. We are referring more patients to specialised care and this is what the patients expect. Long gone are the days of staying at home and managing your minor illness. Yes, we are a busier society and we are much more knowledgeable with access to 24-hour information on the internet, but we still seem to need our GPs to prescribe and refer for more minor conditions.
It seems we are starting to go back to self-help education, as well as using the pharmacy in a wider capacity. Does providing our patients with self-help discourage unnecessary visits to the practice or A&E? Don’t we already have access to the internet to help self-diagnosis? Is this the reason why more patients need reassurance from their GPs? We don’t want to discourage our patients from seeing the doctors but we don’t quite have the answer to our current problem.

Health minister – local MP
The secretary of state for health, Jeremy Hunt, is our local MP. It does give our patients an extra cause to complain, hoping he will come in and change the way the practice is run. Though it can be said, his office has been nothing but polite and understanding when dealing with complaints sent directly to him. This is a good opportunity to explain our position, express the pressures in general practice and hopefully give a clear understanding of our policies and ways of working. Hopefully, this gives an insight into general practice and the hard working teams within them.

Robin Forward, practice manager, Surrey.