GP practices were once again making headlines this week, this time because receptionists could be putting off patients from seeing their GP. Rather than regurgitating the news – you can read more here – we thought we would take a look at the issue in more detail.

First of all, it’s worth pointing out that there are two very opposing views in this debate. Practices, quite rightly, defend their receptionists, and we all know it’s a ridiculously tough job that can be demoralising. However, from the public’s perspective, this isn’t the first time the issue has reared its head and anecdotal evidence does suggest there’s a problem, even if it’s more of a perception than a reality. So what can we do, as practice managers, to improve the situation?

“Practices have to respond to news stories like this and it was great to hear Caroline Brown on the Radio 4 Today programme (click here to listen – the interview commences 1:43 in) fighting our corner,” one practice manager told us. “But at the same time there is clearly an issue and we can’t just defend our teams without ensuring they’re doing their job properly.

“Personally, I think our practice needs to do more to treat patients like customers. How can we improve our customer service? What changes can we make to deliver a brilliant customer journey? Will improved communications and friendlier staff encourage more people to choose us for services such as flu vaccinations? Most importantly, will doing the above improve our ratings with the public?”

Training

In response to those questions, another PM told us: “We thought carefully about this exact situation, following some negative PPG feedback a couple of years ago, and invested in some customer service training for our staff and a communication exercise with patients that explained why we need to ask questions.

“The reception training, which covered everything from body language to telephone manner and the wording of questions, really helped to improve patient perception. Receptionists learnt how to deal with those abusive patients that we all come across – they now take it much less personally and have a sheet in front of them with some stock phrases that the trainer provided – and if any patients don’t want to answer we take notes and prepare staff accordingly. Plus, because we explain to patients that we ask the questions to find the most suitable healthcare provider for their needs, they are much more willing to respond openly. It has really worked for us.”

“I think getting ‘customer care’ training for our receptionists is good; we did it once at my practice and I feel it should be a regular thing,” another PM told us. “That said, patients need to appreciate why we’re asking the questions that we are – and that’s because resources aren’t finite.”

Understanding the issues

Of course, in order to address any issues that may exist, you’ll need to know the problem areas. A study published in the British Journal of General Practice analysed 447 incoming calls to three GP practices for effective communication and the results were then compared with patient satisfaction scores.

The researchers found that practices where more patients had to push conversations forward because of poor communication by receptionists had lower patient satisfaction scores.

Less effective receptionists failed to offer alternative courses of action when they could not meet patients’ first requests, leaving the burden on patients to drive the call forwards, the analysis found. They also closed calls prematurely, before confirming the details of next actions.

In the more effective calls, receptionists made alternative offers and summarised patients’ appointments or confirmed what would happen next.

The researchers said the study had implications for training receptionists, which should focus on confirming appointment details and offering alternative courses of action if patients’ initial requests cannot be met.

Outside of receptionists’ control

Responding to the research, Dr Maureen Baker, chair of the RCGP, said that receptionists were key to the smooth running of a practice, but that in most cases patient dissatisfaction was a result of issues outside the receptionist’s control.

“It is not an easy job, and all too often receptionists bear the brunt of criticism if a patient is not satisfied with the care they receive. Yet, in the majority of cases, dissatisfaction may be as a result of circumstances out of receptionists’ control; a lack of GP appointments due to the intense resource and workforce pressures currently facing general practice,” she said.

Telephone triage

Commenting on the Practice Index Forum, one practice manager suggested that telephone triage is an effective way to alleviate any concerns.

“As a practice, we don’t generally ask people the reason why they are making contact. We have a system where patients are given a telephone triage appointment to give them the opportunity to speak to a GP so we can then support the patient to have access to the most appropriate care. We do this because it allows us to see 99% of patients, where there is a clinical need to be seen, on the same day. Typically, we call patients back within two hours and I would be delighted to receive this type of service in my practice. Yet for some patients this still isn’t enough.

“Supported self-care and clinical triage are our two best tools to avoid the complete collapse of the Primary Care industry. We are trying to work more closely with patients with long-term conditions and minor ailments to maintain or improve health outcomes. We support and promote the universal messages that patients need to hear in order to support better health, lifestyle and service choices. We may well have to move to a system of talking to patients about their medical conditions to further prioritise the calls we get. If, or perhaps when, that point happens, we need a public that are supportive and understanding of why we’re doing this – for us to continue to provide a service.”

Of course, as was pointed out on the Forum, the issues raised in the research aren’t just about patient experience. This is about demand management in an industry that is failing. To be able to support the public, we have to have a better public understanding of the challenges we face in Primary Care – and if this perception is not changed to allow us to evolve in a way that helps us manage demand, clinical risk and the patient experience, then we are destined to fail.

Does that mean the powers that be need to invest in a publicity campaign to try and inform the public? It’s definitely an idea most practices we spoke to would get behind.

With more education of the public and training for receptionists, already-improving standards can no doubt be enhanced further. That’s why it’s worth noting that NHS England has promised funding for training reception and clerical staff in the GP Forward View. More details on that are to be revealed soon, we’re told.

A positive note

As we all appreciate the tough job receptionists have, we thought we would end on a positive note posted in the Forum.

“Yesterday, in a staff meeting, we reviewed a recent SEA for a patient who was admitted urgently; moribund and close to death. The spouse had rung up that morning to cancel an appointment because the patient in question could not get into the surgery, with no explanation or request for an alternative. Our receptionist was not happy and asked a couple of questions, then offered a phone appointment in place of the face to face slot. This was quickly changed to a home visit, then admission. We used the SEA review to praise staff who may be “just not happy” and reinforce our permission for them to go with their instincts. A life saved. No fanfare, no headlines; just a job well done.”

Perhaps somebody should tell the BBC!

We would welcome your comments on this topic. Either post your comments below or join the conversation in the forum here. 

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