Retailers are stacking their shelves with products we wouldn’t normally dream of buying, the debate about tins of sweets getting smaller have resurfaced and John Lewis has previewed its latest ad – all signs that Christmas is just around the corner!
While the festive countdown fills many with excitement, for many practice managers it raises the thorny topic of Christmas cover – both in terms of service delivery to patients and the management of staff. Managing workloads at this most tricky time of the year can be tough as it’s virtually impossible to keep everybody happy.
In a service industry like ours, patients come first – a fact that’s pointed out in the BMA’s guidance about the Christmas period. It points out that it’s vital patients have access to the appropriate services, especially at a time when winter pressures are putting a severe strain on services. It suggests practices should ensure that:
- patients are aware of any closures in advance by using surgery notices, and including messages on repeat prescriptions
- arrangements are in place to ensure that repeat prescriptions are ordered and collected in a timely matter to avoid requests over the period of practice closure
- answer phone messages should be changed at 18:30 on the afternoons of early closure – in particular – for opted out practices where there is a change from the sub-contracted provider to NHS 111
When it comes to closures, the GPC says that if a practice is comfortable that there will be a low-level of demand for services for this period and it is able to run a service that is reasonable to meet the needs of patients at that time, this would not constitute a breach of contract.
Regulations take into account that, at certain times, the need to run a full surgery may not be necessary and therefore, allow a practice to run a service that allows patients to access core services but on an ad hoc basis when required. Practices should advise the Area Team that historically levels of demand have been low at these times, and should be in a position to confirm that contractual obligations have been met on the afternoons in question should there be any subsequent challenge.
Probably the trickiest part of managing the Christmas period is dealing with staff. We’ve all heard the arguments that “they had Christmas off last year, so it must be my turn this year”, “I’ve got children, they haven’t” or “I’ve got annual leave left over so I must be entitled to time off”.
So, what can you do to smooth the festive path? This is a topic we’ve covered before on Practice Index in a post called ‘How to Not Become the Grinch Who Stole Christmas’. That’s a good starting point.
A major concern for practice managers is ensuring fairness when it comes to festive leave. And this is where communication comes into play. There are people who are willing – or in some cases want – to work over Christmas. That’s a great help, although it’s worth pointing out that these people shouldn’t be taken for granted – try to reward them at other times of the year.
Then you could try letting staff sort it out themselves, based on who’s around and what cover is needed. Or, you could look at look at last year’s holiday calendar and make decisions based on who worked the time last year. Finally, when all else fails and there’s no agreement, try drawing lots – in the presence of those affected, of course.
Covering a small practice
For small practices, it can be particularly tough to cover the Christmas period – and this is a topic that was recently covered on the Practice Index Forum.
Responding to a request for advice, one PM responded by saying: “We allow one day per staff member over the Christmas and New Year period. I keep the previous year’s holiday planners to refer back to so if a staff member has had the day after boxing day off, for example, they cannot have it the following year, and they go to the bottom of the pile. They can still have a day off, but it may not be their first choice. This tends to work well with everyone getting an extra day off at Christmas to be with their families.
“If there are any spare days then two days will be granted, this doesn’t happen often though and staff getting two days will only be allowed one day the following year. Nothing is booked until November, I set a date for requests to be in by and process them once the date has passed.”
A harder line view was taken by another PM, who commented: “In a small team, I wouldn’t allow it. No one likes to work around Christmas but its general practice so we have to. If everyone has to, then there may be a grumble, but it will be accepted that this is what it is. Get some nibbles in, have a Christmas jumper day to lighten the mood, or let staff dress festively the whole two weeks.”
Whatever your decision, communication seems to be the key element of successfully managing Christmas holidays.
A smooth Christmas
And finally, here are 10 ways practices can ensure the Christmas period runs as smoothly as possible, courtesy of the BMA:
- Minimise or avoid pre-booking advance appointments, particularly for non-essential services, from 23 December to 6 January
- Minimise or avoid appointments for routine consultations, i.e. non-essential services from 23 December to 6 January
- Ensure on any half day closing that a GP from the practice is contactable by the covering out of hours or other service in case of unforeseen queries
- Advertise practice half day closing arrangements well in advance on prescription counterfoils, posters and other media at the practice, commencing as soon as possible if you have not already done so
- Extend repeat prescriptions so they do not fall due during the period 23 December to 6 January
- Ensure pharmacists collect “collection and delivery” prescriptions before the practice closes
- Ensure patients on opiate substitution prescriptions have enough to cover practice closure periods and collect their prescriptions before closing
- Ensure urgent lab tests carried out during this period have the clinical condition and phone number of the patient clearly on the form
- Ensure special notes are sent to the out of hours organisation on vulnerable patients e.g. those without mental capacity, those with complex or terminal conditions and those where special arrangements are in place (e.g. GP to be informed during the out of hours period if patient dies)
- Ensure residential and nursing home patients have repeat prescriptions, know the opening times and any sick patients have been reviewed before closing the practice
What other tips can you share to help practices manage the Christmas period? Comment below or share your views on the Practice Index Forum here.
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