I’ve often thought that instead of all the ridiculous standards imposed on us, we’d be better off with a version of the Friends and Family test to check our performance. However, this week has killed that particular thought. Staff have been shouted at and I’ve been sworn at. Usually, it’s water off a duck’s back, but this week it has felt particularly painful. I’m no longer living in that utopia where I believe our patients speak favourably about us. Capacity is the issue that has brought this about.
I’m quite literally at capacity; I’ve hit the wall. And I can’t delegate any of the million and one things on my to-do list despite having a very capable deputy.
I sat through a webinar on cleaning standards and that has pushed me over the edge. I do not know why the powers that be think we don’t already make sure our surgeries are spotless and audit like crazy, but clearly they haven’t visited a normal GP practice in quite some time.
I’m convinced that the edicts that come down from on high are aimed at driving practices into the ground. I know I’m cynical – I’ve spent too many years in practice not to be. I really feel that their aim is to damage primary care – and when healthcare is a “caring profession”, that seems to be altogether wrong-headed.
Income protection last year meant that we had a teensy bit of fresh air to breathe. However, the way that they’ve worked it means that this year, we’ve almost no hope of achieving anything. Childhood imms, you can forget them too; there’s absolutely no hope of getting anywhere close this year – or any year, I should think!
I’ve had staff off with Covid and the way things are going, I can’t see any improvement in staff numbers for quite some time.
Thank God we’ve got some say over our sick pay, though, because colleagues in secondary care won’t be shown any leniency. So not only are we pushed for capacity in that direction, I also know that come the time for the salary run, it’ll be more fun and games.
I’ve got about 900 unread emails in my inbox. Actually, they’re not all unread; after checking them, I mark them as unread so that I can keep an eye on the things I need to do. At this point, I’m reconciled to never getting to zero – unless, of course, I “delete all”. The number I’ve been comfortable with over the years is about 100, so 900 feels excruciating.
Clearly, I’m doing a reasonable job of hiding my inner turmoil because my ever-so-capable deputy asked me this week about our social media. I should coco. I don’t trust myself on social media at the moment; I might be tempted to write what I really think… Then the torrent of patient complaints would increase to a tsunami.
A PM colleague has emailed me a few times this week. I haven’t replied (see aforementioned 900 emails). She actually rang me today to check that I was okay, and not dead (though she did say she thought she might have heard about that). I’d laugh at the ridiculousness of the situation, but I’m afraid I might cry.
So, I’ve finally accepted that it’s out of control and there isn’t much to be done about it. I long for the carefree happy days of the early ‘naughties’, when Covid wasn’t even a word. I’ve been here for so long that I might as well hold on for a bit longer. I’ve been on this white-knuckle ride called primary care for quite a while. However, I’m hoping the roller-coaster slows down a bit; I’m feeling somewhat motion sick.
July 8, 2022 at 7:15 am
HI Paula
I agree entirely. I just feel we are being dragged along with new software left, right and centre, patient complaints a tsunami as you say, staff leaving constantly so forever recruiting – which is a mammoth task in itself and all the hundreds of emails swamping us – all of which need us to just do whatever for them by yesterday. Take comfort from knowing you are not alone. That is the only thing that keeps me going!
July 11, 2022 at 8:47 am
Just checked how many unread emails I have – and between the two inboxes (mine and the PM inbox), I have around 1500. And do you know what? I don’t even care any more. The urgent things get done, and other things get left. I have become even more cynical than I was before (like you, been in the job for decades and seen it all before) – and I’ve become far better at saying NO whenever I need to. I keep reminding myself when I see these edicts dropping from on high – NO, and what are you going to do about it? Shut us down? Remove our contract? I don’t think so!
July 11, 2022 at 2:46 pm
I think eventually the stuff that is really important pops back to the top of the inbox. Still stresses me out.
July 11, 2022 at 2:11 pm
Hi Peta,
Thank you for the support. Practice Management is certainly challenging.
July 8, 2022 at 7:22 am
I feel like I could have written this, and I doubt I am alone
July 8, 2022 at 8:28 am
I keep asking when will it just slow down, I have never in my life said I am overwhelmed, but this is now a daily fact and feeling.
July 11, 2022 at 2:13 pm
Jenny,
It’s sad to think I’m not alone in this. I do take a bit of comfort from knowing it’s not just me, that everyone else is finding it tough too, because then it’s the workload that is the issue, not my competence.
July 8, 2022 at 8:12 am
Hi Paula you have composed this so well, you are definitely not alone. many of us have been in the ‘job’ for so long and nothing like the ‘old days’ we all appreciate work roles need to change but we don’t seem have the support of our patients which on the whole we used to. I have a fantastic team around me all really supportive of each other and we get by and still manage to laugh but expectations are too great and we are losing the battle I feel the system is broke…..I never thought I would feel like this. Happy Friday everyone 🙂 its going to be a lovely weekend.
July 11, 2022 at 2:16 pm
Denise,
I hope you had a good weekend. I am back to it today, feeling the heat but have a “to-do” list and my door closed to all. I need to regain some semblance of control.
July 8, 2022 at 8:23 am
This could have also been written by me, so comforting to see you have more emails than me, although I am about to go on leave. I am fortunate enough to have a fabulous group of department managers and deputies around me, we meet every friday for breakfast and a moan – great for our morale. Ice lolies for staff on a hot day also helps 😉
July 11, 2022 at 2:17 pm
Helen,
Friday breakfast sounds a fabulous idea. The emails are being driven down today.
I hope you have a good break from work.
July 8, 2022 at 8:25 am
Defo not alone, I am in the same place.
July 11, 2022 at 2:18 pm
Jani,
At least I know if my partners are complaining about the lack of sensible response from me at the moment, everyone else will be saying the same about me!
July 8, 2022 at 8:30 am
Hang in there, Paula. This too will pass, as they say. Indeed, more and more gets piled onto our workloads within GP land and it has gradually done so since the mid-2000s. Targets to reach have been increased year on year.
The bottom line is, they want GP land to do more and more for less and less money. The whole value for money thing they have been on about for years.
Year on year, they have increased targets to hit and piled on extra work. Is this to undermine general practice or is that simply a side-effect? I’ve been convinced for years that they initially wanted to improve quality and outcomes. However, GP land did this too well, and it cost them too much money.
So, how do you get out of this? Increase the targets, add some extra work and see if they (hopefully) won’t reach the target then., And, if practices don’t, you can keep the money in the government’s pocket and pay overpriced government officials.
Instead, we continued to reach targets as there was also that CQC stick if we didn’t on top of a drop in income.
Obviously, they didn’t like that. So, up went the targets again. A further increase in the workload. Maybe now we would fail to reach targets and they could keep their money in their pockets.
And again, we lived up to the challenges and reached targets. Only for the targets and workload to be increased again.
And guidelines, targets, and what we needed to achieve continued to increase. Practice managers were at the frontline of finding these out. They had to digest them and then regurgitate them to the GP partners and the rest of the practice. The changes happened frequently and in the last few years increasingly so.
I wasn’t at the forefront as a practice manager until 2019. Until 2018, I was one of the GPs receiving the regurgitated guidance in bite-sized and understandable bits.
It is close to impossible to keep on top of this, and we likely never will.
Should we just give up, lie down and play dead?
NO, definitely not.
Instead, general practice might finally need to put their big girl pants on and say enough is enough. Work together to improve the lives of those working in primary care and the patients being served by us. The way things are going at the moment, we are edging towards a point where we are all overworked, demoralised, burned out and start making mistakes. As we all know, mistakes in medicine can mean the difference between life and death.
Will things change now BoJo is leaving? Maybe slightly. But likely insufficiently to bring any major improvements to us all. After all, we have had different people in power over the last 20 years and during the entire time things have worsened.
Something needs to change. This can’t go on.
July 11, 2022 at 2:20 pm
Dr Bennekers,
Something does need to change, I’d agree. Expectations are unrealistic at best. I think change is needed before it’s completely broken beyond repair.
July 8, 2022 at 8:33 am
Thanks for this – 5 minutes after I got in today I had a member of staff crying over her workload. No wonder the NHS Jobs website is heaving with jobs – when the patients have unreasonable expectations and there is no end in sight, thank goodness we have a fabulous sunny weekend ahead. Deep breath and on we go! 🙂
July 11, 2022 at 2:23 pm
Ah gosh, pity those of us who try to advertise on NHS jobs. Improvement it is not.
I’ve never really felt the Monday dread until recently. I did have a couple of days recently where the thought of work was so overwhelming I did think perhaps I won’t go in. I booked a few days off and do feel better about it. It shouldn’t be like this though. I used to love the challenge.
July 8, 2022 at 8:49 am
I’m smiling – now I can be sure ‘its not just me’.
Thank you so much for this post and all the comments.
July 11, 2022 at 2:24 pm
No, judging by the comments, not just you, or indeed me.
There are a whole load of us equally stressed and digging ourselves out of the hole!
July 8, 2022 at 10:09 am
Thought I was the only one sinking – it’s horrendous and so hard not to take personally but thank you for your post. It helps to know I am not alone
July 11, 2022 at 2:27 pm
Michelle,
Definitely not just us. Sad that so many good, experienced managers feel this way.
July 8, 2022 at 10:42 am
Wow, so it’s not just me? Earlier this week I felt like it must be me and that I am incompetent and a better person would be able to keep up and manage. I’m missing things because there are soooo many emails that I mark to get back to but never do. I’m drowning too!!! Great to have some solidarity
July 11, 2022 at 2:29 pm
Andrea,
No, we’re all in the same boat I think. I am hoping that things will get better. The summer is generally easier I think as fewer queries as everyone is off on their holidays. I’m hoping I get a chance to catch up so I’m good to go before the inevitable carnage that winter is likely to bring!
July 15, 2022 at 8:47 am
I can’t believe we are already getting flu queries due to Boots sending out a marketing campaign to encourage patients to go to them!!!!!!!!!!!!!!!! Not sure this summer is quieter with patient demand as high as it normally is in the winter. Can live in hope though
July 8, 2022 at 12:03 pm
You are not alone. The workload is crushing.
Just focus on the little wins, and the moments of appreciation that come along from time-to-time. It will get better. We have to believe that.
July 11, 2022 at 2:31 pm
Yes, there are small wins, today, I have got my emails below 850, so it’s progress in the right direction!
July 8, 2022 at 1:28 pm
Thank you Paula, defo agree with all the other comments. I handed in my notice last Xmas and I am still here! Partners cannot get a replacement and I have no deputy so looks like retirement from PM is on hold. So if anyone wishes to apply we are a lovely small rural practice and the staff are lovely just send across your CV I will be waiting 🙂 enjoy the sunshine everyone
July 11, 2022 at 2:33 pm
Oh Jackie, that sounds really tricky.
I can’t see that not retiring is the answer. I understand your loyalty, but you’ve earned your retirement!
July 8, 2022 at 3:09 pm
Oh my we are not alone although sometimes it does feel like it , I really hope that you are ok and all the other PMs out there are too , its relentless and to be quite honest soul destroying at the moment especially when we all for the most part love our jobs …don’t we ? …We do ….we do…. but maybe just not so much right now.
I keep telling myself and the team that things will get better …but feel that I’m actually lying to myself and starting to think that things won’t get any better ;-( But I guess we have to keep putting on a brave face and remain positive after all what are the alternatives ? jump ship ? but then that’s when they have won ! so let’s stick together and we will get though these difficult and challenging times …I’m not letting anyone get the better of me.
Take care, hang on in there …Things can only get better ! so they say x
July 11, 2022 at 2:40 pm
I keep telling myself that it’s a phase and like any phase, this too shall pass.
I know what you mean though. Trying to keep a brave and cheery face on it for staff is adding its’ own challenge.
July 10, 2022 at 6:42 pm
I applaud you for saying what probably most of us are feeling.
I’ve only been in this role for 3 years and whilst I know I am capable of doing and understanding things I feel like I’ve drowned (sorry bottom of the ocean non responsive).
I personally believe ignorance doesn’t help. General public ignorance, because social media, tabloids are forever slating us instead of actually telling patients what we all do in general practice, especially our reception/admin teams.
New starters who have never worked in a surgery before are shocked at what we do everyday.
Clinicians are exhausted, reception/admin on their knees and PMs well I have no explanation on how we all must feel right now.
Let’s hope it gets better soon but I don’t have much hope.
July 11, 2022 at 2:42 pm
JWF,
I certainly think the general public has no idea. There is a perception that we’re all sitting at home, not seeing patients and being paid to do nothing. It couldn’t be further from the truth, but there is no messaging or comms that give a different message. Only the regular kicking from the Daily Mail.
July 13, 2022 at 11:07 am
I hate to say it but will things only change when we get privatised and most patients can’t afford to see a doctor, back to pre NHS days???
Would be shocking if this is the only way to stop ridiculous demand because ‘I don’t want to go to a pharmacy’, even if it’s a minor ailment and the Pharmacy First service is free ‘I only want to see a GP – they are sitting doing nothing anyway’!
The days of respecting your GP practice staff / doctors seems to have disappeared, sadly. And yes, I’ve been here for many years so remember ‘the good old days’ when we were busy but not overwhelmed constantly and folk were grateful for your help. Sad.