The Secret Diary of a Practice Manager Part 5

June was full of activity and it highlighted once again the scope of work we practice managers have to undertake.

It all started with the second part of Calculating Quality Reporting Service (CQRS) training on Monday. 50 people were booked into the online session but only 38 managed to sign in.  Like last week’s part one training it was affected by technical issues with modules not working. In the end so little was really gained from the training session we only received an overview. However I think if it works better than the demo it will be of benefit and a trail of income can be followed. I hope my optimism is rewarded.

From there I went into a meeting on EMIS Web. Having been told that our surgery update would be towards the end of the installation rollout, probably next year, I was surprised when they contacted me a couple of weeks ago to say we can start the process of switching from EMIS PCS.  This usually takes about 12 weeks for familiarisation.

I must have complained so much about the performance issues of our existing PCS that they hope this will shut me up by moving us on sooner rather than later.

Suffice to say that I am wary of timescales. When we changed from Phoenix back in 2005 to EMIS I had only been in post a matter of weeks. I am well aware of the issues such a change can bring. At the practice we all remember waiting to go live at 9:30am that morning only to incur a delay as the engineers had failed to notify the trainers that the passwords had been changed the night before. It was 3:00pm that afternoon before we signed in having had the whole of the IT department, BT along with several Emis staff trying to find the problem.

This time I am aiming to go into it fully prepared. No date is ideal so we have gone for early December which is the earliest they could offer, this will give us plenty of time to prepare. I will keep you posted on progress plus any useful tips will be most welcome.

Out of Hours and A&E

Are we surprised A&E departments are not achieving targets, and the number of patients waiting four hours or more has gone up?  Another reason to blame GP practices I see.  When will we ever hear it said that it is purely as a result of under resourcing against an increase in demand and a public that demand it now?

We cannot be the only practice in the country offering an open surgery? Simply book in at reception that morning before 10:00am and you will be seen by a doctor, a triage nurse, or both.  You will also be given an estimated time as to when you will be seen so you can go away and come back later. Still however, we get patients going to A&E saying they cannot be seen for days at the surgery.  So they clog up the A&E department instead.

There are times where we have very busy mornings but also very quiet mornings. The latest we have seen a patient is by 1:00pm however it is often much earlier. Then the afternoon jobs follow visits, paperwork and the booked afternoon surgeries.

I cannot expect the A&E departments to phone us to check. They have to be careful who they turn away in case it is something serious, but there must be a better way than the abuse of the system we all see.

One scenario springs to mind. I had a patient phone up at 10:00am the other morning cancelling her and her husband’s new patient check at 10:00am and 10:20am. I asked why, only to be told it was “none of my B.... business”. Sounds like nice a kind of person? I explained to the new patient that she was advised that if she and/or her husband failed to turn up to the appointment or cancel with at least 24 hours in advance we would not take them on our books. She replied “listen mate!!! We just woke up and cannot really be bothered this morning to come down". “Stay calm” I say to myself. Since the patient had breached the practice policy I said “you’d better look for another doctor as we are not taking you on”. Following a torrent of abuse the phone went down.  Until attitudes like this are changed there is no hope for the NHS.

ACCESS

Currently we are trialling an extra afternoon surgery one day a week. Thus offering more pre booked appointments and also more appointments on the day.

We have used a locum for the first two sessions. Following this we have booked two more for the next two weeks. We were unsure to how it would be taken up as patients usually want to see one our own GPs. However I can honestly say we have filled both surgeries each week and this move has been welcomed by our patients.

If the next two weeks are as successful we will make it a regular feature and may even try a second day to do the same thing.  We have worked out it will relieve morning surgeries somewhat and can be financed by increasing our list size. So it is a win win situation, I will post updates as this develops.

Other interesting aspects

Friday the 14th June I received an Email from the IT department with the date for our changeover to EMIS web. No surprises there then, we have been pushed back one week to the week before Christmas. What a stupid time to change. I have rearranged with IT for early January 2014 instead. I have been waiting two weeks for IT to advise on the first stages as none of our new computers had the EMIS web installed.

The IT department told me to phone EMIS and give them our IP addresses and they will do the rest. Great if that was correct but it wasn’t. I phoned EMIS and they said they cannot do it we have to. They gave me clear and concise instructions however every machine had to be done individually. This took me about 2 hours.

I hope this is not the way this changeover is going to proceed. I refuse to be told one thing by IT and another from EMIS!!!

Finally finance seems to be in a state of confusion. We have been told to expect delays to the enhanced payments due to the CCG not getting their act together.  Surely like us, the CCG should have protocols in place to cover such situations and I am sure that many surgeries budget on the expected income coming in on the expected day. I would be interested in hearing any other issues like this.

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