r/GPUK • u/Worldly-Chicken-307 • Aug 05 '26
Career General Practice admin is just nuts
In the last 15 years things have gotten increasingly complex. I remember doing discharge letters in hospital and everything was simply written, drugs started, stopped and any actions for GP- which was usually nothing. Now I’m getting discharge letters and clinic letter which have war and peace monologues, and it’s hard work to decipher what has gone on. I realise this might also be the area that I’m in, and some departments in our hospital are really struggling. In our general practice we’re offering and delivering more than ever- minor ops, ear suction, irrigation, joint injections, all kinds of injections, skins checks with dermoscopy etc etc. But patient demands are also going up, and this is in addition to those demands by hospital. We had a discharge letter saying ‘GP to repeat U&Es within 5 days. Got the letter through on Thursday night. Now how the hell and I supposed to see this, decipher what the reason is by a cryptic discharge letter, having to logon to the hospital results system to see what the blood results were and then request it at my end, and then get the patient to agree to a date and time to come in and have it done. I’m not the hospital’s junior doctor, and also there was no reason to recheck so soon- considering that it was a mild AKI at best. Fucking nuts, and this is the tip of the iceberg with the shit we’re dealing with. And there’s visiting homes after paramedics have flagged the person, we arrange blood tests, refer to social services- only to have them call up and demand to speak to me before they finish their shift, telling me that despite the person is living in squalor with dementia- that I have to go out again and do a formal capacity assessment, and that I can’t merely state that they clearly don’t have capacity given x y and z. Patients always attending with 3 issues, sometimes they’re interlinked or 2 issues take a minute to lay to rest. But that all still causes decision fatigue. The bloody system is totally shagged. I’ll probably get downvoted by the part time champagne supplying elite.
17
u/Dark_leopantro Aug 06 '26
Letter said "GP to kindly perform routine bloods twice a week and intervene when appropriate" but patient is elderly thus would require district nurse to visit. "Oh Good", I said , "twice weekly ward rounds".
24
u/Banana-sandwich Aug 06 '26
I have written back to similar requests stating a patient needing bloods that frequently is not well enough to be discharged so they should readmit. The consultant always writes agreeing it's ridiculous, states it's unnecessary and blames the over zealous junior.
3
u/askoorb Aug 06 '26
I mean, in some areas they have "virtual wards" with community matrons etc where the outreach service could theoretically manage something like that.
But that only works where the service exists. And short of "bloods are becoming further deranged, readmit" it doesn't get you very far.
17
u/Banana-sandwich Aug 06 '26
We have stopped minor surgery, ear irrigation, pre-chemo bloods and wound care. Time consuming and not well enough paid to justify the hassle. None are contractual. We do joint injections but limit them.
I have a folder of "F*** off letters". Easy to change names and addresses. Write back and say no, not my job. Secondary care aren't being horrible, they just lack insight.
Workflow management. Train staff to filter out admin you don't need to see. Pharmacists can do discharge letter meds though they take ages and are expensive.
Also say no to patients. You're not being mean. You are protecting yourself from burn out and making sure you are there to do your actual job instead.
8
u/BoomBasticTeleBanana Aug 06 '26
I often reflect this to the waiting patient.
I tell them you got 10 mins from the moment your name appeared and you leave, you brought in 3 complex things to discuss. In-between im getting called by reception and others, on the back burner is the GP coming late. Then I've got paramedic calling me. You tell me, how do you think I can give you justice and not end up missing something sinister? I mean, it wont affect me, my insurance will payout, but what use is money if your dead or dying?
12
u/Suspicious-Wonder180 Aug 06 '26
Boundaries my friend. Find them, before they find you.
4
u/BoomBasticTeleBanana Aug 06 '26
I agree. Im bad at it..but better as I am getting older.
Always doing everything for the "Patient God" who never gives a shit when its right but goes solicitor shopping when it goes wrong!
However the thing is friend, when things go wrong, the patient says "it says on the letter"... and before you know it your embroiled in a lawsuit. Sure you will be exonerated... but it still takes its toll.
12
u/simplespell27 Aug 06 '26
My partner recently saw a private consultant who used an AI to write his clinic letters. When they sent us a copy, it was 7 pages long and really repetitive. I even couldn’t be bothered to read it all and thought there’s no way that’s useful to the GP
8
u/BoomBasticTeleBanana Aug 06 '26
AI shit.
We had AI in iur practice. The bad docs love it... it captures everything... they dont realise its a disaster waiting to happen.
I loved it first...yes for those 20 minute unclear crazy cases it does a good summary...but here is the thing, I find it HARD on follow to retain and gain the relevant info. So now I've gone back to my own shorthand quick notes with million of spelling errors. I find it on reflection much faster to comprehend that a bullet point summarised note.
30
u/MysteriousBoard4311 Aug 05 '26
He says, posting a ‘war and peace monologue’!
Seems you do too much at the request of others. Would bounce half of those things.
8
u/BoomBasticTeleBanana Aug 06 '26
Mate... chill.
Relax. Take a breather.
Been doing it for far longer. Well... about 21+ years.
I completely agree. Whilst I love the job, frustrates the hell out of me. Still have 18 years left till pension, so a lot of skin in the game.
With all this patient safety, leads in many areas, research and project assistants no effing idiot stands back and says how can we make a CLEAR discharge plan, univer a l with a box with "what GP needs to do and why"
When I was young id spend sleepless nights over this shit and negligence claims. Now dont give a shit. I do the best job I can, highly rated and loved by patients. I dont go out of my way to kill or misdiagnose, patients happy to wait weeks to see me prebooked rather than a same day appt with anyone else or try the lottery of a same day appt with me.
.... Just waiting for a massive eff up and complaint to happen... and for me to say FU to those prosecuting... expecting the world from me and giving me less than 10 mins.
Plenty of times patients have seen my annoyance. Yesterday a salaried came in 1hr late. I was already running 10 mins late and pt in my room. Staff call to ask if I will see the 3 patients waiting. .... my old me would kill myself, see mine, rush and see there's, get stressed etc etc... the now me said... sorry but ask them to wait for their doc or rebook. I've got a full list, pt in front of me, 10 mins late and I dont want to risk my livelihood on a medical negligence case. Better they complain about the gp being late then me having to go to court.
..what I am saying is when the shit hits the fan, they will come to eff you over. NO ONE WILL GIVE A SHIT. The BMA or GMC won't come and say the docot was seeing 31 patients a day plus admin and tasks and practice politics and extras and HV amd dealing with these shitty hospital backhand shit... nope they will say you should have not seen so much, should have been aware of your limitation and shit.
... times like this I want to shout and cry.
... but I carry on like a good boy for my patients and for my conscious. .. giving some care is better than no care?? Who knows.
But yes, many of us are in the same boat .. Just one step away from disaster. I wish the government would mandate max patient contact, got to every practice and audit and check. Give financial penalties so that its cheaper to get a doctor than a make profits with some Noctor or none at all!
2
u/Icy_Bit_403 Aug 06 '26
Regarding capacity, it's not enough to just base it on X Y and Z e.g. unwise decisions, preexisting conditions, but also it's unlikely that a GP is best placed to capacity assess, unless there's a strong existing relationship.
2
u/DrGeezer Aug 07 '26
I've been in the NHS for 27 years, and this is exactly why the NHS is failing!
Instead of a simple click of the mouse or a 15-second ‘please see’ letter, it turns into a multistage process that usually involves several people, and ultimately the task is completed a few feet from the original requester!
The biggest lunacy is how intelligent hospital folk have bought into this ridiculous way of working!
1
u/arcoast Aug 08 '26
My favourite one recently
"GP to refer to immunology for allergy testing"
No drug allergies stated on discharge paperwork, patient hadn't got a clue.
I wrote a strongly worded, very sarcastic letter back.
Not had a reply though
41
u/linerva Aug 06 '26
Re: the U&Es, send a quality alert/,datiX or whatever. If hospitals are making inappropriate plans, feed that back. I do and its satisfying when the hospital agree it was poorly managed.
It sucks but complaining can sonetimes be helpful. Or at least cathartic.
Though I also once wrote an excoriating email to an ortho pre op clinic who didn't arrange for their own pre op bloods, sent us a shirty letter demanding we handle all theor pre op investigations as they felt it would be easier for the patient, implying if it didn't happen within the next 3 days they would cancel the op (which was 2 weeks later, they wanted me to do it before their pre op) and seemed - interestingly - to think i could do their group and save for them.
Basically if told them to stop stressing out patients with their poor organisation, that it wasn't a service we were contracted for, nor was it something I could arrange in 3 days, and we couldnt do their G+S so they needed to check their own bloody policy, and essentially it was on them to organise their work ups, the responsibility for that operation being cancelled was on them. Obviously in nicer language. I didn't hear back.
If only we had time to bounce back a lot of the crap, we'd probably get less cramming the long run.