Frontline staff members play a crucial role in all service delivery. The role of receptionists in a GP surgery is particularly important and also more challenging, because the people they are dealing with may be unwell, may have waited some time for an appointment and may have taken time off from work or other commitments. Often, the receptionist is seen as an obstacle to a patient seeing their GP.
As the GP waiting list is ever increasing, so do the job demands of receptionists and the potential for difficult interactions or communication breakdowns, which can result in a complaint.
Increasing pressure on GPs can also result in receptionists attempting to ‘screen’ patients themselves, or offer clinical advice. This could result in a complaint, or contribute to events which lead up to a patient making claim against the practice. The case study below highlights an example of this.
Mrs Roberts is the mother of Amy, an only child who was born as a premature baby.
Amy often misses school because of stomach aches and sore throats. The doctors cannot find a physical health reason for these symptoms.
Mrs Roberts has no transport of her own and Amy is often too unwell to get to the surgery.
On the morning of the incident, she had to do her shopping and called in the surgery afterwards to request a home visit for her daughter. Amy had been burning up in the night and felt sick that morning. She had to stay in bed and only wanted ice- cream and coke.
Jean, the receptionist has worked at the practice for 20 years. She thinks doctors are overworked and has been told not to interrupt them in surgery unless urgent.
Jean knows Mrs Roberts can be demanding and has heard the doctors discuss that they have undertaken several avoidable visits.
She told Mrs Roberts that the duty doctor had gone out on visits and suggested that Mrs Roberts gave her daughter some Calpol, saying ‘I am sure she will be better soon’.
Later that day, Amy was admitted to hospital with suspected meningitis. Although Amy made a full recovery, Mrs Roberts made an official complaint against the practice to the GMC.
Top tips to support receptionists
Without doubt, this kind of job right at the coalface requires patience and resilience. But reception staff members also need training – so they can handle and diffuse a range of situations effectively – alongside clear policies and procedures. This will help to ensure they are aware of exactly how things work, who is doing what, and understand the scope of their role.
Getting these things right could help to avoid difficult interactions with patients escalating, mitigate complaints and even reduce the chance of a claim.
1. Be clear on roles and responsibilities
It is important to ensure that practice staff are clear on their areas of competence and their roles in a triage protocol if there is one.
Reception staff should never provide clinical advice or make a diagnosis no matter how experienced they are. But they should be trained to signpost the patient to a correct clinician or to a medical emergency service (999). They should know how to determine the need for an urgent/same-day appointment or the need to interrupt a GP for advice.
To determine the severity of a patient’s case, receptionists may need to ask about the nature of a patient’s problem. Front desk staff should however be clear to patients that they do not have to disclose any information if they are not comfortable.
Appointments must not be withheld if the patients do not wish to share information. The last thing you want for your patients is for them to be dissuaded from seeking help when they may need it most.
2. Ensure doctors are accessible to reception staff
Doctors need to be accessible and approachable to their colleagues. When GPs are dealing with back-to-back consultations, it can be difficult for reception staff to approach them. Measures can be taken to ensure that the receptionist can contact a doctor to deal with clinical queries from reception staff.
3. Set clear boundaries for managing poor behaviour by patients
There should be guidance in place for managing patients who behave poorly. Practice staff should be familiar with it to ensure that problems are dealt with in a professional and consistent manner, and in accordance with the practice policy.
Staff should be supported if they have been faced with unacceptable behaviour from patients and incidents should be reported via the practice incident reporting system. Adequate warnings must be given and documented in the patient’s records.
4. Ensure staff are aware of how to deal with persistently abusive patients
When faced with a very difficult patient, it is important that receptionists are encouraged and trained to maintain a calm demeanour and apologise when mistakes or misunderstandings occur. They should avoid getting into an argument, and try to explain the procedures or policies at the practice.
Removing a patient from the practice list would be the last resort, but the steps should be communicated clearly for all staff to ensure consistency in this approach.
The GMC provides some useful guidance on ‘Ending your professional relationship with a patient’ and this can be shared with all staff.1 It suggests that having an aggressive, violent or abusive behaviour are grounds to end your relationship with a patient.
Paragraph 6d of this guidance states: ‘If you decide to end your professional relationship with a patient you must:….record your decision to end the professional relationship – information recorded in the patients records must be factual and objective, and should not include anything that could unfairly prejudice the patient’s future treatment.’
Practices can also consider designating a separate area to deal with upset or aggressive patients.
5. Be clear on when it is acceptable to interrupt a GP
Interruptions may inadvertently cause the doctor to lose their train of thought and may also result in a breach of confidentiality. Administrative staff should be provided with guidelines detailing the reasons when interruptions are acceptable and when they are not.
Interruptions should always be kept to a minimum, and staff should make use of an internal electronic message system for urgent messages.
6. Encourage team-wide discussion about difficult interactions
Team meetings should include non-clinical staff like receptionists. Encourage discussions around difficult interactions with patients – be it on the phone, on the front desk or during the consultation. Such discussions present the opportunity for GPs and practice staff to learn from one another.
7. Ensure receptionists have regular and appropriate training
Training in communication skills for receptionists is crucial given they are usually the first people that patients encounter. It would be beneficial for receptionists to be aware of verbal and non-verbal communication, and understanding cultural nuances. Effective communication is not all about what you say; how you say it is also very important.
It is often quoted that in face-to-face communication the meaning of the message is communicated by: 2
- Your words – 7% of what was liked in a communication
- Your tone of voice – 38% of what was liked in a communication
- Your body language – 55% of what was liked in a communication
Problems may start during the patient’s first point of contact, such as on the phone or at the front desk. Medical Protection devised the A.I.D© model [see below] which sets out the important elements of support and tension required to help bring about an acceptable solution, and teaches this at our workshops.
8. Ensure reception staff have time management guidance
With training and experience, receptionists should try to put adequate time aside for appointments involving complex patients. Appointment information such as its duration and frequency should be clear and accessible to practice staff, regardless of who is in charge of the front desk on any day.
Receptionists – your unsung heroes
Receptionists play a key role in maintaining efficiency and productivity as well as excellent patient relationships. As initiatives are being rolled out to support practices to ‘work at scale’, the learning curve for non-clinical staff has certainly increased.
GPs and practice managers must understand how their receptionists’ roles have evolved, provide appropriate support and consider that patients who are rude to receptionists may be perfectly polite to their GP. Daily challenges faced by receptionists must be acknowledged, and they should feel reassured and be able to escalate any concerns. Do not forget that a ‘thank you’ goes a long way.
With the right systems in place, practices can mitigate medicolegal risks even in the most challenging environment.
|Medical Protection A.I.D© model to manage conflict and aggression in a practice|
The A.I.D© model reminds us of the important elements of support and tension required to help bring about an acceptable solution. The elements of the model are:
1. Acknowledge the patient’s position
'Mr Smith, I am aware that your appointment was at half past eight. I am very sorry for your delay and I can understand why you are feeling upset.'
2. Inform them of your position
'Unfortunately the doctor had to deal with an emergency so his other appointments have been delayed. I understand your position and that you are worried about your son. It would be better if you were able to take a seat with your son at the moment and wait for his name to be called.'
3. Discuss a way forward
'Mr Smith I will ensure that the doctor knows that you are waiting and that you are concerned as you need to get back to work. I will do everything that I can to make sure that your son is seen as soon as possible.'
- Julie Price is head of risk management and education consultancy at Medical Protection
- GMC. Ending your professional relationship with a patient. 2013
- Mehrabian A. Silent messages. Implicit communication of emotions and attitudes. Wadsworth Publishing Co Inc; 2nd Revised edition edition (1 Jan 1981) ISBN-13: 978-0534009106