Bradford CCG’s fund GP Receptionist Training


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Bradford clinical leaders are funding customer care training for GP Receptionists to help improve patients’ experiences at surgeries.

They are responding to patients concerns by looking at ways to improve access to local GP services and are going to hold training sessions for practices in the Bradford area to help staff make each patient feel valued and at ease.

I have included links regarding this topic.

http://www.dailymail.co.uk/news/article-2946645/Stop-grumpy-patients-Training-doctors-receptionists.html

http://www.bbc.com/news/uk-england-leeds-31420045

http://www.bradforddistrictsccg.nhs.uk/news/bradford-ccgs-fund-gp-receptionists-training-to-improve-patients-experience-of-primary-care/

I am very passionate about good patient/customer care, and feel very strongly that Receptionists need the correct support in the way of training. I am saddened by the hard times that Receptionists often get and I do appreciate that there are some that perhaps come under the category of not been the most helpful, but in my experience there are so many good Receptionists out there doing an excellent job.

I am a firm believer that a good trained member of staff is more confident, and therefore able to deal with the many different situations that they are faced with in Reception on a daily basis.

Well done to Bradford CCG for investing in this training programme which will benefit patients, staff and Practices throughout the region.

Lets hope that other CCG’s follow this great example.

Beyond Courage #Guest Blog


No parent should outlive their child. The pain of loss and grief is too much to comprehend. Life taken as such an early age – this is the most heart-moving stories that I have written since starting my blog.

I want to share with you the importance of patient care; it not only extends to the patient, but to family members of the patient. Care good or bad can often be left with such an impact in someones life.

My cousin Chris her husband and their only child Andrew moved to Australia in 1989.

Andrew was diagnosed with Chondroblastic Osteosarcoma on his 21st Birthday after a pathological fracture. For 15 gruelling months he underwent 10 operations including major surgeries to initially replace his cancerous left fractured femur and knee-joint. He went through 16 round of chemotherapy, ending with the amputation of his left hip and leg and ultimately his young life at 22 years and 3 months.

Chris has kindly offer to write a guest blog highlighting some of the patient care that has had in some way had an impact on her – to share how vitally important patient care from the Reception staff through to the nursing staff.

Chris is in the process of writing a blog on this subject so dear to her heart and the link is:

http://www.beyondcouragelancashire.com

and she has also written a book on her journey with Andrew through Chondroblastic Osteosarcoma “Beyond Courage”

The book insightful and greatly moving, “Beyond Courage by Chris Lancashire” does not only let readers experience the admirable courage of a man whose prime of life came to a sudden halt, but it also sheds more light into osteosarcoma and its intricacies.

Thank you Chris for sharing your story with us in the hope that everyone ultimately receives the care that they deserve.

Guest Blog : Beyond Courage

by Chris Lancashire

Thank you for inviting me to your Blog.

My background is in health, and I have worked both in the private and public sectors, in England and Australia over a period of 35 years.

On a personal note, I am a mother who went through the health system, when my son Andrew was diagnosed with Chondroblastic Osteosarcoma, a rare bone cancer, predominantly of the young teenagers and young adult. He passed away in November 2008 at the age of 22 years old.

I feel qualified to say, that the health systems are set up to help, assist and care for the vulnerable, fragile and sick patients that seeks care. Most of the time, the health system does well. Other times, these very systems that are placed to provide these care, failed to deliver these care, to the patients.

It is not the systems, that we constantly have to remind ourselves. The healthcare system is run by people. It is the very people in the healthcare system that actually provides that care.

Travelling with my son on his cancer journey is the toughest role firstly as a mother, and as a health professional. Protecting and caring for him in any way possible is the ultimate. I knew he was confident with the multidisciplinary health care team looking after him. More so, he knew I was able to be there for him, with my background as well as being his mother.

Somehow along this already difficult journey, there were situations and experiences that would make this journey even more difficult. It is at times like these that we always look at the human resources and education within the healthcare systems that can only be improved.

There were several nursing and reception issues, and experiences that also made me reflect on why these staffs was there. I would like to share here with one of this experience.

When Andrew broke his left femur, his contact with the first hospital, was an unforgettable and unpleasant experience. This was on a Saturday, the same day when he broke his left femur. Although Andrew was there for 36 hours, and pending him being transferred to the second hospital, where his orthopaedic surgeon was, it was a long 36 hours. He was in extreme pain, due to his fractured femur, which now had looked like a hugh balloon on his left thigh. Andrew was very drowsy due to the massive morphine injections given to him, very frequently according to the nurse. His left thigh (where the fracture was) was propped up with rolled up pillows underneath, to give the left thigh support. He was bed ridden, on his back and not able to move much, without the fractured ends of his femur grinding together.

Being extremely drowsy, due to the opiates, he was not taking much in the way of diet. His body temperature was up, so he had a high fever. They were no other forms of fluids ordered.

I visited over the Sunday with his dad, and we didn’t see any doctor to explain anything. We knew he was to be transferred when a bed was available at the 2nd hospital. However there was no treatment plan while Andrew was there, as such. When asked, the nurse who came in infrequently told us Andrew was having his frequent morphine injections and waiting transfer.

On Monday, I visited Andrew early around 0800 hrs, in case there was news of his transfer, so that I could organise and packed some of his things. I checked with the receptionist at the nurses’ station, to see whether I could visit him, giving her his full name. She checked on her computer and said, ‘Yes, you can visit. The nurse is with him at the moment, assisting him in the shower.’ My heart started racing, thinking that was not possible. He could not even move. He was almost semi-conscious most times due to the effect of pain relief. I rushed into his room. I saw him lying flat on his back, alone. He was drowsy, but awake and in pain. He had already pressed his call bell, nearly 20 minutes before. Andrew liked his wristwatch on him most times, so he knew it was a while since his call. His breakfast had arrived, and it was placed on his bed table, which was at the foot end of his bed. I saw my son, helpless and in pain. He couldn’t even reach his bed table to get any drink or his breakfast. I had to go and find the nurse looking after him to let her know of Andrew’s pain.

The receptionist made no effort to apologise. By this time, I had made this experience of my son and I known to the nurse in charge that morning.

Patients have a right to receive care, nursing, medical and all forms of holistic care whether in hospitals, care facilities or home. Even the most basic care such as human empathy, compassion and kindness. Too often, we blame these healthcare organisations and facilities for not meeting these fundamental, basic human needs and right for care. We sometimes forget that these very facilities are staffed by people who deliver care at the frontline. For me, I believe, it needs to come from the individual, and everyone that has been given the privileged to be in that position. It is a very humbling position to be, not a position of power or ignorance.

Thank you for allowing me to tell my story.

In honour of my beautiful son Andrew, I have written my book called Beyond Courage by Chris Lancashire. All proceeds from the sale of the books go towards medical research into finding an improvement treatment, and cure for Osteosarcoma. Please feel free to check out the book, and website of the same name.

 

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In memory of Andrew Lancashire 

Infection Control in Reception


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Infection control starts the minute someone walks through the front door of your organisation.

It is important that sufficient information, training and support is put in place for all Receptionists and frontline staff to help them deal with the various daily challenges involving infection control.

Staff need to be reassured that the job that they are doing is done well and that they continue to be supported and motivated to provide a good service to your patients.

Staff should be adequately trained to deal with infection control and this training should include cleaners and all Reception staff.

Training

Infection control training should take place on a regular basis for all staff. Do you include cleaners in your training? Some practices have outside agencies; if so, do they hold a copy of your Infection Control Policy?

Does your organisation have a designated person for Infection Control? Is all your staff aware of whom this is?

Do you have a report policy in place for identifying any risks of infection control – Reception should be included in this policy and know whom they should report to.

The Infection Control lead person should carry out the following:

  • Help to motivate colleagues to improve good practice
  • Improve local implementation of infection control policies
  • Ensure that infection control audits are undertaken
  • Assist in the training of colleagues
  • Help identify any Infection Control issues within your organisation and work to resolve these.
  • Act as a role model within your organisation.
  • Ensure that Infection Control protocols are reviewed and updated on a regular basis – or delegate to an appropriate person.

Hand Washing Procedures – Public and Staff Areas

Wash hand basins with suitable taps, liquid soap dispensers, alcohol rubs, paper towels and waste bins are essential items for all clinical care areas.

Whilst it is normally the responsibility of the cleaner to ensure that all of these areas are kept well stocked, some things might run out during the day. Therefore it is important that staff are made aware that these might need to be replenished throughout the day.

I have lost count of the number of times I recently have gone into hospitals and surgeries finding empty alcohol rubs, and toilets without toilet tissue or paper hand towels. It simply is not good enough.

Staff Immunisation Protection

Your Reception staff will be dealing with many Infection Control issues on a daily basis.

They will be receiving samples at the desk from patients. They will be dealing with patients that could possible come into your organisation with an infectious rash and could be asked to help with spillage. It therefore is important to include them in protection against Hepatitis B.

You should also offer your staff annual influenza immunisation.

Any immunisations given to your staff should be recorded. I would recommend that you record those that declined to have any immunisations.

Handling Specimens

Samples should come in a sealed container. I have had experience where many samples have come in all different shape and forms including:

  • A faeces sample in a child’s bucket
  • A faeces sample inside a plastic sandwich bag.
  • A urine sample inside a Tupperware container – the patient in fact asked when we had tested the urine could she have the container back as it was one of her “best containers”
  • A urine sample inside an empty perfume bottle.

These of course are not acceptable, for one it is not acceptable to expect the Receptionist (or nurse) to deal with this, and of course it is not in a sterile container.

Each and every sample should include all the necessary information about the patient, failing to do so could result in the labs refusing to carry out the necessary tests, resulting in the patient having to do the test again and possibly delaying any treatment that may be required.

All blood or potentially infected matter such as urine or faeces for lab testing should be treated as high risk and the necessary precautions taken.

The Reception Area

At the end of each day the Reception area should be left tidy. Often cleaners are instructed not to move paperwork or other items and work around them. Untidy desks therefore do not get cleaned as well as a clear desk.

Ensure that there are disposable gloves available in Reception for the receiving of samples from patients.

Any spillage in reception should be dealt with immediately and reported to the appropriate person.

Magazines and books should be replaced on a regular basis.

Toys made available for children should also be cleaned on a regular basis.

Public telephones should be wiped at regular intervals.

There should be a designated room for patients that might present themselves with a possible infectious disease i.e. chicken pox, measles etc. It is also important to inform the Doctor or Nurse that the patient is in the designated room, as often there is no tannoy facility to call patients in and often they could be missed.

Ensure that there are sick bowls available in Reception as this will be the first place the patient will come to if feeling unwell.

Ensure there are bins available in the waiting room, especially important for the disposal of used tissues, and possible a sign asking patient to place their used tissues in them.

Receptionist play a big part in Infection Control, more than we might sometime realise and its vital that they get it right, and also get the support that they require to do their job well.

Ensure that new staff have Infection Control as part of their induction training, and the necessary protocols are put in place for the Reception Area.

Talk to your Receptionists in a team meeting, often they will identify an area that may not been covered with a protocol. They are the experts in their area – RECEPTION.

 

 

Patient Access – Appointments


imagesCAUP3U1D“Improving patient access” is all something that we hear about on a daily basis. It constantly being discussed at all levels, Partner meetings, Reception Team Meetings and Multidisciplinary Meetings. There is no one working within the NHS who is not aware of this.

As Managers we all strive to make patient access the best we possibly can. Often systems are changed to try to accommodate patients, yet still we hear people complaining that they are unable to access appointments for days at a time.

Not having appointments can often cause frustration not only from the patients, but from the Receptionist Team too, they often feel that are unable to do their jobs and often having to deal with difficult situations because some patients can become aggressive.

I decided to be proactive and look at the amount of DNA’s we had at the surgeries I managed. We had over 30,000 patients and I was shocked when I realised just how many hours were being wasted on a daily / weekly / monthly basis by patients for whatever reason not attending their appointments.

Patients are often the cause of the lack of appointments. It is not acceptable to just “not turn up”.

But what can we do to improve DNA’s? What does your surgery do to try and keep on top the wasted appointments?

Some surgeries (and hospitals) display in the waiting room the number of DNA’s each month, and this can be pretty horrifying when you see just how many appointments are wasted in this way. But of course the people who did not turn up for their appointment do not see these statistics.

Some hospitals will send out a text message a few days before an appointment, thus giving the opportunity to cancel if the appointment is no longer needed (also a good reminder if the patient has forgotten) This system will only be helpful for those with mobile phones, perhaps not so good for some of the elderly that may not use mobiles.

Some hospitals are now sending out reminder letters a week before the appointment, again helpful when the initial appointment might have been made some months before.

Adding something to a Surgery website is another way to encourage patients to cancel unwanted appointments, you could also display the DNA’s for the previous month.

Practice Newsletters is also another way of encouraging people to cancel rather than just not turning up.

We did a trail at one of our surgeries. When a patient DNA their appointment a letter was sent to them pointing out that they missed their last appointment, and the practice would appreciate if they could not attend a future appointment could they please phoned and cancel the appointment. The letter would go on to explain the amount of DNA’s the surgery was experiencing and that patients were having problems booking appointments.

Another surgery I know of has a system in place, that they feel works extremely well and have been getting positive feedback from patients and the Receptionists. They have over 25,000 patients, and have their fair share of DNA’s. They found the amount of DNA’s they were experiencing each day was getting increasingly frustrating for the staff. The Reception Team Leader started getting the Reception Team on the late shift to phone the patients who had DNA that day to ask the reason why they had not attended their appointment. They make the call as friendly as possible; the call is not made with “all guns blazing” or “pointing a finger” at the patient for not attending. The Receptionist simply asks the patient did they realise they missed an appointment today, and would they require another appointment. They found that most patients were extremely sorry for missing their appointments, and some genuinely did forget, but more important it made the patients aware that the Surgery was monitoring the appointments. Since starting this system they have found that their DNA has fallen.

The most important thing when doing this is when a patient cancels an appointment that IT IS CANCELLED. Often for whatever reason if appointment stays on the screen, despite the patient cancelling the appointment it could result in a letter or a phones call going to the patient.

This unfortunately happened at our surgery, a patient was sent a letter when she had in fact cancelled her appointment, and understandably was quite upset when she received a letter. If this system was to work it is essential that every single Receptionist understand the importance of cancelling appointments on the screen – in not doing so could result in the surgery receiving a complaint.

By highlighting the amount of DNA’s in these ways it lets your patients know that you are monitoring your appointments system – especially for those patients that just have not “bothered” to cancel their appointment.

It could also flag up that patients are perhaps cancelling, but for whatever reason they are not being cancelled on the system – which could indicate a training need.

Are appointments being booked too far in advance (i.e 6 monthly BP checks, diabetics checks etc) if so how can you best deal with this? Could you use the texting system to remind patients a few days before their appointment?

I am always in favour of giving out appointment cards especially to the elderly. Always remember to put the day as well as the date on the card along with the time.

Monitoring DNA’s will flag up those that repeatedly fail to attend.

Always approach patients about DNA’s in a positive way. Explain that the Surgery is trying to look as the amount of DNA’s and at ways of decreasing these and feedback on why they DNA would help with the exercise.

Explain if patients cancel their unwanted appointments then this will free up more for other patients – which could be them.

And when a patient does take the time to call the surgery to cancel an appointment, the Receptionist should always thank them for taking the time to do so.

Patients have to be made aware that by not cancelling their appointments it just adds more pressure to the already busy system.