Staff Christmas Annual Leave

How do you manage your staff holidays – especially at this time of year?

Everyone like to take holidays over the Christmas Break – but it can cause arguments, staff shortages and low moral within this staff.

If you allow staff to take holidays over the Christmas period how do you manage this? Is it the same people who put in for annual leave – or do you do it more fairly?

Allowing staff to have annual leave over the Christmas period can lead to problems – which as a manager will come back for you to sort out so make sure that you plan ahead – have a fair system in place and allow for the unexpected.

Does your Practice have a policy on Annual Leave at Christmas?

Our Practice had a policy that no one was allowed to take annual leave over the Christmas period (usually the week leading up to Christmas and the week after)

But, in extreme circumstances (such as a family trip aboard / other genuine reasons ) we would allow one person from each team to have Annual Leave – but this would be discussed within the tem and I would ensure that most people where happy with it – being the team worked well together this was never a problem.

But, if a person was allowed to take annual leave one year it would be agreed that they could not do it the following year.

What Are the Disadvantages of Letting Staff Have Holiday Over the Christmas Period?

Firstly you have to manage it fairly.

When I first started as a Receptionist the Practice did not have a policy about taking Annual Leave at Christmas – and the same people would put in for leave every year – this always lead to bad feelings amongst staff. Don’t let that happen at your Practice.

Another Practice that I worked in had a rota every year and one person had the opportunity of taking Annual Leave if they wanted it – and it would go to the next person on the list the following year. If you allow staff to take Annual Leave this is a fair way of dealing with it. Staff were allowed to swap between them one year for the next – but that was between them and was done fairly.

If you allow staff to take Annual Leave at Christmas time remember their hours need to be covered – which means that other staff have to usually end up doing extra hours – and it can often be hard to get staff to cover Christmas Eve / News Year’s Eve .

If you allow staff to take Annual Leave over the Christmas period and you have other staff covering their hours – what happens when another member of staff goes sick – and it does happen – how short would that leave you then?

Always think of the worst case scenario – you don’t want to be left with hardly any staff – which could be a very busy time.

Ensure that Staff are Aware of Your Christmas Annual Holiday Policy.

If you decide to change your Christmas Annual Leave Policy ensure that all staff are fully aware of the changes.

  • Discuss at a Meeting
  • Issue letters/memo giving the changes
  • Add to the staff handbook
  • Inform all new staff at interview stage that this is your Practice policy.

Hopefully by having this is place everyone knows exactly where then stand – and hopefully will not leave your team short-staffed at the most stressful time of year.


How do you thank you staff at Christmas?

How do you or your Practice thank your staff? Do you tell them on a regular basis or keep it to once a year at Christmas?

In my experience you will get far more from people if they are shown thanks and appreciation and it doesn’t have to cost very much either.

Here is how I used to say “thank you” to my staff.

Daily Basis

  • When I was leaving the surgery of an evening I would always take time to go into Reception, ask if everything was ok before leaving and as I left always say “thank you for all your help today”.
  • If I needed to go to one of the other surgeries to see one of the Doctors or the Surgery Team Leader I would always make a point of showing my face in Reception – I always wanted to be approachable and let the Receptionists know that I was always there for them. Again when I left to go back to my own office I would always thank everyone as I left.
  • At the end of any Team Meetings I would always thank everyone for coming .

One off Basis

  • When someone did something that stood out and was beyond their job description I would speak to the Practice Manager and she was in agreement we would get the Staff Partner to say “thank you” in the form of a letter. This letter could then be put on their CV and used in their next appraisals (when again it could be brought up).  This was not something that I did very often – so when a member of staff did receive a letter it was obvious that they had been praised for their good work. If the incident was appropriate and with the permission of the Receptionist receiving the letter I would use the incident in the next staff training.
  • If a Receptionist was having a baby or getting married I would organise a baby shower and the Receptionists would get together over lunchtime and have a good laugh. This was great for team work as they would organise the lunch, the presents and work together on making sure it was a great shower.
  • If an older Receptionist became a grandmother I would always send them a congratulations card.
  • If a member of staff was off on long-term sick I would always send them a get well card and tell them how much they were being missed.

Yearly Basis

  • My Practice Manage would send each surgery a Christmas card – I would send one to each individual member of staff thanking them for all their hard work throughout the year. To me this was very important to let each member of staff know how much I appreciated their hard work that year.
  • I would also get a personal present for each of the Surgery Team Leaders at Christmas – just a small token but again to thank them for all their efforts over the year, and let’s face it I could not have done my job as well as I did without their support and hard work.
  • The Practice would give the staff a Christmas Party – usually in the form of a Dinner Dance – this really can keep moral going – and everyone was always on a high for a few days after – staff very much appreciated the Practice doing this for them.
  • The Practice would also give the staff gift vouchers every Christmas – again this was extremely kind of the Partners to do this and again the staff always really appreciated this.

So, it does not have to cost a fortune to say “thank you” but it can be worth its weight in gold.

How do you thank you staff?


Christmas Emergency Numbers – informing your patients

We have a week left until Christmas – your surgeries will be busy with people coming in with the usual coughs and colds that this time of year brings – and of course there will be the sudden rush of people wanting their repeat prescriptions before Christmas – and those that will wait until the very last thing and rush in just before you close on Christmas Eve.

But, have you let your patient know what to do if they should need a doctor during the Christmas break?

How have you advertised this?

  • Notices up in the Surgery?( Don’t forget to put one on the front door in case someone comes to the surgery looking for information. )
  • Surgery Website?
  • Answer machine message?
  • Adding a message to repeat prescriptions.
  • Patients newsletter
  • Telling patients if they ask when then come in our phone?
  • Local Village Newsletter for the more rural Practices?
  • Notices in local Chemist / shops

Excellent but do you also have the out of hours number available on all the above too?

The out of hours will be extremely busy over the Christmas period – I know because I worked for them over Christmas for several years  – and what a fantastic service this gives to local people wanting to see a Doctor when there Surgery is closed.


Are you aware of how many people who do not know that the out of hours even exists? I was completely surprised when working for the out of hours and the Surgery just how many people were not aware of this service. I lost count of the number of people who would attend the out of hours clinic and said it was the first that they had heard of it. And all agree what a wonderful system it was.

People that do not have cause to go to their Surgery very often will not have the need to know about the out of hours. Some people have not been to their Surgery for years – so how would they know it exists?

Some elderly will still wait days over a holiday period or a weekend until their own Doctors Surgery is open they too might not be aware of the service.

And of course you have the “visitors” that will be coming to your area – to stay in hotels, with family or friends –  ensure that if they need a Doctor that you have enough information / telephone number for them to be guided to the nearest out of hours clinic.

So, please ensure that you have the number available – and perhaps a brief paragraph on what the service is for and where they have to go for it.

If you have all the above in place they you have done as much as you can for your patient – and hopefully not many of them will need to use the service.


Effective Participation in Meetings

For those new to meetings or for those who want to improve their input, here are some tips.


Learn about the issues which are going to be discussed

  • Ensure that you read previous meeting minutes.
  • Any issues that you are unsure of speak to someone before the meeting this will save you either not understanding what is being talked about or having to ask it to be explained during the meeting – this will take up time and not be beneficial to others in the meeting.

 Listen to others during the meeting

  • Try not to interrupt anyone that is speaking during the meeting. If you have a point to raise please put your hand up – and you would be given a chance to speak when it is appropriate.
  • How would you feel if you kept being interrupted?

 Think before you speak

  • Before you raise a question or make a comment ask yourself if this is the appropriate time and place to do so?
  • Will you want your question/comment minuted?

Speak clearly and be brief

  • Speak clearly as there will be someone taking the minutes – and it is important that the right information is minuted.
  • Keep your questions/comments brief and to the point – meetings usually have a timescale and it is important that everyone has a chance to have their say.
  • No one enjoys a meeting that over runs – people lose interest

Do not be afraid to speak up

  • If you have a valid question or comment to make do be afraid to speak up.
  • Having a valid question or comment to make can be very important – it could mean a way forward for your organisation and perhaps your team.

Be reasonable, listen to other people’s points of view.

  • If you do not agree with another persons comments ask yourself if this if the time or place to disagree. Perhaps take some time, review the situation and if you still feel very strongly about it bring it up at the next meeting under “minutes of the last meeting”.
  • If you feel that the meeting is not the best place to disagree then perhaps talk to your manager about this before the net meeting and get a second opinion.
  • Remember not everyone points of view will be the same as yours!

Let go.  Even if you think a wrong decision is being made, in the end you may have to let this happen.

  • Sometimes you will disagree with someones decision – it might be something that you are unable to disagree with – you will have to learn to let it go.

When you have a meeting with Departmental heads you will often find a difference of opinion. After all everyone is there to get the best for their team, be it you for your Receptionists, The Lead Nurse for the Nursing Staff or the Senior Doctor for the Doctors or maybe the Practice Manager for her Management Team.

It is how you deal with this that will earn you points – listen to others points of view, offer a solution if you feel there is a solution – learn to work together as part of a team.


Patients With Special Needs (Patients Special Needs Board)

How do you keep staff informed about patients that perhaps need special attention?

What do I mean by “special attention”? Well this could come in many forms but for me as a manager I felt that certain patients needed to be at times “highlighted” to the rest of the staff.

Who would these patients be?

I know a lot of people think that Receptionists ask too many questions – that they are “nosy” or perhaps a barrier to seeing the Doctor – but believe me this is not the case – Receptionists ask these questions on behalf of the Doctors and Nurses and try their very best to ensure than anyone that needs to see the Doctor sooner rather than later does – if everyone was give this priority then the system would be in quite a mess. Then where would that leave the people who are possible at risk and do need urgent medical attention.

For me it was important that these people did not slip through the system without being given any necessary follows ups that were needed.  These people at times needed urgent appointments, urgent prescriptions or just access to the doctors without having to go through the many questions that sometimes a Receptionist has to ask.

Most of your staff will be dealing with these patient and will know of such cases – but what about the staff that work part-time – or those that have been on holiday for 2 weeks – it is amazing what kind of changes can go on in a surgery in this short space of time.

How many times I have seen a Receptionist that has been away ask a patient how their husband/wife/mum/dad are only to be told that they had died. It will happen – but there are ways that you can keep staff updated these issues.

What sort of things would these patients or their families phoning or coming into the surgery about?

An urgent prescription might need to be generated for a terminally ill patient. This could be done almost immediately instead of the usual 48 hours.

An urgent Doctors Visit might be needed for a terminally ill patient.  The visit would be logged without question. And then when the Doctor does his visits he could prioritise this patient if needed.

A patient might need an appointment that day due to a bereavement, or a miscarriage. The patient might be too upset to discuss with the Receptionist and might need to be seen immediately.

A relative of a patient that has recently died might need to see a Doctor. They would not want to wait a few days for this – does your surgery have a policy on patients that have recently been bereaved.

Often if the Doctor is aware that a patient has died he or she will often phone the relatives of the patient – this can be very comforting at this very sad time.

All of the above would mean the patient would need to be dealt with quickly, without fuss or questions and with compassion.

To have their call / query dealt with efficiently without question will no doubly help they already stressful situation.

I decided in creating a “message board” a “specials needs board” or  “patient board” it could be called whatever you like but at the end of the day this is how it worked.

In reception we had a wipe clean board. We used a wipe clean board simply because it was easy to use and update quickly. This would have three sections headed with:

  • Terminally Ill
  • Ante Natal
  • R.I.P. (recently deceased)

At the start of any entry the date that the entry was made should be dated.  This is a way of knowing when the message was written.


Any patients that were terminally ill either in hospital in a Nursing home or at home their name would be entered onto the board and the place that they were at.


If we had an expectant mum that was having a difficult pregnancy, had recently had a miscarriage or a still-born their name would be entered onto the board.


Any patient that had died their name and date that they died would be entered onto the board.

Beside each of their names we would have the patients Date of Birth. This is important to identify the correct patient.

The board would be kept in the Reception Area – but most important not in view to anyone other than staff. This is most important – remember patient confidentiality.

This board would be seen on a daily basis by all staff in the surgery. District Nurses used to come in each morning and have a look to see if any of their patients had died over night.  The health visitors would also check the board on a daily basis. The midwife would look before she started her clinic and the doctors would look before their started their morning and afternoon sessions.

By having the board in Reception it is there for all staff to see – and the good thing about this board is you don’t even think you are looking at it – but when you answer the telephone and one of the names on the board is mentioned you immediately are drawn to the board – the board is almost subliminal you see it without realising it.

You will need to ensure that the board is kept up to-date. You could allocate this job to one Receptionist.

The terminally ill will need to be there until they sadly die and then go onto the R.I.P. (This also highlights those terminally ill that have died)

Your surgery will have to agree on how long you keep the Ante Natal information on there – at our surgery we kept it up there for a month after the entry.

R.I.P – again you will need to agree how long you want to keep the information on there – again we kept it up there for one month.

Try this board system – it really does work and those patients that need special care can get it without having to go through lots of questions to get what they want.

Here is an example of how the board might look.

Terminally Ill

  • Mrs Jessie Jones    DOB 30.03.29   (ca breast)
  • Mr John Smith       DOB 25.06.57  (heart disease)

 Ante Natal

  • Annie White           DOB 26.09.80   (miscarriage)
  • Joan Brown            DOB 25.08.86   (stillborn)

 R.I.P. (recently deceased)

  • Mr Alex Swords       DOB  06.04.75   (died at home)
  • Mrs Susan Bird        DOB 12.12.45    (died in St Marys Nursing home)

You can of course make the board up in any way you think will fit in with your Surgery. But I must stress how important it is that this information is not seen by anyone other than staff.


When a Patient Dies

Does your Surgery have a policy when a patient dies?

You might ask why you might need a policy on this – but it is extremely important in various areas. Let me share these with you.

When one of your patients dies you will probably be notified by one of the following

  • A member of family or a friend
  • A Carer
  • The local hospital (usually comes in the form of a letter or fax)
  • The Out Of Hours Service
  • A Nursing Home (this will normally come via a telephone call)
  • The Health Visitor from your own Surgery (if they were caring for the patient at home)
  • Local Health Authority (the patient might had died in another area/country)
  • You might see it in the local paper under the births deaths column.


The next step is to record the death on your computer records. If your system does not do all of these automatically you will need to ensure that they are taken off.  Ensure that the patient is taken off any clinics that might generate recall letters such as

  • Flu Clinic
  • Diabetic Clinic
  • Asthma Clinic
  • Blood Pressure Clinics and so on.

If your surgery is mostly computer run it is still very important to make sure that an entry is made in the paper notes.

How does your Surgery record patient deaths?


I worked in a surgery before we have our death protocol in place where a very upset wife phoned to say that a letter had been sent out to her husband to have his flu vaccination done – he had died 3 months before. Although someone had entered that he was deceased on his records he had not been taken off the flu recall.

Link up any close member of their family and add to their records that they have been recently bereaved – this will help the Doctor if a member of the family comes in to see them. There is nothing worse than the Doctor asking after the deceased patient. And believe me this has happened on several occasions.

Ensure than any future surgery appointments are cancelled.

Remove patient details for any routine repeat prescriptions.


It is important that you put a stop to any further prescriptions – I am happy to say that it didn’t happen at my Surgery but there have been surgeries that have had people coming in to request repeat prescriptions for deceased patients and because they had not got a policy in place the prescriptions were issued – several times

Who you should informed of the deceased patients death will depend on where the patient died.

If The deceased Patient dies at home / or other place please check to see if they have any future hospital appointments booked.

The  most important thing you should check with your local hospital to see if they had any outstanding hospital appointments.

Ask the hospital to check if the deceased patient had any hospital transport booked. Why?


Again before our Surgery policy was put in place we had a deceased patient who’s funeral was taking place one Thursday morning – the wife of the deceased heard a knock at the door and thinking it was the undertakers she opened the door to find that hospital transport was there to take the deceased patient for his hospital appointment. Now can you see the importance of ensuring that all future appointments are cancelled?


It is important for all staff to be made aware of the death of any patient. How do you record the death of a patient in your surgery?

  • Inform the Doctor
  • Inform the Health Visitor (in the event of a child or pregnant mother)
  • Inform the Health Visitor (in the event that they were due to start visiting the patient)
  • Inform any other healthcare professional that might have a reason to be in contact with the deceased patient.

The best way for this is to send an internal email – and if necessary put it in the message book.

When we reviewed our policy on deceased patients I designed a form that had to be completed. We had a member of staff that had the responsibility of ensuring that everyone was informed of the death. Each section had to be completed or ticked and at the end of the form a surgery supervisor had to sign it too – and this copy was then scanned onto the patient’s records and the paper copy placed in their medical records.

You can design your own form but an idea on what we had on our form:

  • Patients Name and Address
  • DOB (date of birth)
  • Place of Death (ie home/hospital/other)
  • Computer code entered (RIP code)
  • Deduction Requested (deduction from surgery list)
  • Next of Kin (entry made on their notes)
  • Hospital Notified – if applicable (I recommend that this should be done in a fax/email and not verbal.)
  • Hospital Transport Cancelled
  • Surgery Appointments cancelled
  • Doctor informed
  • Health Visitor Informed
  • District Nurse Informed
  • Other staff informed
  • Prescriptions Stopped
  • RIP Message on Notes
  • Records returned to the Health Authority
  • Any other areas that might be applicable to your Surgery

 I hope you have found this helpful. The important thing is to ensure that family / friends are not subjected to any more upset because their loved ones are still on your surgery system as still living.

REMEMBER:  This will be the last thing you will do for the deceased patient – show them the dignity they deserve.

I did go on to have an “alert” board where we also put this information. You can read this on  my blog :

Patients With Special Needs (Special Needs Board)