BY ANASTASIA CHOO

There is a stereotypical image of GP surgery receptionists being grim faced, fire-breathing dragons.  They often score poorly in NHS Patient Surveys. Patients complain that they find doctors’ receptionists obstructive, incompetent and unfriendly. In a recent Cancer Research UK survey based on 2000 patients, 4 out of 10 said they did not like being asked too many probing questions by non-clinical staff just to get an appointment.

There has been much talk over the years to outsource GP receptionist services to call centres in India to reduce NHS costs and have centralised IT procurement, which sounds good in theory but is strenuously opposed by doctors.  Doctors value the front line work that receptionists provide – they’re in the difficult position of having to deal with all the emotions of the ill patients while remaining responsible for the practice and protecting their practitioners.

Why are these GP Surgery foot soldiers seen in such a maligned light? I was given access to observe a busy GP Practice in the Cambridgeshire countryside to find out why these “fire breathing dragons” are subject to such vitriolic comments in surveys yet highly praised and vehemently defended by doctors.

I discovered that their detached manner is not intended to intimidate or belittle patients; it’s a form of protection, to help them avoid emotional burn out.  It is an emotionally demanding job – the receptionist working on the front counter saw and dealt with over 50 patients between 8:30am to 12 noon whilst answering the telephone between patients and triaging these calls.

The following is an example of the scenario in the first thirty minutes of the surgery opening: a queue of seven patients waiting to speak to the receptionist.

The first, a local known drug addict, has forgotten to order his prescription and is demanding that the receptionist sort it out now before he is forced to “go to his supplier and buy skunk!” She explains that he will need to follow protocol, he will need to complete a written request for audit purposes but she will try to catch the GP in between patients.  He is not listening, decides to throw himself on the floor in the middle of the waiting area, causing much distress to the rest of the patients in the waiting area.

A commuter is late for his appointment, instead of using the automated check-in system to alert the GP of his arrival for his appointment, he has waited patiently in the queue. He is already twenty minutes late, which has a knock-on effect for the GP.  The receptionist is obliged, as per doctor’s orders to check if it is an emergency that he sees the GP today.  Could she re-schedule the appointment? It ends in a tirade of angry abuse from the commuter who claims he very rarely sees his GP and pays a lot of taxes and he accuses the receptionist of being nosy and obstructive.

Meanwhile, the phone is constantly ringing and the receptionist knows that she needs to answer the phone.  The patient on the other end is probably unwell and most likely annoyed about having to wait so long.

Next, a proud Mum informs the receptionist that her little boy has been offered a part in the West End production of Charlie and the Chocolate Factory. Could the GP just put his signature against a “Declaration of Health Form” to allow her young son to perform – it’ll only take a few seconds? She is most outraged that this may take up to two weeks as her little boy will need this form signed before the end of the week and it’s a once in a lifetime opportunity. Why can’t the receptionist poke her head through the consulting room in between patients?

I do feel it is relevant that the reader understands at least a snippet of what the receptionist is up against.  Every patient is unique and feels that whatever problem or query they present to the receptionist is important to them.  They are not interested in surgery procedures nor do they care about how busy the GP is. They expect a fast, efficient, on demand service because they pay their taxes.  In the case of the performing arts Mum, her request is not available on the NHS, the GP must process her son’s form outside of NHS time and she will need to pay – which brings in another set of expectations: “if I am paying for this privately, I expect a much faster turnaround.”

An elderly tearful lady arrives to register the death of her husband who passed away while they were away on their 50^th Wedding Anniversary holiday but the local drug addict is still causing a kerfuffle, he is now thumping his fist on the counter and demanding that the receptionist get his prescription immediately.  Another person is keen for the receptionist to just quickly book her in for her appointment and frowns when she is told to use the automated check in system.

The receptionist manages to leave her work station to speak to the GP about the drug user demanding his prescription because, as far as she can see, he is over-ordering and couldn’t have run out yet. The GP agrees and tells the receptionist to call every pharmacist to check that he’s not picked up his last script before he’ll issue a duplicate. She advises the patient that they are investigating the whereabouts of his last prescription, it may take a while but they will not leave him without any medication. He responds angrily and calls her a “F***king b*tch” and, as he storms out, he indicates that she will regret not helping him.

The receptionist remained calm and diverted her attention back to the elderly woman whose husband had recently passed away and takes down some details before passing on the contact number for the local bereavement counselling service to her.  How many readers could remain calm after the aggressive outburst from the drug user?

A new smiling mum arrives to register her baby and book her 8-week check and immunisations; the baby is already eight weeks old as Mum has been very busy and not read her “New Mum letter” but she hopes to be seen sometime this week.  The receptionist informs Mum that these clinics are booked up for the next three weeks but it’s not a problem to be seen beyond the eight weeks.  The new Mum gets very upset and tearful as she is worried about her little baby’s health.  What if she falls ill having these immunisations late?  She demands that a nurse or GP call her immediately as she is not going to simply accept the word of a non-medical “jobsworth” receptionist.

Next the local mayor walks in to advise that he needs to fly to Ghana in two weeks for a business meeting, he’s already investigated which jabs he needs and just needs an appointment as soon as possible.  The Travel Nurse happens to be on holiday and will not return in time and he queries why another nurse or doctor couldn’t administer the jabs? He fails to understand the protocols and does not listen when the receptionist advises him to contact an alternative provider.  He gets political and lectures the receptionist about the state of the NHS.

In the space of just minutes, the receptionist is presented with happiness, sorrow and anger.  It is impossible and, indeed, would be unhelpful for the receptionist to mirror these emotions.  She must remain in control of her feelings and those of the patients; she must remain neutral.

Another challenge she faces is being caught between patients and doctors.  For example, a patient telephoned to inform the surgery that she was intending to “kill herself” and the receptionist’s knee jerk reaction was to interrupt the doctor in the middle of a consultation.  He told her to wait until he had finished with the patient, so she remained on the phone, talking to the patient.  The GP appeared quite unconcerned and flippantly asked “which method does she plan to use?” The receptionist failed to see any ‘humour’ in the GP’s response, even when he explained that this is a repeat offender who always calls when “tanked up.” She then had to relay back to the patient to expect a phone call from the GP and took another torrent of verbal abuse from the patient.

On another occasion a patient with learning difficulties appeared very distraught, asking the receptionist to help him return to his hometown which was over 100 miles away. While she sat with the patient to try and calm him down, another traced his notes and a third contacted a GP and the local Care Home, which refused to pick him up as it was not their responsibility – Police had to be called as he did not require any treatment.

Despite all this, there is little appreciation from patients of the emotional strain placed on a GP’s receptionists, yet they are the stitching that holds a surgery together emotionally and administratively.  In between dealing with patients and answering telephone calls, they process prescriptions and update patient records.  Any mistake could result in serious implications for the patient.

I witnessed several receptionists go the extra mile, such as call a patient back when there was a cancellation or help a patient chase hospital test results which frankly, the patient can do themselves from home.  I’ve seen that patients have an unreasonable expectation as to what the receptionist can deliver.  She cannot magic an appointment on demand as there are only a limited number of appointments that the surgery releases and she is trying to help you when she asks about symptoms, as it is her job to triage the information to a GP who will decide if it is an urgent medical matter.

There is a misconception that a doctor’s receptionist does nothing more than answer the phone and tell patients the “computer says no!” yet what I witnessed is that the job requires a high degree of emotional awareness and maturity on very little pay.

So the next time you are presented with a fire breathing dragon, just think about the emotional roller-coaster she has been on and remember that she does care.