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What to do?

5 Posts

Posted:  03-Aug-2018 21:48
What do you do when you literally have no capacity to see patients.

We all squeeze the extra patient in but what do you do when that extra patient becomes 3 or 4 or 5 and the clinics are all full and there is no more space and no more nurse's available?
In an ideal world we would hire another practice nurse but finances stop this happening.

Is this common everywhere?
Is every NHS service streched beyond belief?

4472 Posts

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Posted:  03-Aug-2018 22:20
Is this a seasonal issue, summer holidays causing a shortage of appointments?

Can you get more protected appointments, so that your chronic diseases take a bit of a back seat. Would that help or is that causing the problem.

I would encourage you to either: take all your breaks, go home on time and don’t squeeze any patient in or claim for ever extra minute of work you are doing. And email all the partners and PM to explain that this situation is untenable. Good luck.

This is just my opinion and not an instruction. T&E x
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2196 Posts

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Posted:  03-Aug-2018 23:08 Log in to like this post
Are the GPs and PM aware this is happening?
If not bring up as soon as possible at the next Practice Meeting. 
If the GPs do not acknowledge there is a problem and have no suggestions then  it is time for you and your colleagues to note every minute of overtime you do and  circulate to GPs and PM asking how they propose to alleviate the problem.
Or do as T&E suggests and  just refuse to work overtime. This cannot just be expected  of you if you have home and family commitments.
The more time you give freely , the more they will take and put upon you.



516 Posts

Posted:  04-Aug-2018 16:42
That horrible for you and your patient's. How can you give them the time they need? You must be rushing all the time. Do the Dr's work like that too? You need to stand up for yourself and your patients. By squeezing them in your're making it acceptable. It's not easy to make a stand and, if you're anything like me, you find it hard to say no, but you must. Sometimes full is full and that's it. No money is no excuse, unless your appts are wrongly filled or timed. The surgery is paid to provide a service, which it sounds as if they're not. (I'm not pointing at you!) if you were going on holiday would you expect 2 or 3 people per seat on a plane, because the airline couldn't afford another plane, likewise the hotel, pop a couple of families in together, that should save a bit????? You must run late all the time, claim overtime, take your breaks and say no as much as you can.

22 Posts

Posted:  05-Aug-2018 16:49
This is happening to me constantly. I'm working through my lunch breaks and stopping late most days.

Reception just cut my appointment times without asking anybody -  For example I often have bloods, ECG and shingles vaccine to do in 15 minutes. 

We have an issue with urine samples and when stock arrives - HCAs will leave them for me to do most of the time. They have extra time for appointments so I think this should be their job as I often go into their rooms and they are playing on thier phones - I wish I had time to do that!

I have raised this to the PM but they haven't done anything about it.

I am relatively new to PN so not the most supportive when you feel like you're rushing everything!  

That said I am looking for another job and will be asking questions surrounding appointment times at interview.

4472 Posts

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Posted:  05-Aug-2018 18:50
How have reception been given the permissions to alter appointment times? Would they do that for GPs? Or any other clinicians for that matter.
Write an email to the PM and GPs stating that this is inappropriate and potentially unsafe. Contact your union for support.

This is just my opinion and not an instruction. T&E x
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13 Posts

Posted:  07-Aug-2018 11:44 Log in to like this post
As a nurse of 25 years I have learned this is a way of life and it is tiresome- Our Gps work like it and we as nurses do
Eventually something will give- incidents etc
The public tend to voice if they feel rushed but they are the force behind the demand to be seen on time and for every minor thing they can think of in 15 minutes! Plus you try seeing patients every 15 minutes and plus telephone triage on another list as duty nurse and then tend to urgent walk ins all at the same time!
Its not sustainable, not safe and not fair - who would have our backs if things went wrong...

4 Posts

Posted:  10-Aug-2018 13:24 Log in to like this post
My suggestion is to refuse seeing extra patients. This had happened to me all the time at the beginning of my career but I stood up for myself. I really showed my claws. I sent E-mails to the practice manager in which I stated that squeezing in patients every day it is not safe for the patients and for my PIN and any bad consequences of the stress, I would make them responsible for any negative outcome. I suggest you to inform the practice manager in writing, expressing your concerns and you are covered. If it is necessary Email her/him from time to time reminding of your work conditions.
Things will get better if you stand up for yourself. Nobody has the right to put your PIN and the patients life at risk. Inform them that they will stand beside you in court if something happen.
Please, do not do anything which is not safe for you. Watch your back first, because we are living in a very blaming society and at the end of the day the managers and doctors might say "why did you not speak up and inform us that you where having problems?" at that point you might answer " but I have informed you? " they will answer " were are the evidence that you have informed us?" they can deny everything which is not written to cover their back. Remember ... "If it is not written it did not happen" does it sound familiar to you this sentence?
Put everything in writing and make them responsible of the outcome. You will see!! thing will start to fall into place.
All the best.

32 Posts

Posted:  11-Aug-2018 15:23
What out of hour services are available in your area? We used to have lots of minor injuries units near by which patients could go to if there were no appointments. These have nearly all closed but we now have “GP Hubs” where appointments can be booked by our surgery or by 111 for evenings and weekends, they have been amazing whilst we have been short staffed.

52 Posts

Posted:  11-Sep-2018 20:19
I'm catching up on recent topics and this caught my eye.
I used to work in a large GP practice (over 22,000 patients, 15 GPs and a couple in training); it was an every day occurrence to work under such pressure. Our practice manager and a couple of GPs joined a nursing team meeting and I actually said ".... even A&E goes on shut down when it's full to capacity, when will you hear that we're trying to tell you we can't keep this up … ". Our sickness was in the roof and it was a catch 22. I left. I'm now in a small practice (less than 5,000 patients) and things are much better. There's still busy days and stressful times but nothing has changed in my previous work place and I'm sorry for those who feel "trapped" into staying.
Would your practice consider agency staff if they won't recruit a permanent additional member of staff?

801 Posts

Posted:  12-Sep-2018 11:57
I agree with everything said. Im too old in the hat to be working like that anymore
we have several appts blocked off everyday to be used up as time comes, i dont work over my time with out billing them.
the more you give, the more they will push. Ive been here nearly 8years and with so few nurses around, Gps will often go out of their way to accomodate us now, as we are lucky to be irreplacable

The gp mentor and our manager are used to be firing off emails to them over the years about putting m/us under unreasonable pressure and expectations, they soon reign it in again,
The gps get paid enough that they can pick up the slack, so make sure they do or move on

19 Posts

Posted:  09-Oct-2018 13:29
I was a lone nurse without a HCA. Everything seemed to come to me. Firstly make sure that everything that comes your way is listed as an appointment..even the urine testing.

When we had our CQC inspection they picked up the ridiculous amount of people seen by me in one day and this was pointed out to the G.Ps and P.M.then things changed. I was given time in the morning to set up, the allotted time for procedures were changed. To return from a holiday break(in which there had been no cover) and find that lots of Health Checks and Smears had been booked in, then other urgent/immediate patients were squeezed inbetween made me mad and this was pointed out as bad planning.

The receptionist work hard, but need to understand a little more what you have to do with each procedure, it does help.

Best of Luck
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