A Guide To Handling Difficult Patients In A GP Practice

Anyone working in a frontline role in primary care will be aware that having to handle difficult patients in a GP practice is ‘just part of the job.’ There are many reasons why patients may become challenging, aggressive or uncooperative, and having a better understanding of those reasons is a key component of primary care training. 

It’s essential as primary care managers, that we fully support those who are in direct contact with these difficult patients so they are well-equipped to defuse the situation while still offering them the essential medical care they need. 

Practice receptionists that feel confident to handle even the most challenging circumstances if and when they arise are a true force to be reckoned with – it’s amazing to watch the difference it makes in action.

But first, let’s remind ourselves why some patients become difficult

There are several causes of patients becoming challenging. These include:

  • Being in pain or unwell
  • Misuse of substances or alcohol
  • Distress, anxiety and fear
  • Difficulties in communicating
  • Frustration and unrealistic expectations
  • Having had a previously poor experience

Difficult behaviour may take a number of different forms including:

  • Being controlling or demanding
  • Being unwilling to listen or cooperate
  • Making threats or verbal abuse
  • Becoming physically violent to property or people

The right customer service training for GP practices staff is the best way to equip receptionists and other frontline staff with the skills they need to address these behaviours and situations effectively and without escalating the problem further. 

Identifying The Nature Of The Problem

The first step in diffusing an aggressive or difficult patient is to identify the source of their problem. Is their behaviour due to their medical condition? Or perhaps they are frustrated due to a lack of healthcare resources in your practice. If there are too few GPs that day, appointments or poor staff communication, patients are likely to have a deteriorating mood. 

Getting to the heart of the problem enables frontline staff to address the issue and diffuse the situation. 

Viewing The Situation From The Patient’s Perspective

It can be really difficult for those in the firing line to stay calm and patient when someone is in full-throttle complaint mode but it’s important to step back and view the situation from the patient’s perspective. Even just giving the difficult patient the opportunity to express themselves and get their thoughts off their chest often helps to relieve their distress. 

Taking A Helpful Stance

Rather than having a defensive posture when dealing with challenging patients, it’s important to avoid this. Instead, finding opportunities to show empathy for the patient’s circumstances is essential, and showing a little compassion goes a long way towards helping patients fell that you genuinely care. Even just moving away from the reception desk and asking them to speak to you privately in the corridor away from other patients, can make a real difference.

Setting Boundaries 

Although it’s important to show caring for even the most difficult patient, it’s important to set boundaries and limits if someone is screaming or using verbal or physical abuse. Frontline staff must be taught how to warn patients about the consequences of their aggressive behaviour via targeted GP receptionist training so that they are well-prepared to deal with the potentially traumatic situation when it arises.

Assessing The Risks

Sometimes, there may be situations in which other patients or staff members could be at risk. It’s important to be able to spot when a patient may become aggressive and to take proactive steps to control the situation. If staff are unable to calm the patient, they need to know what to do to contain the patient and reduce the possibility of injuries both to the patient themselves and others in the vicinity.

Getting The Right Training For Frontline Staff

Unfortunately, targeted GP receptionist training is often under-funded and as a result, frontline staff are left ill-equipped to handle potentially stressful situations with difficult patients. Finding the right primary care training if you’re able to therefore is essential. Orr Medical Training’s Effective Customer Service course is one of the best options. 

Through an interactive workshop that explores the most common challenges that frontline staff face and the effective techniques which can address them, this course improves staff morale, patient satisfaction and the practice’s reputation in the most cost-effective and efficient manner. 

Don’t Waste Your Money on a Practice Extension or New Building!

Bursting at the seams?

On various visits to practices, one of the biggest gripes I hear is “we haven’t got enough space”. To be specific, not enough clinic space. 

It’s often a reason why practices won’t take on registrars, medical students or develop the practice in other ways such as modernising the workforce by adding allied healthcare practitioners.

There’s an easier solution 

It might surprise you and many practices I’ve worked with have tried it.

When considering lack of space, the first thing people think about is building work, extensions, moving, new builds etc. This is always the expensive and stressful solution to the problem.

But what if there was another, much easier way?

The first thing to do is ask the question: during working hours, are all the clinical rooms used at all times for only clinical work? 

This means dealing with patients, whether face-to-face, on the phone or online, not any time of admin such as processing blood results, scripts etc.

The best way to do this is to conduct a room use audit. Start by looking at the appointment screens and noting how many hours in the day each room has not got patients booked in. Then total up the hours. This is time that could be used for clinical contact.

Practices will often find that there are a great many hours of available clinical space when patients could be dealt with, but the rooms are taken up with other tasks such as admin.

How do we utilise the space better?

To allow clinicians to conduct their admin and other non-patient-facing tasks, they still need somewhere to work with access to the clinical system. An ideal option is to create a clinical admin space or a hub, where clinicians can work together in the same room. 

This has lots of benefits, not least of reducing the isolation felt by clinicians working the majority of their time on their own in practice and also the ability to cross check or ask for advice. 

The space doesn’t need to be huge or palatial. It only needs enough space to house a few computer workstations and telephones, as not all clinicians will be using it at the same time. In many surgeries, there are often neglected small rooms that could fit this function perfectly with some minor investment, or why not use the neglected staff room piled high with junk, that would be ideal as a clinical admin hub?

But it’s my room!

The biggest hurdle to overcome is the ‘it’s my room’ syndrome. 

I like to offer this as an option to the partners: would you rather spend £50,000 each on an extension you don’t need, or let someone use your room for a few hours a day? 

It’s a no brainer really, but you’d be amazed how many people would still rather build an extension. Some GPs are very territorial over their workspace.

One way of helping your team to ‘let go’ of their claim over rooms is to de-personalise them. Removing photos, kids’ paintings and personal clutter makes the room into a neutral shared space, rather than a personal one. 

This is also a perfect opportunity to standardise the rooms, so you can find the same things in the same place in each room. The use of wheeled boxes (like many reps use) to move your kit in and out of rooms at the end of a session allows you to have all your equipment and home comforts, but lets you move them easily.

What about the surgery times?

Another common barrier to utilising this system is the “we only need people to work during morning and evening surgery times” problem. 

Why is that? It’s just habit. These times certainly don’t suit all patients and don’t suit quite a few clinicians.

Lots of patients would be delighted with a lunch-time appointment and some clinicians would equally be at home starting after the morning school run, perhaps doing visits or admin first and then doing the largest part of their clinical work in the middle of the day. Equally early morning or late surgeries would be music to the ears of busy commuters. There are endless combinations that could be adopted. It just takes some flexibility.

It’s all about change

The solution to most surgery’s space problems is easy. Fill your clinical rooms only with clinicians involved in patient contact, every minute, from when the surgery opens until the surgery closes. For most surgeries open from 08:00 to 18:30, that gives you a maximum of ten and a half hours of patient-facing time per room, per day. 

The main problem is change. 

People don’t like it, particularly GPs who have sat in the same chair, at the same time every day for the last few decades. Some will have spent more time there than at home or with their children over their lifetimes, so giving up their routine and personal space is a battle, even if it means the alternative is parting with a huge sum of money to provide clinical space elsewhere.

It’s not an easy change to make, but the potential rewards are huge.

To learn more about what our consultancy can offer your practice drop us a line at admin@orrmedical.co.uk

Why Does Your Primary Care Network Need A Strategy?

The start of the journey for Primary Care Networks (PCNs) is just commencing.  Practices will have established their Network and submitted their initial Network Agreement by the 15th May 2019.  The next step is to complete the Schedules to the Network Agreement by 30th June 2019.  

The initial Network Agreement can be submitted on behalf of the Network, however the Schedules need sign off by all practices within the Network.  The Network Agreement and accompanying Schedules form a legally binding document and contain within them 104 clauses and 7 schedules.

The Schedules are made up of: 

  • Schedule 1 – How the PCN holds meetings and makes effective decisions
    • Governance of the Network
  • Schedule 2 – Additional Terms
    • These are additional to the ones that are in the national template, for example, if you wanted to add additional duties to the Clinical Director role that were only relevant to your Network
  • Schedule 3 – Activities
    • For example, how will Extended Hours be provided
    • Who is the provider of services (subcontracting arrangements)
    • For CQC purposes, who is providing the regulated activity?
    • Any other specific considerations for services and/or their delivery
  • Schedule 4 – Financial Arrangements
    • Who will be the lead practice for funding from the commissioner 
    • What level of funding will the network receive
    • What will the funding pay for (i.e. workforce, extended hours, other services)
    • What additional funding may practices/members require/input
    • How will funding be transferred between practices, what for, when
    • How are profits/losses/liabilities apportioned
    • Banking arrangements and accountancy 
    • How is income and expenses dealt with – what is the difference between a PCN and practice income/expense? 
    • Arrangements for cross-indemnities (if required) 
    • Any other specific considerations for funding? 
  • Schedule 5 – Workforce
    • e.g. the employment of the “additional staff roles” that will be available to the PCN at 70% or 100% reimbursement
  • Schedule 6 – Insolvency
    • This schedule sets out a list of suggested different events of insolvency that would enable Members to take action under the Clauses
  • Schedule 7 Arrangements with organisations outside of the Network
    • This is used for referring to or setting out arrangements with organisations outside the PCN. It could be complicated to weave in those other arrangements into the Network Agreement and so Schedule 7 enables them to be recognised and identified by the PCN 

Once all of the above have been submitted, your Network will become functional from the 1st July 2019.  To take your Network to the next stage of being operational, you will require a strategy that considers how it will operate to provide joined up models of care to benefit your local residents.

Your strategy should include, but not be limited to:

  • Governance
    • Decision making & Management Structure
  • Developing the Leadership and Culture 
    • Workforce Development
  • Engagement
    • with the wider partners in your community outside of health, including voluntary, community and faith groups and local Councils
  • Planning the delivery of your services
    • Extended Hours
  • Vision & Values 
    • Where do you want your PCN to be in the future
    • How will you behave to get to achieve your goals
  • Aims & Objectives
    • SMART methodology
  • Priorities for the short, medium and long term
    • What do you want to achieve by when

As you will see, there is a significant amount of time, effort and understanding that is required to enable PCNs to function to the best of their ability.  A strategy will ensure that your Network is functioning at the right level and at the right speed in order to achieve your goals.

For further information on how Orr Medical Training can help develop your PCN strategy, please contact us at admin@orrmedicaltraining.co.uk or on 07012 399097. 

Why Does Primary Care Training Sometimes Fail?

I was chatting to a few practice manager colleagues last week and the topic got onto GP reception staff training – always of interest to a GP and training practitioner like myself. 

They were recalling past training sessions that had failed to have the desired effects; the change in behaviours, the way people just returned to the old ‘safe’ ways of doing things after a fortnight. I hasten to add they weren’t talking about Orr Medical Training of course but it got me thinking.

What are the most common reasons why primary care training fails? After working in the training field for many years, I’ve seen the following circumstances contribute towards why training – and group training in particular – doesn’t always go to plan plus how to resolve this.

3 Key Reasons For Training Failure

  • Staff are required to attend training without being given specific information about how it will specifically benefit them individually
  • Staff fail to fully engage with the training due to poor delivery methods
  • The training is delivered online rather than on a face to face basis leading to a lack of engagement.

Let’s break these down a little further.

Sending an employee to learn something that’s not instantly applicable to their everyday to-do list is a massive time waster. Sometimes on my courses, I’ll also come across practice staff who have been sent on training they don’t feel they need either. Number one job for you as a practice manager: explain to me how this course is going to make my life (not Susan or Debbie’s) easier and give me ideas I can use immediately.

Next up – let’s talk training methods. I can’t count the number of times I’ve been called in to ‘retrain’ teams because the previous training provider used outdated or boring training methods. Death by Powerpoint lectures, cringe-worthy ice-breakers or facilitators that dominate the discussions are all common culprits. And it’s really hard to have a good group discussion when the room is packed to the rafters. Even the most experienced trainer will struggle to check-in with each learner in this scenario.

And what about delivery method? Some courses are perfect to study online. Learners can study at their own pace, in their own time. Others that deal with any form of communication or practical task, I’d argue are always going to be more effective delivered face to face. Why? Because how else are staff going to learn the practical ‘how to’ examples and test these out safely for themselves?

Failed Training – An Expensive Problem

So nobody can deny the need for GP practice staff to have regular access to training courses. After all, training is key to delivering the high level of patient care that is essential at the point of delivery. However, when the training on offer fails to engage the staff who are attending, the financial impact can be serious. We know NHS funds are already severely limited. Therefore, it’s a no-brainer not to waste them on poor quality training. Not only is it a waste of money, it is also a waste of valuable NHS staff time who we desperately need onside. 

A couple of weeks ago I was chatting to a practice manager who mentioned she had quite a young workforce in reception. The team had received some customer service training, but they reported back to the practice manager they hadn’t really got anything from it and the trainer had ‘droned on’ too much. When she told me this story, I knew the reason straight away. The trainer had failed to take today’s young people’s learning styles into consideration. Younger people learn differently nowadays and get bored very quickly. It’s not an opinion, it’s a fact; they’re taught differently now too. If the training isn’t entertaining or they’re not called upon to interact and participate, the trainer has lost.

With general practice under considerable pressure, it’s vital to ensure that staff spend their time only on worthwhile activities that can genuinely improve the patient experience and service delivery.

Resolving The Problem

The good news is that there are many excellent training courses out there for NHS frontline staff which represent outstanding value for money. The key to their success lies in their high level of staff engagement and participation. By allowing attendees to interact with the material and by offering real-life, practical examples which staff can relate to, the best reception staff training courses achieve the desired goal of increasing staff knowledge and expanding their skillset so that they can deal more effectively with patients and ensure the best possible level of service and care at a potentially challenging time in their lives. 

How To Choose A Training Course For Your Frontline Staff

With so many GP practice staff training courses out there it can be hard to select the right one for your own frontline staff team. However, when it comes to finding an engaging, practical course that offers good value for money, there are a few key tips to keep in mind:

  • Always obtain case studies and testimonials from the course provider to ensure that previous course participants have been satisfied with the results.
  • Enquire about the trainer’s background. You need to be certain they have a strong understanding of the reality of working in a general practice environment, not just a generic trainer with no expert knowledge.
  • Find out how the course is delivered. Is it on a face to face basis? Does it involve practical activities and interactive elements? Is there a maximum delegate limit – smaller groups of less than 12 are best in our experience.
  • Does the course content sound like the previous training session you ran? Was it a success or could you spice things up with new trainers, different teaching styles especially for staff taking the same training again?
  • Ask about the training materials. Can you see an example of them to make sure they’re going to be in a format your team will understand and engage with afterwards and importantly, to make sure they are up to date?
  • What sort of follow-up training or support do they offer to participants? Will the provider bolt off into the sunset without so much as an email or phone number for support afterwards?
  • Finally – and this is a job for you – is the learning environment the best it can be? It sounds basic but learning can’t take place if people are too warm, too cold. Think about comfort. Think about the refreshments. Are they going to be distracted?

Orr Medical Training’s Outstanding Courses

I hope that’s given you plenty to think about and it goes without saying, when it comes to selecting the right training for your reception staff, Orr Medical Training are proud to offer some of the best courses around today. 

We only use dedicated experts in their field, not generic trainers, who can’t answer the difficult questions because they are out of their depth. We only use bang up to date course materials, written by the expert trainer themselves. We always provide follow up and support as part of all our training packages.

With many of our practical courses offered as engaging half day workshops, these courses are a valuable use of NHS funds and staff time, and there is even support on hand afterwards to ensure maximum benefit for staff in the long term. Browse our courses and let’s work together soon.

Staff Training: Why It’s A No-Brainer for Every Practice

Day in, day out, me and my team are out training and chatting to GP practice teams across the country. As a GP myself, I’m no stranger to the fast-moving world of general practice.

To say we encounter a phenomenal mountain of work on a daily basis is an understatement!

Everyone feels the pressure. 

And it’s practice staff on the frontline that often bear the brunt of frustration from patients and the constant need to be able to respond swiftly to requests.

So just thinking about the sheer workload you’ve faced as a practice since the New Year, can you be sure that your staff have received the training they need to support them in their roles right now? 

If your practice manages to tick along every day, it’s easy to assume that you don’t need to think about training (“not this month, Matt – our new receptionist is a whizz with the patients” I heard the other day). However, investing in your staff by providing ongoing training could make a surprising, sustainable difference. 

If you’re already running ongoing training, I’m preaching to the converted, but here are a few of the reasons why I’ve found staff training as a GP is so essential for the practice teams I work with: 

Protecting Staff

Stress can be a big problem for all employees working within the NHS, and research suggests that many are considering leaving their role as a result. 

While you can’t do much to summon up surplus resources out of thin air, there are some steps you can take to make the most of what you have. Training helps staff to maximise the skills and knowledge available collectively as a team and to be more effective with the time at their disposal. This creates a positive cycle where staff become more efficient and feel less stressed as a result, which in turn improves efficiency further – and so on. 

With rising workloads and unrelenting pressure, it’s important that our frontline staff feel valued and appreciated. By taking the time to invest in their personal development, you will not only help to improve practice efficiency, but morale will improve as well. 

Future-Proof Your Practice

Balancing the books can be difficult for GP practices and this means that no-one has lots of spare staff floating around. If someone leaves, it can leave an instant and sometimes painful long gap in frontline services. Struggling to train someone new while maintaining business as usual can be almost impossible. 

Cross-training staff isn’t just good for personal development, it’s also beneficial for the practice. By having multiple people within the practice trained across various roles, it means you won’t have a sudden gap in the event of long-term illness or resignation. 

Training isn’t just about sideways movement either; it also provides the opportunity for proactive succession planning. By preparing individuals for promotion, you will be future-proofing your practice across the board. 

Keeping Up with Industry Standards

Even though your staff might be doing a stellar job and delivering an excellent service, there’s still a need to keep up with changes in the industry and the wider NHS. 

Training can help your staff to keep up with industry best practice and also stay abreast of regulatory updates. Whether it’s training frontline staff on areas such as GDPR or updating practice managers on changes to employment law, it’s essential that everyone is up to date on the crucial knowledge within their role. 

Delivering A Service That Stands Out

No-one is doubting that your staff do their absolute best, but providing them with a diverse range of training can help them to provide a service that really stands out in the community. 

Many practices focus on the practical elements, such as customer service or how to operate the phones, but don’t provide staff with training on the soft skills. Whether that’s time management to handle the plethora of emails in our inbox or people skills, taking a more rounded approach to include all the different areas of training could make the service something very special indeed. 

Not sure where to start first? In my experience, if you ask your team, they’ll quickly tell you where the gaps are.

Ready for a Bespoke Approach?

Every practice will have different training needs depending on the level of experience of the staff, and their existing skills. Here at Orr Medical Training, we can help to design the right training package for your practice, helping to ease the burden and boost morale all around.

Give us a call today on 07012 399097 or email us at admin@orrmedicaltraining.co.uk for a no-obligation discussion.