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Receptionists' 'hidden' judgments may be 'risky'

Receptionists' 'hidden' judgments may be 'risky'

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Receptionists should "step out of the shadows" and make their contributions to repeat prescribing "explicitly" known to GPs, it is argued.

A study, published in the British Medical Journal, found receptionists and administrative staff in general practices across the UK often make "important 'hidden' contributions and judgments" to repeat prescribing.

Such judgments serve to bridge the gap between the "assumed" reality of the technology and the often "far messier" reality of day-to-day general practice, said Deborah Swinglehurst, lead author and Doctoral Fellow at the Centre for Primary Care and Public Health at Barts and the London School of Medicine and Dentistry, Queen Mary, University of London.

Yet GPs are often unaware of this input, she claimed.

Swinglehurst and her colleagues found repeat prescribing to be a "complex, technology-supported social practice" that requires collaboration between clinicians and administrative staff.

She told MiP training in the area should not just focus on technology but assist receptionists in the "complex judgments they have to make and the emotional pressure that goes along with it".

While the study found no evidence any of the contributions made by receptionists or administrative staff were putting patients at harm, Dr Anthony Avery, Professor of Primary Healthcare, Division of Primary Care at the School of Community Health Sciences, University of Nottingham Medical School, has his concerns.

"At the moment it doesn't seem sensible for people to be making decisions that have not had the correct training to do so," he told MiP.

"While I'm sure the majority of receptionists are mindful of not stepping outside of their competencies, they could be engaging in risky behaviour and causing undue harm to patients."

Swinglehurst said a lot of receptionists attach post-it notes to query prescriptions and make potential problems known to a GP.

But post-it notes are "not the most reliable form of communicating", argued Dr Avery as they can "easily" come unstuck.

"The concern for GPs is there is a very real risk that if a prescription is presented and falls between the rules, it will get signed off with a very quick glance," he said.

"Any communication made highlighting concerns must be made more explicit."

Dr Avery told MiP there is a strong culture in general practice that "doesn't necessarily recognise the value" of training of receptionist staff.

He argued it is difficult for receptionists to make demands for training as it all depends on where they are in the 'pecking order'.

"We have to work out whether we want to continue to have such wide variations of how practicing operate with regards to how they engage with collaborative repeat prescribing or set core principles that all practices should adhere to," he said.

Yet, in research submitted to the General Medical Council on the monitoring of repeat prescribing, Dr Avery found there was a general culture in GP surgeries whereby receptionists and administrative staff felt they could raise issues with GPs and not feel as if they were "treading on eggshells".

However, he did acknowledge that some GPs can be "difficult" and receptionists are forced to "tiptoe around so as not to upset them".

Swinglehurst told MiP this hierarchical structure was found in one of the practices studied. She argued the culture gave way to a greater chance of more complex repeat prescriptions, leaving receptionists "more prone to error".

Why do you think receptionists and administrative staff shy away from making their contributions to repeat prescribing more explicit to GPs?

Your comments (terms and conditions apply):

"Why do you think receptionists shy away from making their contributions to repeat prescribing more explicit to GPs? In my experience they do not. In my practice we train our prescription clerks well and their job is defined as far as it is possible to do so by protocol. The clerks have an excellent relationship with all the GPs here and the GPs truly value all that they do. The article is a useful reminder for Practices of the pivotal role the prescribing clerk plays but some of the more academic conclusions are nothing more than tautological in that dysfunctional practice is dysfunctional. I would score the research based on this summation as C minus and must do better! However I did read the BBC News report of this research and I must confess it gave a much more positive impression." - Norman Boyes, Petersfield

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