As receptionists win more power to decide who sees a doctor… how to get past the despot on your GP’s front desk

• Receptionists have been instructed to get tough when arranging appointments
• Some 10,600 UK practices have signed up to the 2016 Care Navigation scheme
• A quarter of all patients are being ‘triaged’ by a receptionist over the phone
• The receptionist can divert a patient to a practice nurse or a pharmacist 

Dragons, battleaxes, despots – they are all harsh but, in some cases, fair words to describe the modern medical receptionist. Today, more than ever, the front-of-house staff at your local GP surgery or clinic represent the front line in deciding how we are treated for everything from everyday ailments to serious problems and even emergencies.

These staff, who are not medics, now get four hours of training that qualifies them to decide whether or not you see a doctor, or need another kind of help, under the 2016 Care Navigation scheme.

And, given the daily battle for appointments, they’ve been instructed to get tough.

GP receptionists are receiving four hours of training to decide whether or not a patient should be allowed to see the doctor or diverted to a practice nurse or the local pharmacist

Some 10,600 practices across the have signed up to the 2016 Care Navigation scheme

Launched to ease pressure on GPs, the scheme currently has 10,600 UK practices signed up. Receptionists are monitored by Health Education England (HEE), and the health and social care service regulator, the Care Quality Commission, checks standards are upheld and that receptionists have had adequate training.

One in four patients are now being ‘triaged’ by a receptionist, so they do not see a doctor but instead get an appointment with a practice nurse, or are told to visit their pharmacist or even dentist instead.

But the changes have not been entirely welcomed. Rachel Power, chief executive of the Patients’ Association, says many people feel their traditional route to a GP ‘is seemingly gone’.

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And a recent survey from Cancer Research UK found that 40 per cent of respondents disliked talking about medical matters with receptionists, with the charity warning that many with serious illnesses could be put off visiting their GP.

Doctors have reservations too. ‘It’s better to avoid duplication by matching a patient with the right person, like a nurse or a pharmacist,’ says Fiona Cornish, a Cambridge-based GP. ‘But it shouldn’t be an excuse to fob off someone who needs to be seen by a doctor.’

Yet British Medical Association research shows the scheme has already freed up time that doctors can spend with patients – about 80 million saved appointments each year. So how should patients navigate their way around a receptionist for the best possible outcome? 

Be specific about your health problem to ensure it gets picked up immediately. ‘Passing blood in your stools is a red flag that puts you top of the priority list, for instance,’ says Kirsteen Atkinson, a GP receptionist for more than a decade.

However, patients should not feel pressured to divulge details, says Myra Upton, president of the Association of Medical Secretaries, Practice Managers, Administrators and Receptionists (AMSPAR). And training is supposed to make receptionists aware of many patients’ reluctance to talk about problems, and they follow guidelines to avoid causing embarrassment.

At Dr Cornish’s practice, receptionists follow an approved text to give patients an opt-out. She says: ‘Typically, this would be, “So that we can direct you to the right person, can you give me some ideas of your symptoms or is it personal?” ’

Myra Upton adds: ‘Receptionists will get the gist if you say it’s an intimate issue, and there’s always the option to write it down and pass over a note.’ 

GPs should deal with chronic conditions with an unclear cause such as severe headaches. Nurses, on the other hand, usually handle anything needing antibiotics. ‘If you tell the receptionist you have a sore throat, a minor earache or a possible urinary tract infection, you’ll usually be told that a nurse will deal with you,’ says Dr Cornish.

You could be told to see a pharmacist if you have typical symptoms of a cold and want to get a prescription for flu medication or paracetamol. These are no longer available on the NHS.

‘If you still want to see a doctor, that’s your right but you may have to wait for an appointment,’ says Myra Upton.

If symptoms worsen or change in the interim, it’s best to call again to explain. Alternatively, you can call the 24-hour 111 NHS helpline. 

Under the 2009 NHS Constitution, GP practices must try to fulfil a patient’s request to see a specific doctor. But in reality they can refuse if there are reasonable grounds. Surgeries also have a duty of care to provide an appropriate service, according to Dr Cornish.

That means accepting the receptionist’s decision in most cases.

Dr Cornish points out that receptionists should always refer to a GP if unsure. Anyone abusing staff may get a written warning or be removed from the surgery list. But, according to the NHS Constitution, NHS staff must also treat you with dignity and respect your rights. 

Many GP surgeries now provide online services and apps. Patient 2Practice and Patient Access are among those schemes the NHS offers – check your surgery website. They enable patients to book appointments, order prescriptions, view medical records and ask a doctor health questions. Most are available 24 hours a day, seven days a week, and are password-protected so personal details are safe. 

A GP receptionist will tell you to call 999 in a crisis. However, doctors will see non-life-threatening ‘urgent’ appointments, either by allocating a specific number of slots or via a walk-in clinic.

GPs will also pay a home visit to people who insist it is an emergency but cannot leave their property. But beware exaggerating symptoms as this could damage your relationship with your doctor.

Receptionists assess if you need an appointment then put you in contact with a nurse or doctor or call you an ambulance immediately.

If you feel the matter cannot wait, but it’s not an emergency, going private is another option via an online service. 

Before you call the GP, have background details ready such as when your symptoms first appeared.

Be proactive in contacting your surgery if you have a medication review coming up, or a screening such as a smear test.

Get written consent from a partner to deal with prescriptions, appointments and routine medical matters. ‘Receptionists will not be able to give you your husband’s blood results, for example, without signed consent,’ says Myra Upton.

Receptionists can organise repeat prescriptions to be verified by the doctor, but not usually over the phone. Check if you can download apps such as dimec.me which allow you to order repeat prescriptions. They can also give results over the phone if you verify your identity. 

Surgeries are often busiest when the phone lines first open in the morning. ‘Phones buzz continuously as patients are often queuing for on-the-day emergency appointments,’ says Kirsteen Atkinson. Her advice is to leave inquiries until later in the day if possible. 

Receptionists make most of the 250 million patient appointments with GPs each year, so it pays to build good relationships with them. ‘We are a much-maligned group of hard-working people,’ says Atkinson. ‘We want to help but we can’t always give the patient what they want.’

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