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Importance of


skills in practice

Like any good business a practice must satisfy its customers and good telephone skills by every practice member are vital, says

Dr Nicholas Norwell of

the MDU

Telephones are an important tool in primary care. They are used for everything from ordering repeat prescriptions to triage. Many practices have also introduced telephone consultations. It is vital that everyone in the practice who deals with patients by phone has the right level of training and confidence when using the telephone.

Telephones have many advantages, such as making the practice more accessible and convenient for patients. But they are not without their hazards ­ there is nothing more annoying, for example, than a phone that is constantly engaged or answered with the caller immediately being put on hold.

Poor communication is a common theme in patient complaints and claims notified to the MDU, so having a clear and consistent telephone policy is essential.

An MDU survey published in 2001 revealed that 6 per cent of GP complaints in one year related directly to telephone communication. The MDU offers training seminars for GPs and practice staff1 and many misunderstandings with patients can be avoided by considering a few points.

·Get off to a good start. Check the identity of the caller by taking their name and asking them to spell it if necessary. Make sure the caller knows who you are.

If the caller is telephoning on behalf of a patient, make sure you verify exactly who he or she is. It is important not to discuss confidential information with a patient's friend or relative without the patient's consent.

·Try not to interrupt the caller and regularly acknowledge what they are saying. It may be helpful to repeat back what they have said or summarise the gist of the call.

·Keep your tone neutral and appropriate and avoid over-familiarity. The use of first names may be resented even if you know the caller. Even if you are extremely busy, under pressure or tired, don't let your politeness suffer. Remember the caller may be extremely anxious or worried about their health.

·If the caller is making unreasonable demands or is being rude or discourteous, point this out but stay calm and in control of your emotions. If you also resort to anger the situation will quickly escalate.

·Allow callers time to explain a problem. If time is short or you are aware of other patients waiting to see you, find a diplomatic way of moving the conversation on.

·If you feel a patient has a genuine cause for complaint, for instance an especially long wait on hold to make an appointment, explain promptly and apologise.

·The practice should have a complaints procedure, and practice staff should familiarise themselves with it.

Whenever a complaint is made listen carefully. Before responding, make sure you know exactly what the patient's concerns are. Patients who are anxious and uncertain can become angry. You can halt this process by offering reassurance and an explanation.

·Being put on hold for an indeterminable length of time can increase frustration and anxiety. There are several ways in which being put on hold can be made more bearable.

Keeping the caller updated on how long they may have to wait and offering a call back if it looks like they may have to wait a while can help, as can finding out why a person is calling and referring to practice guidance on when to put a patient straight through to a GP.

·Ensure that when a patient is on hold they can't overhear discussions about others.

Telephone consultations

Telephone consultations with patients will only be suitable for certain situations ­ for example, management of a long-term condition ­ and patients need to understand their limitations. In particular, a telephone consultation offers no scope for examination.

Make a note of what was said and agreed during a telephone consultation and that the patient gave their consent.

Try to ensure phone consultations are kept confidential ­ you might suggest the patient avoids using a mobile phone, for example. The GMC provides specific guidance for doctors prescribing over the telephone in its prescribing FAQs2.

Practice policy

The practice may wish to consider introducing a policy or protocol to minimise the risks associated with telephone use. It could include:

· Confidentiality issues

· When, and when not, to give results over the telephone

· Location of phones to balance privacy and ease of use

· Staffing levels

· When to interrupt the doctor and dealing with

urgent calls

· How to deal with visit requests and messages

· Standard phrases for answering the telephone

· Ensuring calls are documented as appropriate

· Regular review of telephone training requirements

· The use of nurse triage/telephone surgeries

· Emergency contact arrangements

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