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At the heart of general practice since 1960

Partners suffer real cuts in pay

Three GPs share their approach to a practice problem

Case history

At long last your head receptionist is leaving.

You have put up with her for many years during which time she has been rude to the staff, patients and doctors alike. She has failed to embrace changes in general practice and can be work-shy. You are delighted she is leaving (she

is taking a similar job in a new practice in the town). Just before she leaves, you get a phone

call from the senior partner in her new workplace asking for a reference. What do you tell him?

Dr Harry Brown

'You could politely decline the request and leave it there'

It is not easy to dismiss staff these days, so when someone who is performing badly and who is not popular quits, then it is a relief all round. But it would be interesting to learn from your departing receptionist why she has resigned.

She is presumably working out her notice, so whatever you tell her new employer it will not affect her status with you. When asked for a reference there is one simple golden rule ­ always tell the truth.

When you receive the call, make sure you are in an area where it is confidential to speak. If not, take the doctor's number and ring him back at a mutually convenient time, making sure you both can talk openly without being overheard.

You should have known in advance if you were going to be asked to provide a reference and so you may have expected this inquiry and have a response already formulated. But if you are caught unawares and did not expect to provide a reference, then you may want to speak to the receptionist first. This will also buy you time to seek advice from colleagues and, if necessary, the BMA. You may also wish to check what your legal obligations are.

If you decide to provide a reference over the phone, then you may want to stress to the doctor that what you are going to say is in confidence and must not be repeated. Or you can say you will provide him with a written reference, a better choice since comments made on the phone can be misrepresented.

Explain what your thoughts are about the receptionist as objectively as you can. Tell the doctor that you are making these statements without any bitterness. You are trying to be as factual and as honest as you can, and offer some good points as well as the bad to make the reference balanced.

Alternatively, you could politely decline to provide a reference at all and just leave it there!

Dr Harry Brown has been a full-time NHS GP in Leeds since finishing vocational training in 1987 ­ he is interested in clinical pharmacology and health information and is also a trainer

Dr Rachel Pryke

'If politicians can put

a positive spin on dire deeds, so can I!'

Clearly my first aim throughout is to ensure the receptionist leaves. However, my own reputation and that of the practice means that I cannot lie outright even if I am somewhat economical with the truth.

If I had some warning that the phone call was pending then I would firstly ensure that the receptionist had given written notice. In this case the pressure would be off.

Next I'd rationalise why she was so bad. Was it because of her personality, personal problems or because she was simply incompetent? If the latter, then she may have had a verbal or written warning which would be hard to conceal during the phone call.

If I were the new employer I would be pretty upset to be dealt someone who was frankly dangerous. So I would not dump this woman on an unsuspecting colleague. I'd just concentrate on trying to get shot of her.

As we have an appraisal system for all staff,

I hope any personal problems leading to poor performance would have been recognised, even

if not resolved. I would cautiously share this information if relevant to her ability to work.

This leaves the most likely explanation for poor performance ­ personality. Here, her failings could be couched with reference to our practice quirks and foibles which would not be present in a new post.

Perhaps her inability to cope with a computer issue could be phrased 'I'm sure she will cope with the challenges of a different computer system', leaving the optional ending 'even though she failed to cope with ours' unspoken.

Meanwhile there must be something positive to say to keep the conversation balanced. I would certainly try to do so.

It is always possible that she harboured a longstanding grudge over a minor and long-forgotten incident that caused her goodwill to evaporate. In this case, a new workplace could be the making of her. I could stress the latter.

If politicians can put a positive spin on dire deeds, then so can I!

Rachel Pryke completed her VTS in 1993 ­

she is now a part-time principal in

Redditch, Worcestershire

Dr Trevor Rees

'You could snatch defeat from the jaws of victory with a wrong move'

It seems likely that if you say the wrong thing here you might snatch defeat from the jaws of victory. One minute you're basking in the delight of the imminent departure of a difficult member of staff; the next you risk having her dumped back into your lap.

However, as she has already handed in her notice then it must be assumed that she has been offered and has accepted the post of head receptionist at the new practice.

The further assumption must be that the partners and the practice manager at the new practice have interviewed her at least once, if not twice, and would almost certainly have taken up written references, so they should be in a position to have made a judgment about her suitability for the job. They should also have been able to make a decision about her abilities with regards to her interpersonal skills.

The post she's taking up means that she is going to be dealing with existing staff, some of whom might have been in competition with her for the job, and so her ability to fit into an existing team should have been at the top of the list of items to discuss at interview.

Asking for a verbal reference at this late stage makes you wonder if they are getting 'cold feet' and are maybe looking for a way out.

So, to be fair to both the receptionist and to her prospective employer, I'd suggest that I wasn't the best person to ask for a reference as we had never seen 'eye-to-eye' but that was due to our individual personalities. If he wanted an objective point of view, then he should contact our practice manager who is charged with dealing with references for staff.

Dr Trevor Rees finished his VTS in 1983 ­

he is a partner in a six-partner training practice and is also an undergraduate

tutor at the University of Birmingham Medical School

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