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Residential home matron drives us mad
Three GPs share their approach to a practice problem
Until recently, your practice had an excellent relationship with one of the local residential homes.
The matron was an ex-nursing sister who minimised unnecessary calls on your time by using her common-sense and judgment. Unfortunately she has retired and the new matron seems to have little of either.
The practice is getting almost daily requests for urgent visits or non-repeat prescriptions. Often these are during evening surgery and for problems which are trivial or could have waited.
Tonight you attempt to offer telephone advice about someone who is described as very lethargic. The matron replies: 'So you are refusing to visit then?'
Anxious to avoid a complaint, doubtful about the matron's ability to assess patients safely, you do indeed visit to discover the lethargic patient happily polishing off her tea in the dining room.
Dr Harry Brown
'Above all, make sure the home's patients are in no way disadvantaged'
First, remember to keep your head. Be pleasant, professional and keep any nasty thoughts about the excessive demands from the residential home to yourself. You may regret saying something in the heat of the moment about the waste of your time. Just say thanks to the matron, go home and sleep on it.
Next day discuss this situation with your partners and decide on a course of action. Assuming the partners in the practice agree, ring the matron a few days later and have a chat with her. Tell her that due to the increasing workload from the home, your practice does not have the resources to cope. Tell her that and that you are putting the home on alert that it will have to find another practice to take over your role.
Do not put a deadline on it and do not remove anyone from the list. Just put gentle pressure on the home. Equally, do not personalise the issue by blaming the new matron and try to avoid conflict and argument.
Perhaps even a breakdown of some recent incidents such as unnecessary calls and prescription problems would be useful in the discussion. This would give you an opportunity to explain your actions and elicit a response. The ball is now on their court.
If the home admits it is being too demanding and is willing to look at reducing its calls on your time, then that is one way forward. Equally, explain the ins and outs of telephone triage and discuss with the home why it thinks its demand has shot up. It could be that a regular weekly visit from a GP could solve many of the problems.
No doubt the home will get the message. If it makes no moves to find a new practice, and the same demands continue, then involve the PCT and see if it has any suggestions. However, make sure patients are neither disadvantaged nor suffer. This must be the primary aim at the end of the day.
Dr Harry Brown has been a full-time GP in Leeds since finishing vocational training in 1987 he is interested in clinical pharmacology and is also a trainer
Dr Trevor Rees
'We most cerainly need to tackle this situation before it escalates'
The change in the personnel at the top at the residential home seems to have been a disaster with regards to the management of the residents' medical needs. Either the previous matron was missing a lot of problems or the new incumbent is playing a game of 'cover my back'.
I would initially tackle the unnecessary request for a visit. I would point out that the patient's condition did not warrant me disrupting an evening surgery to visit as a matter of urgency.
I would also emphasise that the decision about visiting the patient lies with me, and the implied threat of a complaint if I hadn't visited was not only unnecessary, it was also unprofessional. I would tell the matron that I wouldn't expect her to take that sort of attitude in the future.
Then it would be back to the practice to converse with my partners to see where we go next. It seems we all are finding the departure of the previous matron a blow and we most certainly need to tackle this situation before it escalates. If any other local practices have patients at the home, it would be worth contacting them to see if they are experiencing the same problems. If they are, then it would add weight to any action we take.
If, as a partnership, we are of the opinion that the matron's competence is questionable, then the only option is to approach the owners of the home formally to express our concerns. Not only are her actions disrupting the practice, potentially they are dangerous because of the risk of crying wolf and a patient suffering because we don't take things seriously.
Dr Trevor Rees finished the VTS in 1983 he is a partner in a six-partner training practice and is undergraduate tutor at the University of Birmingham medical school
Dr Sarah Humphrey
'Making the matron feel she is supported may help to control our workload'
Initially, I would bring up the subject of the frequent visits and non-repeat prescriptions at a practice meeting. It would be interesting to get all the doctors' opinions. I would ask them how they have dealt with such requests in the past. If it turns out we have all found that the calls have been inappropriate or non-urgent, then we have to decide on an action plan.
We would need to ask why is the new matron behaving like this? Could it be that she is inexperienced and feels overwhelmed with her new post? Did she have a bad experience in the past with a patient, which means she tends to be over-cautious now? Is she simply not trained sufficiently for the job? Is she not fully aware of the practice's policy regarding visits and the ordering of non-urgent prescriptions?
After reaching a plan with my colleagues, I think it would be of value to arrange a meeting with the matron. We would need to let her know what it is about. This would have to be done sensitively. I would leave it open with a statement such as: 'I know you have just taken over the running of the residential home. The other GPs and I thought it would be good if we could meet up to discuss the services our practice offers and how we feel we can all work together for the benefit of the patients.'
At the meeting I would get more background about the matron's experience. I would give her a practice leaflet and would let her know our visiting policy. I would also suggest local pharmacists can be helpful with some of the inquiries she may have if we are not available. I would emphasise that, unless it is an emergency, the doctors would prefer not to be disturbed during surgery.
I would ask in what ways we can help, such as would having a set day each week when we visit be better? Or perhaps a certain day when she rings for routine queries would be helpful. This might help her feel more supported, at the same time giving the practice more control over workload.
Dr Sarah Humphrey is a part-time GP in north London