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At the heart of general practice since 1960

When barrack-room lawyer joins patient participation group

This week

a 'typical' practice

problem is looked at

from different

perspectives by

two GPs

ur practice has a patient participation group that meets monthly with a partner present. It raises money to buy equipment that benefits patients.

Over the past few years the group has made several valuable suggestions. It is run by volunteer patients. Recently it has been joined by a woman who seems determined to find fault with the practice, and is keen to extend both our opening hours and what she describes as our 'accountability'. She loves the sound of her own voice and is a real barrack-room lawyer. She claims to have canvassed many patients' opinions, and is talking about approaching the PCT if the practice will not 'co-operate'.

GP's advice

Try to get this awkward patient on your side

Irritating patients are a fact of life, and it would seem that after many good years, your patient group has finally struck unlucky with an awkward personality. This woman has her own agenda and the missionary zeal to pursue it. Her survey is a wish-list. She is asking other patients if they want evening opening and is getting the answer you would expect. In an ideal world nothing would ever shut.

Make it clear that you encourage lively debate but it is ultimately important to distinguish between what is practical and what is not. Money-raising schemes are to be encouraged as they improve services to patients where NHS funding is lacking.

When it comes to extended opening, point out that current NHS financial and staffing resources limit services. Medical manpower is a very precious commodity and must be concentrated during working hours. The new contract, if accepted, will make an even clearer demarcation between in-hours and out-of-hours work. There are out-of-hours centres and NHS Direct for patients if necessary.

Accountability is already fully covered by your patient charter, in-house complaint system and your contract with the PCO.

It would be tempting to oust this woman but smarter to try to get her on your side. Imagine her fundraising capabilities! She may even come up with some good ideas. So fight your irritation, challenge her calmly, and compliment her where appropriate.

lImagine this woman's fundraising capabilities! Resist temptation to oust her

GP's advice

Don't give in to this troublemaking patient

Unfortunately, voluntary organisations such as this, where untrained individuals can wield influence over professionals, tend to attract people who see themselves as reformers.

You cannot make fundamental changes to your practice because of the demands of one vociferous patient who claims to have the backing of others.

If the changes this woman suggests are unreasonable, either because they would increase your workload unacceptably or because they

would compromise patient confidentiality or the running of the practice, tell her so without further ado.

If they are feasible, assure her you are listening seriously, invite her to form a sub-committee and submit detailed proposals in writing, and ask her for the names of the other patients who support her so that you can approach them yourselves to find out what their views really are. You may well discover that they are embarrassed by this woman's activities but too intimidated by her to put up opposition.

The bottom line is that your practice is not obliged to bow to the wishes of the patient group. Provided you are observing your contracted hours of availability and are meeting the minimum required standards of clinical governance, and most GPs comfortably achieve both of these, this woman is likely to receive nothing from the PCT apart from a reputation for being a troublemaker.

lYou cannot make fundamental changes to your practice because of one woman

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