Nishma Manek: The real gatekeepers of general practice

New to a GP practice, I was recently asked to spend an afternoon with our practice receptionists. I wasn’t sure what to expect.  

But that day gave me a new understanding of what they really do—and a realisation that it’s one of the hardest jobs in primary care. I must admit I hadn’t given it much thought before.

Fielding the highly-charged emotions of those who inevitably feel fobbed off in a system under pressure, day in day out, can’t be easy. Putting myself in their shoes felt like being the bouncer of a horribly overcrowded nightclub.

Watching them also made me realise something: as GPs, we often consider ourselves to be “the frontline.” But we’re not really—the receptionists are.

They might be the first people to hear the pain that illness stirs, the first to see the strain that it uncovers, and the first to be casually offered some specimen of bodily fluid as a greeting. Or even, as they told me, an envelope stuffed full of faeces once from a patient who didn’t quite follow the instructions.

The rewards felt few and far between. Like GPs, our receptionists are exposed to the grit, the love, and the turmoil that exists in our community, witnessing the clouds of emotion that gather in the petri-dish of a waiting room. But they can’t step into the thick of it, or do much to waft them away. Perhaps that’s not what they go into the job for—but I wonder if that makes it harder. Because what’s left felt like a pretty thankless task at times.

Working in the NHS, we all inhabit an uncomfortable void that’s easy to forget. But that afternoon with our receptionists showed me that there is a silent expectation of professionalism in the consulting room that isn’t always evident at the door. And yet they offered their patience and kindness unreservedly, without much exposure to it themselves.

Like all of us, they may not always get it right. But they usually do. I’ve seen them placate a waiting room of fuming patients. And sometimes, without decades of medical training, act on instincts that change a patient’s entire trajectory.

Like a relative of mine, who suddenly discovered a new lump in his neck one morning. He was due to fly out that evening for his wedding, and en-route to the airport turned up unannounced at his GP surgery. He hadn’t been there since he was 14, and knew he was pushing his luck as he walked into the commotion. But something about the fear in his eyes made the receptionist create an extra appointment for him at the end of a busy day.

My family will never forget her—because she started a cascade of events that led to him being diagnosed with thyroid cancer. Our gratitude for the skilful GP and specialists involved in his care will remain with us forever. It’s something we talk about often, just as our own patients do. But in truth, it was the receptionist that saved him from a delay in a life-altering diagnosis.

On the other side, as a doctor, I’ve been indebted to our receptionists for many similar stories. They know our patients just as well as we do, and sometimes their astute observations make a bigger contribution to the patient’s care than anything the GP might have done. How often do we trace such stories back to the person who opened the book in the first place?

As GPs, we mourn the lack of time that we have for our patients thanks to rising demands, increasing complexity, and mounting reels of red tape. But after spending the day with our receptionists, I truly began to see that they experience all of that too, while having to bear the heat of emotion it draws out of our patients.

As always, the New Year has been accompanied by the thunder of patients descending on GP surgeries across the country. We will continue to speak out about the challenges, attract some sympathy and gratitude for our plights, and quietly admit that most weeks are peppered with things that keep us in the job.

But as we plough on through the pressure in 2018, let’s spare a moment to thank the people holding the whole thing together—our GP receptionists.

Because, in truth, they’re the real gatekeepers of general practice.

Patient consent obtained.

Nishma Manek is a GP trainee in Cambridge. She was on the FMLM National Medical Director’s Clinical Fellowship Scheme 2016/17 at NHS England. She tweets at @nishmanek.