A conversation with two receptionists.
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Doctors and receptionists in a group practice completed a questionnaire about the image of the practice and reactions to recurrent stressful situations. The results were shared among the participants in a way that preserved anonymity. A year later a further questionnaire was completed which showed that respondents perceived that beneficial changes had taken place. The changes were seen as being mainly due to an increase in mutual understanding between the doctors and their receptionists.
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The power and influence of receptionists in general practice has been the subject of little research. We argue that the structural position of receptionists and the nature of primary medical care give receptionists a potential discretionary role in determining access to the general practitioner. A major criterion for access is the imputed urgency of the patient's condition, which frequently involves the receptionist making a medical assessment based on only a brief verbal exchange. The paper draws on interviews with a sample of over 1000 adults about their experiences of the reception process in general practice. The receptionist's role in the following areas is examined; delay in obtaining appointments, asking the reason for surgery consultations and home visits, reducing the number of home visits by suggesting patients attend the surgery, putting patients through to speak to the doctor on the telephone and giving health advice. Patients who have experienced receptionists as an active intermediary are more likely to report interaction difficulties with receptionists. The survey data lend support to two major findings: (1) that as practices become larger and more complex receptionists operate with more rigid rules, leading to greater hostility expressed by patients towards reception staff; and (2) parents with dependent children and young adults express more antagonism, because they are more likely to experience the receptionist as a 'gatekeeper' with whom they need to negotiate to see a doctor for acute care for themselves or for their children.
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A postal questionnaire was circulated to 90 receptionists working in general practices in a single health unit and produced an 80 per cent usable return rate. The questions asked included items relating to their work and training. Over half the respondents gave advice to patients on medicine matters for which they were not trained. Deciding upon the urgency of home and surgery appointments were the two tasks which were most disliked by the receptionists. Receptionists thought patients would find them helpful and few receptionists found patients aggressive. Many receptionists agreed that they should have training before they start work and even more agreed that they needed in-service training.
Receptionists are important for the efficient functioning of a practice. They are the eyes and ears of the practice and become a most valuable resource. There should be both formal and informal mechanisms for them to feed back information to the practice decision makers if better practice performance is to be achieved.
Seventy receptionists from 20 general practices in Newcastle upon Tyne were interviewed using a questionnaire to determine their demographic and social characteristics, tasks performed and training experience. The majority of receptionists were mature married women working part-time; only 13% had received any formal training. Most receptionists had no career structure and only 9% had ever been given a written job description. Thirty-one per cent of receptionists did not feel appreciated by their general practitioners and more (49%) felt unappreciated by the general public. However, they believed their main function was to help patients. From the description of their work receptionists are clearly integral and essential members of the primary health care team.To achieve the development of primary care services it is likely that practices will need to employ more ancillary staff, and these staff will require more pre-service and in-service training.
The influence of receptionists on continuity of care in four group practices was examined. Twenty two receptionists were observed making 543 appointments and afterwards were interviewed about their personal priority for continuity of care. One of the practices ran a personal list system. It was found that the personal list practice attracted more requests for a specific doctor and time which were then more difficult to satisfy. Most receptionists thought it was important that patients should see the same doctor but their influence seemed to be small compared with that of the doctor as expressed in practice policies. Marked variation in demand for individual doctors was seen in two of the practices without a personal list system.
Two training courses for receptionists in general practice were evaluated by questioning participants and doctors before and after the course took place. The results indicated that the training had been enjoyed and that participants had acquired a good deal of knowledge which they would be able to use effectively in their jobs. The courses and the evaluation exercise are described.