Hello and welcome to BJJP Interviews.

I'm Nada Khan and I'm one of the Associate Editors of the bjgp.

Thanks for listening to this podcast today.

In today's episode, we're speaking to Dr. Steph Stockwell, a senior analyst based at RAND Europe.

We're here to discuss the paper she's published here in the BJGP titled Evolution of the General Practice Receptionist Role and Online Services A Qualitative Study.

So, hi, Steph, it's great to meet and talk about this work and one of the reasons I really wanted to talk about this is that I think it's timely work, given that we know there's an increasing emphasis just in general practice on triage and also the multidisciplinary team.

You talk in the introduction of this paper just about the role of receptionists, which has been evolving and changing in recent years.

So just talk us through that a bit.

Yeah.

So this work came about because we were doing some work for the wider de facto study, which was a.

An observational, mixed methods study that involved delete reviews, some surveys, ethnographic case studies and some interviews.

And it was whilst I was doing some of the ethnographic case study work that we spent a lot of time around reception staff because they were the ones who were doing most of the digital facilitation, which is the phenomena that we were.

Were looking at.

It was whilst doing these observations that the idea for this, this paper came to me, as, you know, often the.

The first point of call for, for patients making contact with general practice and they're really crucial for helping to manage that demand and facilitating patient access to care.

But during these observations, I noticed how the perception of what a receptionist did, particularly among patients and the public, was a little bit outdated and the array of technologies and platforms that they were having to manage and, and help patients use as well, was really sort of the stereotype of answering telephone calls.

So, yeah, the rationale for this work sort of came about on the back of that and it made me want to look back at some of the work that we did for the De facto study and to see what sort of impact the online services had on the role of GP receptionists.

Yeah.

So you wanted to look, as you mentioned, just at the impact of online services on sort of the evolving role of receptionists.

And as you mentioned, you took quite an interesting and varied approach here.

So you did the ethnographic work that you mentioned, but you also did interviews with patients and staff and practices and the ethnographic work was really interesting.

So you were actually sitting in eight different practices and observing what receptionists were doing.

But I want to really focus on what you found here and I think the first thing to talk about is that the receptionists had a really different and varied role between those different practices and even within the practice itself.

So talk us through that.

Yeah.

So speaking to a couple of receptionists who'd been in the role sort of a longer time, they were reflecting in their interviews about how the role itself, from their point of view, having been in it for such a long period of time, has changed.

Previously they would do sort of fewer and more repetitive type jobs, but now it's just so much more varied.

That's just one person within their role over a period of time.

But then we were noticing that receptionists within one practice and between the different practices, we went into what was conceptualised as a receptionist.

What the receptionist role looks like was very different and it was impacted by whether the practices had specific administrators, so people like reception clerks or IT officers, the number of different receptionists that were available and working on.

On shift, and also the confidence and competence of each specific receptionist themselves.

Yeah, it's interesting you talk about experience and I think that probably a lot of people who work in general practice might reflect on that.

But talk us through what you found in terms of the differing experience that receptionists had, just in terms of how comfortable they felt with the varied role or changing role.

Really.

Yeah.

So some staff who were sort of newer to the role, it's all.

They're sort of known.

We had some cases of.

Because there was sort of a lack of training and support around some of these newer bits of the role in a formal sense.

There was a lot of support happening from receptionist to receptionists and sort of learning on the job types of things.

But it would mean that for newer members of staff who are learning on the job, they might be shown something by one person and then shown how to do the same task, but in a slightly different way by another person.

And then for that new member of staff, that could be quite disorientating, quite nerve wracking, because then they didn't really know which was the right way to do it and which way they should be doing it.

So, yeah, because of that lack of more formalized training there for newer members of staff, that was.

That was quite tricky.

Yeah, fair enough.

So maybe a nod there to the need for more formal training rather than the ad hoc kind of training that people get on the job, potentially.

Yeah, fair enough.

And I think that one thing that a lot of people working in general practice and probably patients really can empathize with is how people get through to practices, you know, by phone or by E consults.

It's quite complicated, actually, at the moment.

And you talk about this in terms of demand management in this work.

How did this impact on the receptionists?

Yeah, so it's, as you say, it's not just them seeing people as they walk in face to face and letters and telephones, which was, you know, how things happen traditionally, but all of these different online ways to access practice, which is great for patients, but, you know, can be a bit of a nightmare to manage.

So you've got things like email, you've got online triage tools, you've got practice websites, you've got different apps.

And then, you know, during the pandemic, the NHS app came in, so sometimes practices were running, you know, a more local app with the NHS app with the practice website and all of these things.

So there were lots of modalities for patients to contact the practice via, which in.

In some ways can be a good thing.

You know, it's.

It's just the reception staff were saying, it's.

It's not actually reducing demand, it's just the same level split across multiple different things, which adds complexity to what they're having to manage through those different channels.

And did they have clear pathways on how to manage that?

How did they deal with that?

Yeah, so, I mean, every practice was kind of worked it through differently.

So they might have some members of staff who would monitor emails, they might have some members of staff who would look at econsults or something like that.

So they split it up that way.

And other people might say they split it up by the individual person was responsible for the different way in.

Others split it up by a bit more of a rota to try and make it a bit more varied for staff so they didn't get bored doing the same thing every day.

So they might have a morning being responsible for whatever E consults were coming in, and then the afternoon they might be doing something else and someone else would take over that role.

So, yeah, each practice was sort of.

Different, increasingly, and sometimes referring to receptionists more as care navigators.

How did reception staff that you talked to or observed look at this?

And what was their perception about that?

Yeah, so the navigation of patients has always been sort of a key part of the receptionist role.

But, you know, with the increasing skill mix within general practice, where they route people to is is changing and become more Complex.

But the addition of the online services adds another level of complexity because.

So, for instance, when patients were phoning up and there were no appointments left, receptionists were sort of navigating patients through the find routes, because that way they could offer people an appointment because there had been slots saved for econsult appointments or something like that.

So there was just an extra level of something that they could help patients navigate to try and get access to an appointment.

And receptionist themselves said, you know what, that is actually quite helpful, implicating some patients.

You've got someone on the phone who is looking for some help, there are no appointments left.

And so actually being able to say, well, if you go through this route, actually I can.

Can offer you something.

And that made things a little bit less stressful for the receptionists.

I think that really speaks to the perception of receptionists being seen in the public as these sort of dragons at the front door of general practice, where actually we all know that they're really just trying to help the patients rather than block patient access.

And it's a shame that that perception is still really persisting because they are kind of that front door to overstretched services.

Really.

Yeah, no, absolutely.

And there were.

There were lots of cases that we saw where receptionists were really trying to help patients through that digital facilitation, you know, helping them to use the online services to try and help them get the.

The care that they.

That they needed.

You were embedded in these practices.

Did you get a sense from sitting and observing what was going on, what worked and what didn't work in terms of the reception role?

Yeah, I think when receptionists were tasked with something quite specific for a short period of time, that they could then dedicate their focus and their attention to that thing.

And they did it really, really well.

Other instances where maybe there weren't as many receptionists to kind of balance that demand coming in, it felt a little bit more.

From my perspective, it may not have been the experience of.

But from my perspective, it looked a little bit more chaotic because there was a lot of task switching and trying to balance things.

Whereas where you had, this receptionist is going to be on telephone calls, this receptionist is going to be on E consults, this one is going to be doing X, Y, Z.

That seemed to really use the skills of the people and keep them focused on a task, which meant that things were, I don't know, a little bit more calm, potentially from the outside looking in, at least.

Yeah.

And I think we all know that things can sometimes get a little Bit chaotic in general practice or anything to sort of ease that sounds like a good shout.

Wonder if there's any other key findings that you want to pull out from the paper at all.

One thing that was really interesting was that a lot of the online services are sort of badged as a great way to kind of reduce workload and, you know, help staff and help patients and all that kind of thing.

And in some ways they do because, you know, if patients can self serve via online routes, that can kind of sometimes help reduce some of the workload for reception staff because of the links that are available to people they can book into appointment slots and things.

But that requires the patients to actually be able to do it themselves.

And you know, when patients aren't able to do that themselves, it's often the receptionist that they call upon to help them.

So that doesn't actually reduce any, anything for the receptionist themselves.

There are also cases where patients were using the online systems incorrectly.

So either because they didn't really have a, an understanding of how to use them properly or how they were intended to be used, or actually where patients were trying to work around the system to try and get what they really wanted.

And that involved the reception staff having to kind of reconcile things behind the scenes.

For instance, people might be booking into inappropriate appointment slots because they don't understand that actually you don't need a 20 minute appointment with this particular practitioner for a blood test or something.

And so that would require the receptionist to go in and rebook it and move things around.

Or they might fill in a form, an inquiry form online, but it's the wrong form because those forms go to this particular team and those forms go to that particular team, but the patient doesn't really know that.

They just see, you know, it's on the website, so it just goes to the, the practice.

And.

But if they, if those forms do go to the different teams, then it's normally the receptionist or the administration team, depending on which practice, that has to do all of that work behind the scenes to then redirect it to the right people, the right teams.

So that was, that was quite an interesting thing that I hadn't really thought about in terms of that sort of hidden work that the receptionists are doing behind the scenes.

It sort of sounds like, you know, that kind of calm duck above the water and then the sort of legs are really going underneath.

Just a lot of work going on really to help manage that.

And I think it's an important point to make, especially with an increasing emphasis on Online services in policy, really in terms of how people want general practice to work?

Yeah, absolutely.

I wonder, just given the findings from this work, what do you think it's important for practices to know here to help support their reception staff during this period of flux and change?

Any tips for practices?

Yeah, I mean, for me this work really is important for the consideration.

When you're thinking about recruitment and retention of GP receptionists, we can see that the role has definitely evolved and become more complex since the introduction of these online services services and that should really be reflected in job descriptions and skills requirements.

Maybe having that digital element in there, the digital competencies in there for those who are newly recruited or already in post, maybe some more formal training or support for those reception staff might be helpful.

As I said earlier, even if it's just here's how we're going to do it in this practice to standardise the messaging and practices within a single surgery, that could be potentially helpful.

But I also think it's not just on the GP practice to make changes.

I think a lot of these online systems are developed by tech companies and if for instance, the systems were really simple and really easy for patients to use and to use them correctly as they're intended, then that would actually reduce the workload for the receptionist trying to rectify things behind the scenes.

So it's also on the developers of these technologies to co design those from the patient facing side of things so that patients can understand and easily use them and to make them very intuitive.

Then also the behind the scenes version that you see, that the receptionist staff see and other members of staff see it in the practice, they're also co designed so that they are useful to those people in those roles and they can be used in a way that, you know, isn't going to overburden them, it isn't going to create more workload and actually makes things easier for them.

Brilliant.

Yeah, really helpful advice, I think, for practices and as you say, also for people designing these different systems too.

You know, we do it in research to co design systems with patients and with the people who are going to be using it.

Wise words, great.

But yeah, I think that's probably a great place to wrap up.

But I just want to say thanks very much for speaking about it.

Thank you so much and thank you.

All very much for your time here and for listening to this BJGP podcast.

Thank you.

Steph's original research article can be found on bjgp.org and the show notes and podcast audio can be found@bjgplife.com and it would be great if you could join us next year at the BJGP Research Conference.

The website is up and running@bjgp.org conference and we're holding it in Bristol on the 20th of March.

Looking forward to meeting you there, but thanks again today for listening and bye.