As a practice manager I feel very lucky to have seen first-hand how amazing it was to work in a GP practice during the pandemic; there wasn’t a better place to work. We rarely get to see our medical professionals in action as it’s usually behind the consultation door. But during the pandemic they led us as a team and the nation through one of the most difficult times we have ever known.

We got to see our GPs and nurses shine in one of our darkest times, backed up by our incredible administrative team. Each section of the practice pulled together tightly knowing we depended on each other like never before. Every single GP practice was rowing in the same direction, offering a sense of camaraderie to each other as we went along, against a tide of murky waters that we had never navigated before.

Setting up a support network

Having the support and advice of other practice managers around the country was vital to continue to run our practices. What started as a WhatsApp group of practice managers from all around the country developed into our own website, practicemanagement.ie, set up pre-COVID-19. The function of the website is simple, with free access to help practices in their daily functioning. The support from our manager group was and still is incredible: we helped each other source PPE, vaccines, phone systems, IT. It’s a never-ending circle of support from managers all around the country offering up as much as they can to help each other out.

Our staff made my job as practice manager easy; they turned up for work every single day without any hesitation. Like everyone else they too felt the fear of what COVID-19 could do but they still turned up each day. The staff took to all the new policies and procedures seamlessly and, while our reception team guided our patients over the phone, our medical team were also busy dealing with our new ‘virtual’ waiting area. There may have been no patients physically in the waiting area but there were triple our usual numbers in our new virtual waiting area. Patients were delighted we heard, and we kept on going.

Looking back, I can now say it was a privilege to have managed the practice through this uncharted time. At the time I wouldn’t have called it a privilege as there was so much uncertainty: I questioned everything, glad to have the support of fellow practice managers around the country and I was grateful I was not alone in the uphill battle we faced every single day to get our practice to where it needed to be in the new changing world of technology, or to make sure the stock of PPE was delivered.

During the height of the pandemic our patients praised the practice for our work, all healthcare staff were hailed as heroes. We participated in the clapping for our medical and hospital staff, all while feeling we had just a tiny role to play in it all.

We felt pride working in our practice, and as admin staff we felt we had a huge role to play, which drove us to do better and do more. Receptionists worked so hard to take every single call, trying hard not to miss one and to get every single patient’s COVID-19 concerns dealt with at speed. Then we ran the COVID-19 vaccine clinics that were a great success and patients praised our every effort. We felt all the hard work that had gone into the clinics were worth the happy faces on the patients after they got that vaccine cert.

So what went wrong? How did everything seem to change overnight!?

The mood changes

Suddenly the practice was busier than ever before: all the appointments were being snapped up as soon as the phone lines opened. Patients got angry with us. We didn’t have enough phone lines to answer all the calls, we drafted in more admin staff for the phone lines but that just didn’t seem to help the issue. Patients were annoyed and defensive with us. We hired more GP help and hired more administrative help. The anger and irritation just seemed to build and build. Patients were permanently angry that we didn’t have immediate availability.

It’s hard to see where this has all come from. Some of it seems like almost a craving for COVID-19 to be gone and things to go back to the way they were, and it feels like we are in the firing line constantly. People seem unable to cope with any setbacks. And some of the new ways of working that seemed like a good idea at the time might be biting us back now – like the availability to speak on the phone to a GP on the first day of an illness, compared with waiting three or four days before deciding to endure a morning waiting in an emergency clinic. The reality is that the workload has escalated hugely, yet we still have the same number of staff to deal with it.

Most of the difficulty is all based around availability – patients do not want to wait, be it for an appointment, a report, forms to be filled or prescriptions. The issue is the timeframe.

The tensions are in the “now” availability. However, we only have a certain amount of availability between booked slots and on-the-day emergency slots. When they fill up there is nowhere else for the staff to fit in extras. There is already a list of extras such as the patient that says it’s chest pain, the patient that is undergoing cancer treatment and cannot wait. All those daily extras are already piled up along with patient requests for medical certs, social welfare certification, hospital referrals, prescriptions, forms…the list is a daily list, not a one-off list.

Fighting to keep up morale

It feels like a whole new battle again, only this time the battle is to help the staff deal with the onslaught of patients’ frustrations. A battle to keep morale up and a battle to keep staff in the jobs, where only a year ago they were being praised for their efforts for turning up to work. It’s a battle to provide more in a time where we have what seems like less. Receptionists are not the only ones to feel this, the sense of helplessness trickles right through the practice. I have had GPs reduced to tears after a difficult encounter on the phone with an angry patient. Everyone is feeling that our systems are failing as we cannot keep up with the demand.

We have changed our appointments system at each stage in the pandemic to keep up with the pressure, so we are flexible and comfortable changing the whole system to meet demand. But this new wave is like none ever seen before.

Patients are incredibly irritated and the hostility some of our reception staff face on a daily basis has tripled, compared to pre-pandemic. Where verbal abuse previously was a ‘one-off’ it is now a daily occurrence. So frequently does it happen now that it’s not even being reported, as receptionists say to me “it wasn’t too bad” or “I forgot” – they are becoming immune to it.

We have tried to put in some measures to protect our staff such as updated voice messages so the patient can be informed before they go through to our staff of availability, in the hope that this eases the sense of tension or defensiveness that the patients seem to carry before they even speak to the reception team. We know patients feel irritated at delays and long times on hold music and then to be told there is no availability – we are aware of what the issue is but we just can’t seem to ‘fix’ it. It feels like we could open our practice 24 hours a day and still it wouldn’t be enough.

It has been very hard for all of us to have worked so hard, sometimes at huge personal cost in terms of the risk of COVID-19, to now feel so underappreciated and yet still have to keep going. Just as the patients have to accept that they can no longer expect to receive the same service they used to get, I wonder if we too have to learn to adapt to the reality that we can’t actually offer that service we used to.

Sticking together as a team

At the start of the pandemic our practice held a full team meeting every morning as we tried to keep up with the rapidly changing guidelines. Two years later it is still going strong. We meet every morning for five or ten minutes just before 9am, to take the pulse of the practice and see how we will get through the day. Our admin team and clinicians get to share their experience and support each other, which helps us all get through the day that follows.

Our GP teams are our most precious asset; we need to do everything we can to support them through the most challenging period that has ever happened in general practice.