Editorial Comment

Practice Managers Manual

The long version of an extensively revised handbook for a new and existing GP Practice Managers is now available. It was originally prepared to give to a newly appointed practice manager at a practice in West Yorkshire. It will need adaptation to fit the needs of other practices and will no doubt continually need to be brought up to date. The contents were last brought up to date in July 2015.

You can download the Handbook from the Resources Section of  It has also been added to the Tool Page.





Editorial Comment

Encouraging Patients Not to Use A & E

I have always thought that to steer patients away from going to A & E to another NHS service was an uphill almost impossible task. GP Practices have religously warned their reception staff not to make clincial comments.

Many solutions have been and are still being tried to encourage less use of A & E ranging from Minor Injury Units and Walk-In Centres to the ‘111’ telephone line and you could ask your local pharmacist in a consulting room the size of a shoe box. One group of CCGs in West Yorkshire has published a leaflet which attempts to direct patients to the ‘right’ location.

The leaflet suggests (my comments in brackets) that

URGENT CARE – CALL ‘111’ This is to be used for worsening health conditions, when you need advice, when you need to see a doctor out of hours, and if you have severe dental pain.

SELF-CARE – Look after yourself if you have a hangover, a sore throat and and runny nose. (This means self-medication and a well stocked medicine cabinet)

PHARMACIST – Go to see a pharmacist at your local pharmacy if you have diarrhoea, a running nose, a painful cough or a headache. (I have never known a pharmacy have access to a toilet. What’s the difference  between a runny nose and a running nose?)

GP SURGERY – Go to see your GP for cuts, a stomach ache, and a back ache. (Oh if that was all that could be on the list)

NHS WALKIN CENTRE or MINOR INJURY UNIT – Use this service for Cuts (but you said I should go to my GP), sprains, rashes, and a cough.

A & E – Go to A & E if you are choking, have chest pain, severe bleeding and are blacking out.

I have to say that broadly speaking I found the list or the idea of a list useful, but there is a risk of such lists causing confusion and directing people to the wrong place. It is like the instructions given to GP reception staff not to give clinical advice. To start listing ailments and symptoms and saying do this or do that without a proper history or clinical assessment is never wise.

A couple of points to bear in mind. Minor Injury Units tend to have access to a radiography unit if not then A & E it is. The Minor Injury Unit I attended yesterday after a car shunt did not have triage. Therefore there was an hour plus wait before beeing seen. At leastt in A & E I would have been triaged or would I.

My second point is there is an assumption that practice nurses will be on hand to deal with minor injuries. This is not what they are paid for.

As I have said a leaflet is a good idea but they are extremely difficult to write.

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Editorial Comment

Practice Managers Survey 2015

This is the final request for survey forms. The deadline has been extended to Tuesday 17th February 2015.

Please submit forms to

If you want to keep your reply confidential you can fax it to 020 7099 5585.

The Survey Report will be published on this web site and on

Many thanks to those who have already sent forms.

Survey about GP Practice Manager Salaries