1. Managing difficult calls and communication in the practice
Greg Coghlan CPN, SMI LCS liaison

2. Non-clinical staff experiences
Communication difficulties with patients either on the phone or in the surgery
Demands, unrealistic expectations and urgency
Patients that say they are feeling suicidal
Repetitive calls or requests

3. Communication difficulties with patients
It would help to feel prepared for challenging interactions with patients and/ or their significant others by having a degree of understanding about their difficulties when they are unwell.
Some patients might have mental health issues, such as an emotionally unstable personality disorder and may lack empathy about how they make others feel when communicating. People with a personality disorder are likely to have difficulty with the way they think about themselves and others; they may tend to have difficulty changing patterns of unwanted behaviour/ communication.
Some patients may have high anxiety levels, or some kind of stress related illness .

4. Communication difficulties with patients
Some patients may have a severe and enduring mental illness such as Bi-Polar Affective disorder or Schizophrenia who when unwell may struggle to communicate rationally or coherently. They may be lacking self awareness/ insight and may not be aware about how they might be coming across to others
It is not your responsibility to fully understand the clinical problem but it would be helpful to try be sensitive to the fact they are stressed. This is difficult but remaining calm and consistent is important .

5. Communication difficulties with patients
Some patients might just be difficult people, and some patients may just be relatively ordinary people under huge amounts of stress because of physical health problems
Carers, families, or significant others can suffer enormously because of their loved ones ill health. Try to be sensitive to the stress they may be experiencing.
Understanding how to respond relative to the problem is important; be clear about what you can do to help resolve the problem

6. Demands, unrealistic expectation, urgency
Patients or their significant others may pass on a sense of urgency about their problem
They may become frustrated or angry feeling that no one cares
It is not the role of admin staff to assess the clinical situation or the accuracy of the patients’ description of their problem.
Tell the patient that you will take down a message, ask them what they would like to be put in the message. This can help the patient feel heard and validated

7. Demands, unrealistic expectation, urgency
Read back the message to the patient and make sure you have their up to date contact details. This can help to reassure the patient that their concern has been taken seriously and will be passed on accurately
Manage their expectation about when they are likely to hear back from someone

8. Demands, unrealistic expectation, urgency
Impossible to have a 2 way conversation with someone who is upset or angry
Try not to engage or reason with them or get into conflict. Let them explain the problem, sometimes this alone might calm things down. Tell them what you can do in response to their problem if anything at all
You can try to say “if you speak a little slower it might help me to understand how I can help” without pointing out they are being unreasonable you can encourage them to slow down it will remind them that you are trying to help them

9. Demands, unrealistic expectation, urgency
If not calming down you can say “I can hear you are frustrated but I can’t help you when you raise your voice”
“We do need to end this call in a couple of minutes, what is the message you would like me to pass on?”
It is an unrealistic demand of your time if someone talks extensively about their life to you on the phone. You could suggest that it might be more helpful for them to talk to their clinician about those details or issues. Try to wind up the call by saying that you must go so that you can pass on the message you took accurately from them
Inform them of their right to complain and how to go about it

10. Patients that say they are feeling suicidal
People wanting to be seen because they feel suicidal, no GP available on site. It is not your responsibility to clinically assess the risk of suicide. Ask if it is helpful to have the next available appointment, if they accept then that is reassuring enough. In addition:
You can offer them the phone number for:
Mental Health Rapid Response Service (0300)
Mental Health emergency line that is open for anybody to call
Phone MHRRS to pass on the patients basic details and name of GP, no clinical details need to be discussed; they will make their assessment

11. Patients that say they are feeling suicidal
Encourage the patient to attend A&E where they can see a mental health professional
If they say they have taken an overdose/ going to harm self today advise them to call for an ambulance or attend A&E. Make a note on your system of the contact and the advice you gave. Your practice is not an emergency service, you can do little beyond advising how to access the appropriate help. You or your colleagues can phone the police if a patient says they intend to commit suicide after speaking to you, the police will respond with a welfare check.

12. Repetitive Calls or requests
Several times per day and hard to get off the line
Raise issue with management to involve clinical staff to make a plan of action; you can then remind the patient of the boundaries of contacting your service. This may include identifying one member of the team such as the practice manager to speak to the patient.
Agree a scripted response which could flag up alongside their name on the system

13. Repetitive Calls or requests
It’s about improving the patient’s relationship with the service
Frequently lost prescriptions or running out of medication: could be a clinical issue such as poor concentration or chaotic presentation. Raise with management to involve clinical staff to make a plan of action such as prescribing for pharmacy to deliver weekly/ monthly blister packs. Overuse, abuse, or selling on the black market: again a matter for clinical staff to put a plan in place including specialist referral

14. Significant others or other professionals
Demands to be seen urgently or home visits for significant others
Offer what is realistically available, such as duty doctor phone call or next available appointment beyond that they will need to decide how to proceed such as A&E attendance or phoning for an ambulance
Significant others can access carers support via clinical referral you could advise them to ask their GP to request a carers assessment.

15. Significant others or other professionals
Sometimes professionals from other services will need reminding about your policy for home visits
Educating/ sign posting about the pathways that you are aware of to access help and treatment

16. Thank you for listening