Summary
The role of receptionists is under increasing scrutiny as general practice organisations struggle to meet patient demand and increase the range of non-clinical roles. This review confirms the pivotal role receptionists play in delivering safe and effective clinical care often without recognition or relevant support.
Regarding their impact on service delivery, the continuing role of receptionists in performing a range of administrative tasks was confirmed, as were more explicit clinically related tasks, that is, prioritising patients for consultations, facilitating repeat prescriptions, and communicating blood test results. Studies exploring patient attitudes predominantly described the lack of trust in reception staff who were viewed as unnecessarily obstructive when attempting to gain access to GPs. Finally, in considering receptionist experience, receptionists described the contrast between their confidence in performing administrative roles and the anxiety induced from the clinically related tasks, particularly where judged by patients as the key decision-makers in allocating appointments.
Strength and limitations
Notably this is the first systematic review, to the authors’ knowledge, exploring the roles and impact of GP receptionists. It provides a valuable summary of their value at a time when delivering primary care is complicated by a chronic lack of capacity, and non-clinical roles are being used to expand the primary care team.18 Best practice in review methodology was used, including data gathering, quality assessment, and analysis.21,24–27 Although a formal meta-analysis was not possible, the narrative synthesis enabled identification of three themes, which allowed a holistic interpretation of receptionist work. It also offered valuable insight into the toll taken by some of the blurred boundaries that persist in their role in the practice team.
The search was limited to beginning in January 2000 because of an awareness of the changes in size and scope of primary care in the past two decades that would have reduced the relevance of prior work conducted at a time when practices were much smaller and the primary care landscape less complicated. Although studies were limited to the UK, broader lessons can be drawn for medical office staff in other models of healthcare delivery where their interaction with clinical tasks is not explicitly defined and supported.56
Comparison with existing literature
In terms of service delivery, the responsibility of receptionists for booking appointments has remained unchanged for decades yet is now performed in an environment of excessive demand and growing patient expectations.57–59 Although there have been changes in telecommunication technologies60 and referral pathways, the studies identified in the current study described how receptionists typically perform the role without structured support.10,34–38,40 It is notable that primary care receptionists perform similar clerical roles alongside tasks involving patient assessment in Australia,61–64 New Zealand,65 France,66 and the US.67
Any decision on the appropriate next step for patients made by reception staff is complicated by the increased options provided by the growing scale and scope of practice organisations68 and the sharing of resources across primary care networks69 alongside broader infrastructural shifts via the introduction of integrated care systems.6,70 This complexity also risks compromising receptionists’ contextual knowledge of individual patients gained from their continuity of contact.71 In the UK the receptionist workforce is predominantly White and female,28,29 which may be of note considering evidence that frontline public sector workers are more likely to demonstrate leniency towards requests of those with whom they share social demographic characteristics.72 However, this has yet to be explored in general practice receptionists.73
The pandemic motivated introduction of ‘total triage’ that required every patient seeking clinical contact to provide reasons and symptoms for their request and this was the first time the vital role of reception staff in triage was formally recognised, although it was mandated without additional training for any practice staff involved including receptionists.60,74,75 The introduction of online symptom checkers is expected to provide consistent algorithmic-based decisions on triaging patients and ease pressure on reception staff76 but with concerns that such automated systems will lose valuable contextual information.77,78
In terms of patient attitudes, the data described how adverse interactions with patients typically stemmed from their frustrations in obtaining a consultation.31,51,52 Issues in seeking appointments via telephone have existed for decades59,79 and NHSE have failed to substantively address the issue by staggering the release of appointments.60 Fundamentally the disconnect remains between a shrinking clinical workforce and an older, increasingly unhealthy population,71 meaning many patients with genuine needs either blame receptionists for a lack of access or fail to seek care.17 In other countries, such as New Zealand, receptionists can be viewed with similar suspicion, particularly among underserved populations,80 and in Australia receptionists experience similar abusive and intimidatory behaviours.15
Evidence from this review described the mistrust patients have in receptionists because of their lack of clinical training45,46 or the suspicion that they are dishonest brokers focused on protecting GPs.38,53 It also means that similar to other frontline care providers they can be exploited by patients gaming the system who view them as less consequential than their clinical colleagues.81,82
Patients’ hesitation in disclosing their symptoms to receptionists might be mitigated by the mooted professionalisation of GP receptionists.38,83 In the meantime, more must be done to educate patients around the concept that non-clinical intermediaries, such as receptionists or those employed through the Additional Roles Reimbursement Scheme (ARRS), are capable of supporting the most appropriate course of care and/or support.84
Finally, in terms of the receptionist experience, the studies identified described how their involvement in repeat prescribing and communicating test results led to uncertainty and anxiety among receptionists.29,42,45–47,49,50 However, it was their role in providing access that appeared particularly problematic,28,29,31,38,40,54 and perhaps it is this that contributed to their being among the most complained about members of the NHS workforce.60,85,86 In performing this role evidence suggests they receive only informal support from colleagues, and no training in coping with conflict.87,88 Since the pandemic, patient antipathy has become more sinister with increasing incidents of physical abuse,18,89 with some mainstream media outlets fuelling distrust between patient and primary care provider.15,90 There was evidence that the experience of receptionists can be improved by reducing cognitive load, improving training and feedback, and ensuring that IT systems harmonise with personnel and work practices.29 In other high-income countries including Australia there have been recent moves to improve satisfaction and workforce retention in part by ‘professionalising’ receptionists by increasing training and qualifications.65,91
Implications for practice
As general practice adapts to the introduction of integrated care systems and associated collaborative working with secondary, community, and social care settings, the pressure on receptionists is set to continue.57 This review confirms their part as key non-clinical members of the practice team performing a series of clinically related tasks in a highly pressured environment. However, the additional complexity presented by broader system-wide integration offers the opportunity for policymakers and senior staff to reappraise their role for what it consists of: a multiplicity of administrative, organisational, patient-centred, and clinically responsible tasks. At a time when the ARRS is funding additional non-clinical roles in primary care to improve patient experience, developing a structured and holistic training programme for GP receptionists appears an obvious step.92 Competencies might include safe prescribing practices, literacy in medical terminology and result communication, or the ability to sensitively manage interactions with concerned or anxious patients. It is also worth acknowledging the overlap of the traditional signposting responsibility of receptionists with the new NHSE categorisation of that aspect of the work as ‘care navigator’, trained to direct patients to various sources of help, advocacy, and support.31,32 However, the recognition of the clinical influence of receptionists requires careful political and social consensus-building and brave commissioner-and policy-level decision making; it cannot be the responsibility of practice organisations with already stretched resources.93
Despite the evidence demonstrating receptionists’ impact on safe, effective care and patient experience, they continue to perform the role without mandatory or structured support from senior clinical colleagues or commissioners. With the growing, if controversial, integration of ARRS-funded non-clinical staff into primary care teams the time is right for policymakers, commissioners, and senior practice staff to reconsider the parameters of the role to include clinically relevant tasks, and explicitly recognise its value and the support and training needed to sustain it.
