• Jonathan Hammond, Katja Gravenhorst, Emma Funnell, Susan Beatty, Derek Hibbert, Jonathan Lamb, Heather Burroughs, Marija Kovandžić, Mark Gabbay, Christopher Dowrick, Linda Gask, Waquas Waheed, and Carolyn A Chew-Graham.
• School of Community Based Medicine, University of Manchester, Manchester, UK. jonathan.hammond@manchester.ac.uk
• Br J Gen Pract. 2013 Mar 1;63(608):e177-84.

BackgroundGeneral practice receptionists fulfil an essential role in UK primary care, shaping patient access to health professionals. They are often portrayed as powerful 'gatekeepers'. Existing literature and management initiatives advocate more training to improve their performance and, consequently, the patient experience.AimTo explore the complexity of the role of general practice receptionists by considering the wider practice context in which they work.Design And SettingEthnographic observation in seven urban general practices in the north-west of England.MethodSeven researchers conducted 200 hours of ethnographic observation, predominantly in the reception areas of each practice. Forty-five receptionists were involved in the study and were asked about their work as they carried out their activities. Observational notes were taken. Analysis involved ascribing codes to incidents considered relevant to the role and organising these into related clusters.ResultsReceptionists were faced with the difficult task of prioritising patients, despite having little time, information, and training. They felt responsible for protecting those patients who were most vulnerable, however this was sometimes made difficult by protocols set by the GPs and by patients trying to 'play' the system.ConclusionFraming the receptionist-patient encounter as one between the 'powerful' and the 'vulnerable' gets in the way of fully understanding the complex tasks receptionists perform and the contradictions that are inherent in their role. Calls for more training, without reflective attention to practice dynamics, risk failing to address systemic problems, portraying them instead as individual failings.

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