title: Slaying the dragon myth: an ethnographic study of receptionists in UK general practice.
abstract: BACKGROUND
  General 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.
  
  
  OBJECTIVE
  To explore the complexity of the role of general practice receptionists by considering the wider practice context in which they work.
  
  
  METHODS
  Ethnographic observation in seven urban general practices in the north-west of England.
  
  
  METHODS
  Seven 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.
  
  
  RESULTS
  Receptionists 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.
  
  
  CONCLUSIONS
  Framing 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.
authors.affiliation: School of Community Based Medicine, University of Manchester, Manchester, UK. jonathan.hammond@manchester.ac.uk
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hammond
authors.forename: Katja
authors.initials: K
authors.lastname: Gravenhorst
authors.forename: Emma
authors.initials: E
authors.lastname: Funnell
authors.forename: Susan
authors.initials: S
authors.lastname: Beatty
authors.forename: Derek
authors.initials: D
authors.lastname: Hibbert
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lamb
authors.forename: Heather
authors.initials: H
authors.lastname: Burroughs
authors.forename: Marija
authors.initials: M
authors.lastname: Kovandžić
authors.forename: Mark
authors.initials: M
authors.lastname: Gabbay
authors.forename: Christopher
authors.initials: C
authors.lastname: Dowrick
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.forename: Waquas
authors.initials: W
authors.lastname: Waheed
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Chew-Graham
mesh_terms: D001071:Appointments and Schedules; D004739:England; D005194:Family Practice / Q000592:standards*; D020793:Gatekeeping / Q000592:standards; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007400:Interprofessional Relations; D008496:Medical Receptionists / Q000592:standards*; D016134:Organizational Policy; D011361:Professional Competence / Q000592:standards*; D024382:Professional Role; D011369:Professional-Patient Relations; D014504:Urban Health
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