Remember that hellish world of oppression and misery, where the line between truth and lies was blurred, and terror stalked the land? No, not primary care over the last 12 months—but George Orwell’s seminal book, Nineteen Eighty-Four. Room 101 was the torture chamber in the Ministry of Love where people’s worst fears were kept. Later, the eponymous TV game show would see guests choose their most hated things to put into Room 101.

There can’t be many practice managers who haven’t wanted to consign a patient, a form or a procedure to a similar fate. Here we take a light-hearted look at some possible choices, in what would have to be a fairly large Room 101..

Tiny pay rises

It’s fair to say that the 3% pay rise announced in summer 2021 was not met with much enthusiasm. The collective sigh uttered by most NHS staff would probably just about have been heard above the clapping last year, back when NHS staff seemed to be truly appreciated.

People who say ‘it’s not my problem’

Anyone who speaks these words within earshot of a GP practice manager either has a very interesting sense of humour, or they are genuinely asking for trouble. They seem not to realise that, whilst a problem may not be theirs at that moment, the more it is passed around and delegated, the quicker it grows into everyone’s problem. A practice manager will never utter the phrase, yet they nearly always find themselves holding the problem parcel when the music stops.

Abusive patients

This has always been a risk for those in patient-facing roles, but in the last 12 months it’s become a problem of worrying proportions. From bomb threats to throwing blood-soaked garments at receptionists, no member of staff should ever have to endure such horrendous experiences. It demands action from all in society to look out for early warning signs and prevent this type of behaviour.

Instant gratification

This seems to be a driver for some of the patient abuse issues. People see instant gratification systems in their everyday life – coffee from Starbucks to go, whole series on Netflix to stream at a moment’s notice, and answers to problems you never knew you had, courtesy of Google. When the same can’t be achieved for complex medical issues (especially given that some of the systems used in the NHS are just not up to the job), people get agitated and then look to apportion blame.

GPs with trust issues

There’s always one GP (or maybe two, or perhaps three) who just refuse to delegate, share or collaborate. They’ve seen off several practice managers in their time, whilst never quite grasping the reason why the staff turnover rate is as high as the pile of complaint letters in the receptionist’s in-tray.

Deliberately-negative media stories

The rise in incidents of angry or abusive patients has been attributed in no small part to the media. In the dark days of the lockdowns, some bright spark in Fleet Street decided it would be a good idea to paint a picture of locked surgeries with online-only appointments and no face-to-face working at all. They didn’t let the small matter of the truth get in the way of their story. It didn’t help when the NHS issued a letter ‘reminding’ GPs of their responsibility to offer face-to-face appointments, and an apology followed soon after.

Powerful but out-of-touch people

Into this category fall politicians, executives, directors and other powerful but usually uninformed people, who make big decisions affecting many lives without ever having troubled to understand how GP surgeries operate and what challenges the staff face in terms of funding and capacity.

And one choice that would probably be on many of our lists:

Recently, there’s never a shortage of shortages

Another one where the finger of blame points (at least partly) towards the media. It always seems to happen the same way. The supermarkets issue statements assuring everyone that there are no supply chain issues or shortages if everyone shops normally. The media picks this up and adds their spin. The next day there are huge supply chain issues and national shortages, with pictures of empty shelves splashed all over the newspapers. And those toilet roll hoarders probably deserve a special place in Room 101..

So, what nuggets of wisdom can we glean from this ghastly assortment of woes? Some themes underpin all of them, though many of them are simple good manners and common sense. Being valued, for example – truly valued and understood, and recognised for the work you do, is unsurprisingly very important. Reward for all hours worked, at a fair rate, and with patients who appreciate the pressure the system and staff are under, would also go a long way towards alleviating some of the despondency the profession is feeling.

But for now, if you need a moment’s break from the stresses and strains of your day, why not think what you’d put in your Room 101?