GP receptionists play a major and important role in ensuring that patients get the correct treatments when they need them, according to a study published in the British Medical Journal (BMJ).

The study focuses on how GP surgeries administer repeat prescriptions, which account for up to 75% of all medication prescribed, and the authors, from Queen Mary, University of London, note that it is often assumed that this process is simple and automated. However the study found, surprisingly, that more than half of all repeat prescriptions requested by patients were classed as "exceptions" by receptionists.

Typically, this was because the medication, the dose or the timing of drugs requested by patients differed from what was on the patient's electronic record. Receptionists used a great deal of creativity and judgement to decide which prescriptions could be processed by the "automatic" system and which required input by a doctor, the study found.

In the majority of cases, receptionists were able to resolve complex queries within 48 hours, ensuring that patients received the treatments they needed promptly and efficiently, say the authors, who comment that their findings fly in the face of popular opinion that receptionists act as a barrier to patients getting the treatment they need.

"It's often assumed by patients, and by some doctors, that processing repeat prescriptions is a safe, automated process driven by a cleverly-programmed computer. Our research suggests that, in the majority of cases, it's far more complicated and staff on the frontline do a lot of unseen and unappreciated work to address that," said lead author Dr Deborah Swinglehurst, clinical lecturer at Queen Mary, University of London.

"We've also found that staff feel a strong sense of responsibility for ensuring that patients get their prescriptions quickly and safely, which is in contrast with some popular stereotypes of doctors' receptionists," added Dr Swinglehurst.

The receptionists' work, which the study authors describe as "hidden," included a wide variety of methods such as using a list of medicines to match brand names with generic equivalents or telephoning patients to clarify ambiguous requests. Where patients requested different repeat medications or at a different dose or timing from what the computer system suggested they needed, receptionists were found to be adept at prompting doctors to decide what to do, and did so with a variety of methods  ranging from electronic messages to "post-it" notes.

"Half of patients in the UK receive repeat prescriptions and some of these are for potentially dangerous medication, so the safety implications are enormous," commented Trisha Greenhalgh, professor of primary care at Queen Mary, University of London, who also worked on the study.

Many repeat prescriptions are far from simple, and require careful but swift decisions by non-clinical staff, said Prof Greenhalgh, who added: "this study has revealed how high-quality medical care can depend as much on the common sense and moment-by-moment practical judgements of frontline reception staff as it does on the formal safety features built into computer systems."