GP letter about DD’s missed hospital appointment

[MindatWork]

I was originally going to post this in AIBU but am too scared so just wanted to get others opinions on whether I’m being a bit precious. Apologies for length .

My 6 month old DD has been receiving outpatient treatment at the children’s orthopaedic clinic at our local hospital for the last couple of months. The administration of the clinic has been a nightmare with very poor communication between the reception staff and consultants’ secretary re appointment dates/times, regular 1 hour waits at clinic etc.

Her final appt was originally booked for the wrong date by the receptionist (a week after it should have been as she also needed an ultrasound booked for the same day), so I duly called when we received the letter and asked for it to be cancelled and moved to the correct date. All fine, we had the last appt and we’re now waiting for her check up next month.

This week we received a letter stating we had missed an appointment at the clinic (the wrong one which I’d asked the secretary AND the reception staff at hospital to cancel) and they had rebooked her for the next available date. This was copied to our GP.

We’ve now received a bit of a threatening/scolding letter from our GP advising that they’ve been made aware we missed a hospital appointment for our daughter and though there could be a reasonable explanation, they need to flag it because of the “possibility of neglect” !

I called them straightaway and politely explained it was a cock up at the clinic, but could/should I ask for this letter to be removed from her record? I know it’s probably an automatically generated letter and it’s good that they keep an eye on potentially vulnerable children but I find it weirdly upsetting that the word ‘neglect’ is now on my DD’s medical record.

Her treatment was upsetting enough after a difficult birth including a scbu stay and a very tough first 3 months, and we were meticulous in following every direction from the consultant.

Is it possible to ask for it to be removed or should I just leave it?

Some people seem to have completely misread the OP. OP wasn't indignant or rude she didn't sound like she objected to vulnerable children being protected when red flags appear. She just wanted it noted correctly that in her case it wasn't a red flag.

Trainee GP here- it's a bit annoying but it happens and a simple explanation with a note in the GP records will suffice.

I do wish that somebody with a few brain cells would take a hold of hospital admin, and give it a good shake up. It doesn't seem to matter which hospital, it seems to be utterly, shockingly shite the length and breadth of the land

It doesn't need a 'shake up' it needs the people with 'the brain cells' to stop cutting funding whilst crowing that they are protecting frontline staff. There's no point protecting frontline staff if you have no quality admin support to back them up, you just end up paying frontline staff professional wages to do a substandard attempt at admin. No amount of new tech, training, or 'shake ups' will solve the fundamental problem that if you don't employ enough humans to do a job properly it won't get done properly.

If it's the length and breadth of the country that should give you a clue that it's a massive systematic fault and not an issue with individuals.

It sounds like a generic letter but i understand why you are annoyed i had similar where they sent me to the wrong clinic twice, 3rd appt made and the consultant never turned up. I got a letter about wasting NHS appointments and if i didnt attend the next one i would be removed from the clinical list!

Really, AnyFucker? I'm not talking about the clinical staff, I'm talking about really, really basic errors of administration that must be costing a bomb, and, quite honestly, wouldn't be tolerated anywhere else.

I could give you several examples of consultants' time that has been deployed unnecessarily - wasted, basically - simply because of a lack of decent admin support. And that's just in relation to my own/my child's medical treatment. Multiply that across the country, and it has to be a serious problem.

My point was, surely somebody should have the nous to sort this out? Admin staff wages will be much, much lower than those of consultants, or, indeed quite a few grades of medical staff. It's a false economy to scrimp on admin to the point that it results in having to unnecessarily use a much more expensive resource. This is very, very basic management theory. Hence my comment about lack of brain cells.

Yes..... that was precisely my point, hatgirl

There is a lot of "false economy" in the NHS. The whole organisation pretty much limps along on it.

I don't think you can get it removed but you should be able to get a note on the file. Speak to PALS.
For what it's worth, I have experienced loads of this kind of low level crappiness in my long life. I have MS. I was once sent for an appointment at entirely the wrong hospital. I was also sent somebody else's appointment card. Another important referral was filed incorrectly and took months to unravel.
When my Mum was dying, I was like a terrier with her appointments etc (a polite one because, crucially, I have also learned that any slight disclosure of frustration or distress makes them handle you in a different way and makes it more about trying to manage your upset rather than fix the problem).

I wish it worked the other way. Dd was referred and it sat on a desk for nine months and no one checked to see why she'd not been seen. I rang and was lied too. Luckily I don't give up and rang again but she's still ended up waiting eleven months to be seen instead of two and may need hospitalisation right around her GCSEs and AS level exams .

And this is one of the many reasons the NHS is struggling. Admin systems that belong in the dark ages and cost millions in errors and waste

I’m sure your number will also still be included in those of “terrible” people who don’t show at appointments and when the daily mail next reports on this

A marker for neglect! I’ve heard it all now. You’re the mother of a, possibly unwell, 6 month old. Time keeping and remembering appointments is hardly going to be your forte right now. If it is an admin error please challenge it to death! You should be completely fine RE social services if your baby is happy and well cared for, so don’t worry

Oh and if you can & need to, please get private healthcare! You’ll be in much better hands and won’t be messed about in terms of appointments

In my experience the problem is you never have the same people on reception long and they often won't know which clinics to book patients into. Sometimes the doctor will say see again in one month but there are no free appointments at that point so the receptionist books them into a different but wrong clinic to avoid the patient kicking off.

It's obviously more convenient for a patient to be able to book the next appointment on the way out of clinic but it does mean more mistakes.

@balloonyellow It wasn’t a timekeeping issue or a matter of remembering an appointment - it was booked on the wrong date and I’d asked them twice to cancel it!

I’m not bashing the nhs in general as I had outstanding care when I had my DD. It’s just - as others have said - dealing with the administration can be so frustrating when you see time (and appointments) being wasted.

I think it’s a training/ resource issue in this case - there was a new woman on reception who I saw being trained during numerous visits from about halfway through our treatment. When we went for our last appt she told us to go and book a follow up X-ray for 6 weeks time. We duly trotted round to X-ray only to be told you can’t ‘book’, you just turn up, and where was our paperwork? Schlepped back round to children’s outpatients ‘Oh yes sorry, here’s your X-ray request form, just make sure you’ve had it done a week before the appointment’ 😩. She also promised to remove the errant appt in the op from the system but never did.

@Snuggybuggy It always seemed to be quite hit and miss - sometimes we would make our next appt on the way out and would receive the letter 2 days later, sometimes the reception would say ‘oh I don’t have time to call the secretary now I’ll do it later’, then I’d call the secretary a week later to follow up and nothing had been booked.

Choose and Book is an expensive nightmare too.
Often it is impossible to book anything. Twice I have been booked into the wrong clinic by the telephone team, having been advised on line that there are no appointments at all, anywhere.
The doctors I saw at those appointments tell me it happens all the time.
Medicine is so specialised now, it is important to get the correct person.
I was supposed to see a lymphoma specialist and was booked into the anticoagulant clinic. Waste of time and money for everyone. That was 2 months ago and the appointment for the correct clinic was supposed to be this week but has been cancelled by the hospital.
It is wearing.

I believe you OP, I've spoken to plenty of patients who have been told that we will be in touch with an appointment only they haven't actually told us

It tends to work better with smaller outpatient clinics that are physically based near the admin team with consistent staff. You build rapport and they tend to liaise better to make sure that the loose ends are tidied up and patients get what they need. With a big multi use outpatients with staff constantly moved around it's never the same and they probably don't have the contact details of each admin team immediately to hand.

Mamy times in my medical training I have been forced to do admin tasks (no one else to do them, only way to ensure they actually get done). It makes NO bloody sense. Paying Dr wages and taking me away from clinical decision making and actually getting people through their hospital admissions quicker when you could pay an admin salary. It drives me bonkers!

(That's not me being arrogant. Im more than happy doing admin tasks, just I think my time would be spent better doing the job my very expensive and mostly publicly funded training has trained me for!)

But WHO thinks that is good/acceptable, MissPhonic?

Do the medics ever get together and confront the managers and demand this changes, for everyone's benefit?

I think you are massively missing the point Tolleshunt. You seem to think that it's in the power of the NHS staff to change this, that all it needs is a bit of 'nous' from the right people.

Do you really think that collectively the NHS staff are a bit thick, incapable of suggesting cost effective measures up through their managers, or challenging the existing shit systems? Do you think those managers are deliberately not listening just for the hell of it?

The NHS is being systematically and deliberately underfunded to a point of collapse. It's not accidental, it's not because none of the 1.5 million NHS employees can't come up with any 'nous'. There's nous spaffing out all over the spot, it's what's keeping a dying, flagging NHS limping along and no one has the heart to put down.

They. Don't. Want. To. Sort. It. Out. They want it to get so bad that they can justify selling bits off.

I don't think you can get it removed but you can certainly get it some evidence of it as an error, either a letter from you or they can record it as an error. Tbh it's only ever going ti be looked at again if you subsequently don't bring your child to an appointment, so I really wouldn't worry.

Multiple failed appointments is a sign of neglect, I understand why you are annoyed but it is good that they are on top of it from that perspective. It's more important to catch actual neglect than annoy someone with a legitimate error.

I'm a dentist so slightly different but the amount of people who don't bring their children to dental appointments is shocking, appointments for treatment. Children who need multiple extractions under GA, have DNAed multiple assessments. The amount of people who always have a reason why their last dentist kicked them off, always an admin error and then subsequently DNA all of my appointments. I know it's less serious than a hospital but I would be slightly dubious of when people tell you admin error stories.

Not in your case OP, but the majority of DNA appointments I see are people just not turning up. When I worked in the hospital people would always say the date was wrong on my letter, or card. When I wrote the card myself and sent the letter myself. So you can see why they might be harsh in their outset, because for me anyway it's so so common for people to just not being their child to appointments.

The exact same thing happened to us.

Dd2 needed a scan on her kidneys at six weeks Obviously we went. Got a really shitty letter off our GP saying that this could be classed as neglect, my HV was notified too and to contact the GP immediately- which I did and explained we had gone.

When we went along to see the consultant to discuss the findings of the scan he was really abrupt with us and tried scolding us too about the no show, chuntering in about neglect and SS. My Dh got really shortwith him and told him to toddle off to radiology and go and find the scan.

He cane back very apologetic and asked if we would like to make a complaint. It hadnt been sent to any one. Just sat in a file. The findings off the scan were positive and we were just happy about that tbh and left it with him to deal with but thinking back, what if she has actually been really poorly and it was missed, we should have complained.

North west hospital.

Oh dear, you are really taking this personally, hatgirl. I'm not missing the point, though I suspect you might be.

I agree with you!!

I agree that 'they' (i.e. The Tories) are deliberately running it down.

I just am interested in how those at the coalface feel about it, and what efforts are made to counter the deliberate neglect and starving of funds. I wonder what tensions there are between clinical staff and management, and how these play out. Do the two 'sides' pull together to make the best of a bad job, etc?

Curiosity, really, as a service-user, taxpayer, and previous state-sector employee.

From an outside perspective, it is hard to know how much cohesion and shared-purpose there is between clinical staff and management. There is obvious waste, though, which in a climate of swingeing financial cuts is clearly going to add insult to injury. So I wonder what is done to minimise it.

For the avoidance of any further doubt, I'm not trying to denigrate the front-line staff!!

Not taking it personally, I'm not an NHS member of staff nor are any of my close family or friends. It's actually my job to challenge the NHS on funding and practice issues. All I usually see is a lot of people working far more hours than they are paid to do, to prop up an unworkable system, whilst the people who actually have the power to change any of it for better are actively trying to do the opposite whilst pretending the are protecting frontline staff.

Not funding enough back office staff to get the appointment system right is a skip and a jump away to arguing to computerising it wholesale to avoid 'human error'

I think you are a being a bit disingenuous really, You've said a few times in a few different ways that the issue is that the staff aren't standing up to challenge it, or that they aren't getting the right people in to solve the problem. That's just not true.

I don't think you understand just how hierarchal the NHS is Tolleshunt. It might seem silly but for most NHS staff the idea that they can challenge other staff in higher bands is almost unthinkable. It's just not how it works. .