to think NHS is unreasonable

[dolphin01]

Just received letter inviting dp to book outpatient appointment. This letter states that if you don't book appointment with 2 weeks of letter they will assume you don't want appointment. Surely people could be on holiday for 2 weeks.
Furthermore they state that they will offer you 2 possible appointment dates. If you can't make them you will be removed from list and referred back to gp.

YANBU. I just got a letter from GOSH; I have until the 22nd to make an appointment. That is LESS than two weeks, what would happen if I was on holiday - which will happen in a fortnight as we are off in a caravan for the start of the summer hols.

If I had had to go through referral again becaus eI was on holiday I would be

I've left 2 messages on voicemail so far as nobody's anserwed the phone. Still waiting for a callback.

You are and you aren't (helpful aren't I? )

YABU because they usually run services like that if they've had problems with high rates of unattended appointments in the past, just think how much longer you'd be waiting for an appointment if they just dished them out on referral to everyone - you'd be shocked how many people never bother to get re-referred and just aren't interested. Two weeks is standard for very busy services, it's just not feasible to manage 100's of active referrals for weeks at a time, even with the abolition of the 18 weeks waiting time this is unlikely to change for a lot of services purely down to the numbers involved.

YANBU because most people aren't interested in how/why the system works and don't know to ask their GP to specify they might not be able to call within a certain time period - why more GP's don't ask when they're with the patient I don't know. If you do miss the time slot most GP's are happy to re-refer if you just telephone the surgery.

I work within an NHS department

We run the same system but with 4 weeks as a cut-off timescale.

I think that is fairer. Recently, when a suggestion was mooted to change it to 2 weeks, we resisted it mightily.

YANBU, even though I know how many millions of NHS money is wasted on unused appointments.

But would there be so many missed appointments if the system was better? During my pregnancy with DS I had scans and appointments with private and NHS.

With the private appointments you rang up, your call was answered and you spoke to a receptionist who you told when (roughly) you were free. She then offered you an appointment in the time which was convenient. When you went in, you would be treated politely and told if there was going to be a delay. If you needed to book another appointment you spoke to the receptionist and booked it before you left.

With the NHS, you were sent a letter with a random appointment. You would try to contact them to change it but no-one would answer the phone. You would get put through to another part of the hospital, who would not be able to help and would transfer you back. If/when you eventually got through, they might change the appointment time, or they might send you another appointment in the post, which again you might not be able to make. When you went in for the appointment as often as not you would be ignored and treated rudely. The average wait would be 2-3 hours, and no-one ever apologised or even told you how late they were running. If you needed to book an appointment, you would have to be sent another letter, you were not allowed to book it in person.

I know that the private medical centres have more money, BUT much more NHS time was wasted with the constant rebooking of appointments than would have been using the private centres system, and TBH I can see why people don't turn up for appointments that they can't keep and can't change.

I don't want to come across as critising the NHS staff, most of them work very hard in difficult conditions but the systems in use are so inefficient and no-one seems to care!!!

I think it is about targets. The figures will show that no one has been waiting longer that two weeks from getting a referral to being offered an appointment.

Difficulties in rescheduling/attending is the reason that a lot of services use the invite to call system - to provide an element of choice and to sort out in advance when people can actually make it. There have to be limits though because compared to the private sector there are always going to be higher numbers of patients involved which makes things harder.

Of course there are some services that still just give you an appointment and you're expected to attend, but there's not a one size fits all solution unfortunately. Personally I prioritise my health over any other commitments, but even then things do crop up that prevent attendance - I suppose to an extent I've accepted that if I'm inconvenienced I can't expect a national service to bend to my particular needs...... there has to be an element of compromise from both parties.

The rudeness and incompetence of some staff though - I wouldn't hesitate to encourage formal complaints about them. There are some people working in the public sector that you wonder how they manage to get to work in the morning without getting their nose broken.

Party, yes there would still be many missed appointments

We make 90% of our appts over the phone (if people can be bothered to answer their mobiles in the 1st place....many don't have landlines any more). We only send an appt if we cannot make contact.

We speak to a person, arrange a convenient time, leave a contact number where there is an answermachine that is dealt with throughout the day. All messages are followed up within 24 hours.

And we still have a high DNA rate.

People have been spoiled by the NHS in this country...to the point where they totally take it for granted. Some, not all, I might add...but enough to waste a lot of my time.

I agree with AF..people are constantly complaining they can't get an NHS dentist..I work for one and AT LEAST two people a day make appointments to register and then just don't turn up.

Government cuts mean that many clerical/appointments staff are being cut.

Not NHS staff fault. Frustrating though, I know...and only going to get worse, I am afraid.

AF - we call them the day before to remind them and get blatently lied to constantly - these are for appointments they've called to arrange!

People forget that not everyone is like them and there are a lot of people wasting everybodies time and money on a regular basis. All we can do is refer them back to their GP who will refer them again for the whole cycle to kick off again - it's not like we can refuse the availability of the service....

We also call people to remind the day before, have often spoken to people who say they are coming and then STILL don't come.

yup

they tell blatant lies

you can usually tell though

when you give them directions and say have you got a pen ready, they vaguely say "err, yes..." and give them a contact number you know they aren't writing it down

is not hard to predict which ones will default

unfortunately though, you still have to set that time aside in case they do rock up...which is taking time away from other patients < quietly fumes >

MN has englightened me today. Firstly, I have learned that people have given up sending rsvp to party invites, and now that people don't bother with appointments at hospitals/surgeries.

What is wrong with these people? Lazy lazy lazy.

Makes my blood boil.

I am seriously struggling with the NHS at the moment, not enough professionals, can't get anywhere with finding equipment etc for my ds. Now I know where the money is going...

getthepartystarted that is terrible - which hospital treated you like this? It would not be acceptable at my local hospital.

I would advise that you write and complain, as if not nothing will change.

IME a system like this does reduce the number of missed appointments because you are sifting out quite a lot of people who were never going to make it.

However, I do think that no matter what system there is there will be people who just don't turn up, even if they've confirmed, had reminders etc. And this can be for a variety of reasons. Some people are scared and drop out at the last minute, some just forget, some are ill and maybe being admitted elsewhere or can't get out of the house. It's not just that people don't bother.

And if someone in dolphin's position were to ring she'd simply be given an appointment and the holiday taken into accout.

I know there are people who don't turn up, but the system shouldn't be designed to make everyone suffer because a minority are rubbish. And I bet some of the people who don't turn up actually never got the letter or have phoned to try to rearrange but couldn't get through or left a message that has never been returned.

How does the system make everybody suffer? And believe me, it really isn't a minority for some services (I work in a department convering 3 specialities and run numerous clinics for different services within those).

Of course there will be cases that really are not the patients fault eg. letters, answerphone msg's (although I have to say it's another tip gained from working in the environment that I wouldn't leave a message without following it up by trying to speak to someone later), those cases are truely in the minority.

Nobody is ever banned from a service entirely, if you accept you are using a service that millions of other people are also using it's invitable that occasionally you will have to deal with errors in communication and a little inconvenience. It's not ideal, but unless you are dealing with complete incompetence, you have to cut a little slack.

Everyone is suffering from being sent rude letters that assume you are not going to turn up, from being given appointments at times that may be impossible or inconvenient, from being sent letters that demand a response even though you might well be away for two weeks when the letter arrives, from being unable to get through to re-arrange, from attending appointments in overflowing clinics where you have to wait for at least an hour... if all these people don't turn up, why do you have to wait so long?

Not all clinics work that way, of course, I had regular physio appointments at one time and they were very good if you had to rearrange. But the appointment times you were given were still inflexible and relied upon you being able to take a whole morning off work. That's before you even get onto the lack of public transport and the car parking charges...

Tbh, the comments on letters been rude is more your interpretation in my eyes. If you're dealing with 100's of referrals a week limits have to be imposed somewhere. It's not a ban from the service it's reasonable time limits in which to do things. If you miss a cut off date due to been away, then granted it's not your fault, but it certainly isn't the services. I've already pointed out that I think GP's need to get into the habit of asking at the point of the referral ideally.

Impossible or inconvenient appointments - well it's just unavoidable for a national service, some effort has to be made on the part of the patient. The NHS can't cater for everybodies individual schedule and if a morning needs to be taken off work and there really is no other alternative (that reasonably may require a longer wait or extra travel if you can't make the orignal one) that's down to the patient to prioritise imho. I sympathise with travel issues (I don't drive), but again that's my responsibilty, I have to take some in regards to my own health. If your incapacitated the NHS will help.

I don't really understand how you don't see the connection between people not turning up affecting waiting times? We trialled calling people in off the waiting lists for last minute cancellations and got a very negative response, most missed appointments you won't know about until then and there when there is really very little you can do in terms of filling a slot. Not to mention that most clinics are double booked in my department now (preciesly because of DNA rates) and all hell breaks loose the rare clinics the majority turn up....

I could go on forever, , but the fact is there are far too many patients who don't care and it really affects the whole service. Don't forget that pretty much everybody who works in the health service comes is a patient too and comes across the same issues, if the way a department is running isn't effecient in your eyes, pass along your thoughts, you may be onto something, but you really have to consider a very big picture.

I agree with everything you say bestb4. There really is no way round the appointments being inconvenient for some people. I've managed clinics where we only had the Consultant once a week - that was a choice of 4 possible appointment times per week. When he wasn't with us, he was at other hospitals and units. There was simply no way we could have arranged an appointment at 6pm on a Friday, for example, because that's the only time the patient could make.

And for those slots where someone doesn't arrive, there is very often plenty for the clinician to be doing. Catching up on phone calls, correspondence, even stopping for a few minutes to eat, dealing with the urgent issues that come up while they are in clinic.

It was BWH. I did complain, and subsequently got moved to another day/clinic which was much better, but the original day/clinic is still exactly the same. I don't think that you should only get a reasonable level of service if you are savvy enough to complain.

I completely agree that you can't expect to have a service tailored to your needs, but my experience was if I was given a 1pm appt time I would have to leave work at 11:30am to be sure I would be there half an hour early (as they threatened in their letter if you were not there early your appointment could be canceled) Then it would be usually be 3/4 hour (once 5.5 hours) from my actual appointment time for less than fifteen minutes of total contact time. I don't think it is reasonable to expect patients to have to practically a whole day off for such a small amount of actual time.

I have never missed an appointment in my entire life, but if the reason for the appointments hadn't been my baby (so not for me) I would have given up.

Admittedly this is just one hospital and I am sure that others are far better, but I do believe that in some areas of the NHS there is an attitude that patients should be treated like supplicants who should be grateful for whatever we get, when in fact we are the customer and should be treated with at least a basic level of courtesy and respect.