“Each missed appointment costs the NHS £152”

[TronIsAnAwesomeCatName]

Ok. I normally steer clear of AIBU, and am prepared to be flamed here because many people seem to treat criticising the NHS as blasphemy. But AIBU to think that £152 for 10 mins with your GP is just extortionate? How the flip does it cost the NHS that much for the GP to sit there and talk to me, maybe examine me (rarely seems to happen tbh) type a few notes on their computer? A private GP offers 15 min appointments for £55.
How is the NHS spending £152???

I think it is a mistake that cheaper items are no longer prescribed.

I went to the Dr recently and got a prescription paid £9 for it. It cost NHS more than £9. Other item couldn’t be prescribed, cost £3 retail. I am no longer allowed to give them £9 for it . They lost £6

dusty you are missing out that a prescription charge is not paid for the vast majority of prescriptions issued (around 90%). Also a medication that costs £3 over the counter, costs a lot more for the NHS to prescribe and dispense.

I think that you the cost of your presciption drugs ought to be printed on the label. So many people don't appreciate the costs of that.

Most good pharmacists wouldn't let customers pay £9 For something available over the counter for £3. The people getting the £3 item on prescription are the people who aren't paying anything for the prescription and oddly it costs the NHS much more than £3

Nobody pays directly in Scotland but i still think the costs should be highlighted.

The NHS has some curious "pricing policies". I once worked up a proposal for charitable funding for a project between various NHS trusts which included psychologist appointments. In my budget I calculated these at the rate a consultant charges for private (insurance funded) work (which would include their overheads for renting a room and paying a secretary etc).I was told that this was way too low for a mid-grade NHS psychologist. I was not popular when I said that we'd go private then....

I love dna me! My lists are far too heavy and a dna gives me some breathing space.

Sounds like they could save money by sending some nhs patients to your private GP...

They need to get the infrastructure in place and thought through more though - I've missed appointments in the past because the first I knew of the appointment was when the 'You missed the appointment' letter came through. It had been sent first class - the letter about the appointment was sent second class and they'd taken a week to get it into the postbox. In one instance it was for an appointment that was needed as a result of a complication after ds2 was born and there was probably a 2-3 week turnaround from when they said that I would need the appointment to when I would have had it (and then a week beyond that for the letter to turn up!) so if they had sent the letter reasonably quickly after sorting out the appointment for me I would have had it in time before the appointment. However it seems their system at the time was to book the appointment for you, then the letter got put into an admin person's in tray to write and sort out... Bonkers.

But if there were even 10 of those sorts of appointments made a week, where the letter didn't get sent out before the appointment happened, and that's just in one department, you can see how quickly appointments get wasted unnecessarily

I've also had an appointment that I almost missed out on - I was sitting there waiting to be called, checked with reception a couple of times as it had long gone past the time I was due in but didn't want to hassle them too much as I know that there are times when appointments need to overrun. Eventually the doctors came out, I stood up to go in expecting to be called - only to be told they were leaving as I had missed my slot. When asking why, as I had been sitting there since before my time to be seen, turns out that they hadn't come to check in the waiting room if anyone was there because they could hear that there was nobody there - there was no talking or noise. I had been alone (apparently people usually bring somebody with them so there's chatting!) and reading a book (so not on the phone talking or playing beeping games) and they hadn't checked on the system either. They also told me they wouldn't offer me another appointment as I'd missed two appointments (see above!) so I dragged them down to the receptionist's desk to get them to confirm that I had been there on time and so I hadn't missed this appointment, plus I'd got the other letter with me, that was dated after the date of the appointment, to prove why I'd missed that. So they grudgingly said they would do the appointment there and then (and cut into their lunch time!) but in hindsight I wish they would have let me make a new appointment as it was a very quick and perfunctory appointment that was very unsatisfying and left lots of questions unanswered.

I've also had GP appointments that I've been at but had booked the last one of the day, only for the GP to have not got any appointments preceding it, so not scrolled down to see the end of the day and then gone home thinking that they had finished...

So while patients can miss appointments, there are times when this is the fault of the system which they need to fix themselves.

I also think that maybe if some appointments could build in a little flexibility into the system so for example, if somebody turns up early and somebody turns up late, the system could automatically switch their appointments over to reduce wasted time.

It is really interesting to read the assumptions and ideas that people hold in relation to NHS financing.

We have a distinction in the NHS between purchasers of healthcare (clinical commissioning groups) and the providers (hospitals mainly). Hospitals get paid per appointment, so the ‘cost’ of a missed appt is not necessarily the actual cost of the service, but a cost in the sense that a hospital loses income when clinics are cancelled or patients do not turn up. In either scenario the hospital / NHS loses out. The cost of that appt will be based on average costs across the NHS, so some hospitals will make a surplus and some will again lose out.

Hospitals generally spend more than the income they receive, and many of our hospitals run at a loss, with a growing financial deficit. NHS finances are in an absolute mess. Add that to the challenges of increasing obsese, elderly and long term sick populations, and the huge difficulties in recruiting staff at all levels, and we are on the verge of a crisis.

Several people missing the point that I wasn’t complaining about being informed of the cost - certainly don’t think I’ve been indignant about it(!) - I understand the need to make people aware - I am questioning why it is so much, when the same service can be provided for a third of the price privately, that does smack of systemic inefficiency (note - not individual inefficiency - big difference - I fully expect every individual doctor, nurse, support and managerial staff to be working their hardest, as we all do in our own jobs! But if the system is broken then the whizziest manager in the world isn’t going to be able to mak e it work.

But seeing as it seems the cost I was sent in my reminder text was probably inaccurate, hopefully, I’m less concerned

this is part of their effort to make you feel responsible for everything that goes wrong due to mismanagement (ie instead of questioning how things are run we're meant to accept that we're taxing the system with our presence and there are always people worse off etc

Exactly ... and IME too much of it is driven by attitudes capable of producing something like "if they have to ask, they can't afford me"

The average cost includes a lot more than just GP time

• receptionist
• computer costs
• tests
• equipment
• consumables such as gloves etc
• nurse
• rent, heat, light
• insurance

I have seen private GPs and the final cost is often higher as I had to pay for all of my blood tests individually and then for the follow up telephone call to discuss results. Some private doctors are excellent but one doctor (paid for by employer) just seemed to be a money making wheeze - he didn't even have basic equipment (looked at my throat using the light on his mobile phone) and his "report" was just a cut and paste from my hospital records!

The NHS provides some expensive services that the private sector avoids - suce as the cost of intensive care. The NHS cannot cherry pick "profitable" patients

Sadly I've had way too much experience of hospital over the past few years and the inefficiency (mainly of the system, not of the people) makes my blood boil.

• I've had appointment letters posted to me after the appointment date

• arrived to be told that the day that the clinic is on has now changed so come back on Friday. Ok, that cost me, not the NHS but what of the patients needing hospital transport? Plus, I lost a day's wages and had to pay train fare into Central London

Clinics where you are seen by a dr, then sent for an xray and then back to see dr. Repeated several times. Eventually we asked the dr if an xray was needed on the next visit and if so could we have the form now and then have the xray first, so that we would have it when we went to see him. He was genuinely astounded at this and said what a good idea!!!!

Duplication of tests because 1 hospital can't talk to another - ok I understand that it costs too much to upgrade IT systems so how about giving test results, scan reports etc to the patient so that they can share them to multiple caregivers? I do get copies of blood results, reports etc but it can take months to get them sometimes. When you go privately you are automatically given test results and very quickly so that if you are seen by different consultants they don't need to duplicate tests. (I have given the NHS copies of tests that I've had done privately and they have accepted them so it isn't only a safety consideration.)

Why are patients given such large quantities of drugs when starting a new treatment? I have so many tablets here because a treatment has been changed or stopped part way through a course either because they weren't working or because of an adverse reaction. The pharmacy won't take them back and so they are wasted. Why not only supply a week or 2 at a time until treatment is established? (still only issue 1 prescription so the patient only pays 1 charge but chemist could issue an IOU as they do now if they don't have enough of an item in stock).

These are only a few observations but surely when you multiply across all patients the savings would add up?

When I was little my GP surgery didn't have appointments. Every surgery was open so you turned up and waited. No missed appointments and everyone who needed to be seen was seen. Something to think about?

I think the private GPs are artificially low as a sort of "tempt you in" offer. They make up the difference charging for tests, follow up appointments and basically having you in the system. I think they also tend to get the minor illnesses and inconveniences presenting there as more complex and serious illnesses would be prohibitively expensive and well catered for in the NHS system. There is probably a lot of "check this wart," and ingrowing toenails which they can speed through.

I would rather guilt laid at the door of people not showing up for appointments than all this guff about paracetamol and prescription calpol (even better if we would start blaming the politicians for the mess instead of turning on each other).

If you lot are so unhappy with your treatment on the NHS DON'T FUCKING USE IT.

But you will won't you??

Unfortunately people rarely value that which they get for free

How about considering how much a GP practice gets paid?
£85 rising to £87 for each pt to see their GP and nurses as many times as year as they need to - or in some cases we have patient's who say, "I'm entitled cause I pay my taxes"
The average number of apptmts used to be 4/yr per pt. It is nearer 10 times a yr now but GP income has not increased this amount
Over 90% of NHS apptmts are with GPs who only receive 6% of the NHS budget. Hospitals are in deficit so CCGs are taking money from GPs to bolster the Trusts.
Hospital apptmts are 30 mins so that is the large associated cost of a missed appointment.

But every time someone cancels there is someone else who needs to be seen and they were already tagged to the end of the day and can't be seen earlier because someone didn't think to let the surgery know. Demand exceeds supply so when you may be at home having seen your GP at 6pm, your GP will be working until 9-10pm.

So when you pay 95 quid for one GP apptmt just remember your GP only gets £87 for as many appointments as you want each yr.

Bless the NHS and those wonderful underpaid, overworked staff. They do it cause it's a vocation. Could you say the same for the private pay per apptmt GP....

You may have to wait 3 hours to see your GP but bear in mind they may be dealing with some very poorly or terminally ill patients. Your ingrowing toe nail isn't an emergency!

Sorry, this attitude bugs me every time I read it on here.

We have every right to complain about the NHS. We aren't complaining about the staff, on the whole. We are complaining about the organisation that appears to be wasteful to many of us. We should complain because that is how things change. We should lobby MPs to make changes, to fund care properly. We shouldn't just accept whatever crumbs we are thrown gratefully.

And yes. Maybe the dr was running late because they were seeing someone in more need than me and I would gladly wait if that is the case. On the other hand, I've been sat in the waiting room at 9am for my appointment and watched the dr walk into the surgery at 9.45, have a laugh and a chat with the receptionist about taking their child into school, make a coffee and still not call me in until after 10am. No apology, nothing. No terminally ill patient being seen, no emergency patient crawling in off the street with their head hanging off. Just a dr who wasn't that bothered about patients sitting waiting for them. Meanwhile, I was trying to explain to work why I wasn't likely to be showing up anytime soon.

@DustyMaiden It's a new rule that's coming in at the end of the month

So you see a private consultant and are do pleased to only pay £x (or nothing, if covered by work insurance). Then realise the private prescription would cost £50-250, whatever, and go back to the NHS dr to 'convert' it to an NHS prescription. But yes, private is great and so efficient. Especially when you don't actually have to pay.

It says this on the letters I get for my son to have his appointments with paediatric eye clinic too.

LifebeginsatGin I haven't used the NHS in over 12 years. I live abroad where the free at the point of use healthcare functions far more smoothly. The NHS is no longer anything close to being the shining example it used to be, and doctors are not better nor worse than anyone else, nor do they work harder in proportion to what they earn over the course of a full career than others in any kind of caring, health, social work or education job (I know, I'm related closely to plenty of them). It's not sacrilege to say that.

But it isn't really just a matter of "if you don't like it don't use it" is it?
I have had appointments cancelled, consecutively for 3 years.
Ive turned up for appointments that were cancelled on the day, at a huge personal expense. I can get myself to appointments in fairly little discomfort. I can cover my childcare costs and I can speak in my own language . I can communicate with Pals, albeit to no avail. At a push , I can go private. I have in the past at huge expense, and by that point my situation was pretty dire.
So I personally feel that drawing attention to things that could be improved within the NHS is important, for those of us that have no choice . A cancelled appointment is a whole different ball game when the public transport cost is your weekly food budget. Or complaining to Pals isn't so easy if English isn't the first language.