“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???

It’s the insurance that inflates the price.

All those ‘no win no fee’ cases cost the NHS (and all private consulting doctors tbf) more money than you can imagine.

I'd be more concerned about the bed blocking costing them billions and repeat A&E visits for patients who need day surgery.

My surgery would have cost the NHS £1500 (as confirmed by my consultant who was as angry as I was)

Me attending A&E about 15 times in the 3 months wait for surgery due to needing IV morphine for pain relief and them repeatedly trying to admit me and intentionally bed block for weeks on end probably cost them shy of several hundred thousand. The therapy I need on the NHS for my PTSD as a result of the shitshow lasting months on end will cost them another several grand.

The NHS is on it's arse because of piss poor management. Not lack of funding. It is pissing out money because no one can seem to effectively run departments or teach doctors and nursing staff to appreciate costs as well as healthcare.

If it costs £1500 for surgeries that are otherwise costing you millions over the year, instead of £600k, then you set up dedicated surgical teams and get people in and out as quick as possible. Initial outlay for long term savings - what a genius idea hey.

Just a dr who wasn't that bothered about patients sitting waiting for them

I have worked with one like this but not for long.

Change your GP, put in a complaint. Most are not like this but the odd ones give the rest a bad name. If you complain in writing they will respond and more people who complain about this will result in GP needing to change. Also, post a neg review on NHS Choices to give the GP the luck up the *rse they need.

I agree there are bad apples but this is not the majority of them .

I got turned away by a gp for problem I had. Apparently nothing wrong with me. The next morning I was in a&e and then rushed to surgery with the same problem which could of avoided surgery if I’d been given the correct treatment the day before. Why do I need to take up a valuable appointment to get my pill repeated? Why can’t the pharmacist check my blood pressure?
The amount of times I’ve been in knowing what I need from the doctor to be fobbed off for then 24/48 hours have a shocked doctor wondering why I wasn’t given the medication I clearly needed as on my notes is shocking. Then again if they can’t get dh’s penicillin allergy right even though it’s in big red letters what chance do any of stand. Then the doctor who went onto google to check symptoms for hand foot and mouth I give up.

@Chattymummyhere

Hopefully, with such continual appalling treatment you have made complaints and they have been upheld, and you have received a formal apology?

No I haven’t formally complained. My midwife once filed a complaint on my behalf though. Im used to crap standards from the nhs that I only go if I know prescription medication is needed. If it was my children getting bad treatment then I would. Can’t fault Pediatrics when my child needed them same as the military doctors are fab it’s general gps I find are the problem.

@Chattymummyhere
Do complain. I work for the NHS and I would want to listen and improve the services I was involved in providing. Sounds disgraceful.

@Tistheseason17

I did complain and I also left the practice and went to another surgery. Drs at the new one are fantastic apart from the more than 4 week wait for an appointment. It's so bad now that they close the appointments once that month is fully booked so you can't even attempt to book until the next lit are released. So actually, you might wait 8 weeks for an appointment.

I agree with a PP - those of us who are able to negotiate our way through the system, albeit at a cost, should speak up and complain in the hope that it can improve things for the more vulnerable patients who perhaps aren't in a position to find out about alternatives to their GP etc.

The argument used to be that if you have a life threatening illness then the NHS is fantastic but this just isn't the case now. My dad was admitted with a massive GI bleed last summer. Lack of appropriate treatment led to him suffering a heart attack as a result. The heart attach happened in the early hours of the morning and he received no treatment until we arrived at 8.30am and complained to absolutely everyone until he finally saw the most amazing dr who spent the whole day stabilising him.

We formally complained to the hospital and met with a group of consultants who admitted that the heart attack happened as a direct result of him not being given a blood transfusion despite him losing 4 units of blood during the haemorrhage. Had he received the blood he would not have had the MI and they apologised unreservedly, promising that staff had received training and procedures would change. Thankfully dad recovered but only because he had family who were willing to speak up. (plus amazing health insurance that enabled us to transfer him that day to a private CCU where they could care for him properly)

Just watching Ambulance on BBC1 and you can see just how bad the system is. Patients being taken to already collapsing EDs because the paramedics can't get an answer from the GP surgery and so on.

We really do need to rethink how we use the NHS. The system almost forces patients into it whilst at the same time collapsing from over use. Until you have cause to use it you cannot comprehend how unwieldy the system is - repeated visits to refer for tests, to get results from tests, to plan treatment, to start treatment, to monitor treatment. I attend OPD every 3 months to see my main consultant, interspersed with visits to the nurse consultant and my GP. They are all doing the same thing and ultimately rely on me to relay the information between them all because the admin side is so slow (I am still waiting for the clinic letter from January to be signed by the consultant and sent out. It's out of date now as treatment has changed.) Why not have just 1 person monitoring and co ordinating and then liasing with the consultant if necessary?

But, aside from this, all of the HCP that are treating me are fantastic. They never make me feel rushed, discuss my care with me, involve me totally in the care planning and really help me to live with my illness. It's just that the system is so disjointed and complicated that nothing is easy or straightforward.

Admin also needs staff and costs money and lots of these services have been cut to the bone. This might explain some of the long waits for correspondence.

I don't know how you can have tests and treatment started, monitored, changed, without appointments (telephone, face to face).

What I meant, but didn't explain very well, was surely 1 person could do that not 3 people basically all repeating themselves?

Honestly, I have blood tests done by all of them because the GPand the hospital can't see each other's tests (different health authority) and the nurse needs them done more frequently than the hospital. Then I have an appointment where the tests are ordered and then another to get the results, except that the wait for the tests (or procedure) is so long that I have the follow up before the procedure has been done (or hospital decide to change drug dosage and so write to GP asking them to prescribe, except see above "still waiting for clinic letter from January" so then I go back for review but new drugs not started or test results not available yet so given another appointment to come back, and then we start again.

Am sure GP, or nurse practitioner, could co ordinate and review. If any problems arise then ask consultant to see me.

Sorry for the ranting. It is just so frustrating to try and navigate this.It just cannot be cost effective to do it like this. The repetition of blood tests must cost a fortune alone.

As an accountant I know that you can cost something a million different ways... there is no such thing as “the cost”. However, I’m pretty sure the calculations used have been done with the intention of setting the cost to be as high as possible without being completely fictitious... for instance, the cost of thr doctor’s training could have been apportioned in (even though it happened 30 years ago), alongside an estimate of the additional treatment costs associated with a typical person whose condition deteriorated because they miss an appointment (ie if they turned up a month ago they wouldn’t have needed an operation).

What’s clear to me is that the £152 isn’t the cost of an appointment as most people would ordinarily understand it, even including surgery overheads. If this is based on a 10 minute appointment, that’s £912 per hour, or (assuming a 20 hour’s
surgery week as doctors will do stuff other than be in surgery) £18k per week, or (assuming a 45 week year including holidays), £820k per year. Say a GP in his/her sole practise earns £100k per annum, that’s £720k per annum for overheads... that’s not a remotely credible figure.

SweetieBaby - IKWYM and I understand your frustration. There is overlap and repetition and also things being missed. IMO there just isn't enough staff. Not enough Consultants, GPs, specialist nurses etc. There are various shared-care agreements to make things easier but it's definitely not a smooth process. If GPs took over the coordinating they'd be even more swamped.

They should be quite relieved some people don't show up

By the time I've waited for someone to arrive , keep checking, give them their 10 minutes leeway ( we have 25 minute appointments so if someone is 10 minutes late we can use our judgement if we see them or not. And yes, there will be the inevitible Well I'm always kept waiting ...not true, we try to run on time)

We have to phone them,(and listen to the excuses why they didn;t attend, usually argueing their appointment is the next day, then when they agree it was today, say "Oh, well, I'm a bit ill".....We have to send out a letter and email the GP.
And our patients have a text or phonecall reminder the day before

It would take less time if they did turn up. .

This is a sensitive subject for me as im a community nhs member (think nurse) who has a really high did not attend list

Each day i have 5 slots. On tuesday 1 was not home, 1 did not turn up to the office. 1 cancelled in the morning. For each of those prior to the appt i have called /sent letters etc, i then have travel time of aprox half an hour, then the 15 min waiting if they turn up. They dont attend so i then have to rebook an appt (so a 1 appt thing takes 2 slots) and contact again. And it will take me at least 20 min to write that up.

Im on about 27000 a year. I have annual leave, one morning a week i have meetings, one day of trainung a month.

My support network is huge eg. My immediate manager sees no patients and theres at least 5 above him on increasing ammounts of money.

We have about equal amounts of admin as we do clinicians, a trust legal team, hr, occupational health, it support, estates, training team etc. Thats just who i have had contact with in the last two weeks and not factoring rent, cost of equipment my work phone etc.

I think people would be shocked at how much it costs for them not to turn up.

Not to mention i have a huge waiting list that i cant get to because my appointment has been allocated to them

"I mean a private GP still has admin staff, lighting costs etc.

Also aren't GP practices private concernd that get funding from the NHS?"

I was reading an article the other day that states that not only do NHS organisations have to pay business rates, and private medical organisations can register as a charity and get big tax breaks. So the NHS has to pay ever increasing taxes, whilst the private companies increase their profit.

GP surgeries aren't independent entities. They are grouped together in Clinical Commissioning Groups, which are then grouped into Areas which make up NHS England. The CCGs simply control the purse strings in the sense that each surgery has a budget and they have to pay the pharmacies, hospitals and dentists for all the treatment that each patient receives.

I had to have expensive surgery outside of area and my case had to go through IFR (Individual Funding Request) to be discussed and deemed medically worthy of paying for me to have the surgery elsewhere in the country. Just as well really, as I couldn't get it done locally and without it I was visually impaired and could have ended up blind.

I love the NHS. Only an hour ago they sent me a text to invite me to book an asthma review. I called and got booked straight in on Thursday at 8:30am, with a text, email and google calendar notification sent before i was even off the phone. No reason fir me to forget now!

However, speaking as an NHS Systems Trainer, one of the biggest sources of financial drain that doesn't get mentioned much is the admin cock ups. Certain staff who have been around since the dinosaurs often refuse to use newer, streamlined processes and technology. It causes errors, the need to redo stuff, distress to patients and slows everything down. But it's very hard to sack people from the NHS, sometimes my team just have to wait for the worst offenders to get too arrogant and commit gross misconduct, then we can breathe a sigh of relief because they're out. It's happened more than a few times!

GP surgeries aren't independent entities

This is incorrect.

They are independent businesses. Usually partnerships.We don't pay hospitals, pharmacies or dentists.

We have a core contract of £85 per patient registered with us.

With this money I have to pay service charges, management fees, utility bills, phones, admin staff, nurses, practice based pharmacists, GPs. This includes pensions, sick pay, paper, ink, everything you have to pay when you run a business. I'm a partner.

The CCG in our area is so worried about hospital deficits it is cutting GP funding and using it to prop up hospital debts. This is where management is costing the NHS money. Plus they've had 2 restructures costing tens of thousands....

I manage inefficient staff properly but @TittyFahLaEtcetera is right. I know plenty of managers who are too frightened of getting sued to address those ensconced in poor practice.

Threads like this make me wonder what the amount of money people lose whilst waiting for appointments.

I perhaps oversimplified in my explanation, but I used to work in Commissioning and in my area the PCT/CCG does fund treatment. One of my colleagues now in an acute trust literally spends two weeks per month correcting admin errors so that the CCG agrees to pay for those episodes. Although the money does not come direct from the GP surgery, and technically comes from a centralised CCG pot, in our CCG at least, it is divvied up and listed by surgery and the amount allocated is determined by number of patients. It's not the same money that you use to run your practice of course, Tis and it's kind of hypothetical as none of it passes through your books. This is how I've always understood it in both my work in a CCG and secondary care, although I suppose different CCGs may have different procedures.

My trust sends a similar text reminder, but the figure used is an average, and the figure the OP quotes sounds much more like a consultant appointment fee rather than a GP one. Different specialities cost different amounts and the price varies depending on whether you're seeing one or more clinicians and whether it's your first appointment or a follow up.

For example, an appointment to see a general surgeon, say for a hernia check up, would cost either £163 or £206 for a first appointment, and £70 or £104 for each subsequent appointment. (Said hernia repair would cost anywhere between £1744 and £4361 for surgery and aftercare).

Source: NHS National Tariff improvement.nhs.uk/documents/597/Copy_of_Annex_A_-_National_tariff_workbook.xlsx {downloads an excel spreadsheet)

My comment about GPs not being independent entities was however, very poorly worded. I meant my response based on some of the replies implying that GPs were effectively making up their own prices, and meant to point out that GP surgeries are members of CCGs and are accountable to their CCG, NHSE etc.

I live in Kuwait. There's an abundance of excellent private hospitals. However you can go to a government clinic, walk in, show your ID and pay the equivalent of £4.50 and see a doctor pretty much straightaway. Any medication you need is included in this price. You do have to pay at the government hospitals also for X-rays etc but it's pretty reasonable. I love the NHS and what it stands before, but as I can see exactly what the current government is trying to do and its shocking.

Hi @TittyFahLaEtcetera
It's rubbish isn't It?
So much money wasted in secondary care by hospital trusts.
I had a tissue viability nurse call and say the GP practice had to do their post OP wound care. I explained, No - hospital has tariff for this. The response was simply...well we haven't got anyone here to do it. CCGs are pitting hospitals against GPs and Community Teams. Our CCG is dictator led and we have started to revolt. They want us to deliver more on less funding.

Oh well, hey ho! Rant Over, soz!

It’s actually incredibly difficult to cancel appointments at hospital clinics which doesn’t help. I have attempted to cancel several for my elderly parents who have been too unwell to attend at that time and it has taken literally over an hour, on hold on the phone, no ability to leave an answer phone message. I have resorted to email but as expected it didn’t get noticed and we received a letter complaining about the missed slot ( at which point I posted a copy of the email).
More admin staff would make a massive difference

It's difficult to change appointments too, at some hospitals.

I try to make follow up appointments in person but sometimes it isn't possible - if the clinic has over run the appointment desk has closed by the time I leave, or often I make an appointment and then receive a letter to say that the appointment has been changed. Sometimes I can't make the new appointment because I have another appointment on the same day or can't get the time off work but it is so difficult to change it. On one occasion, despite repeated phone calls to the appointment line (where they told me I had been discharged and so couldn't change the appointment!!!!) I asked PALS to intervene. Apparently someone had pushed the wrong button and discharged me, rather than re booked me.

Again, as a fairly competent person who has worked in the NHS I have some idea of how to navigate around it, but if I were someone who had difficulty with communication or wasn't quite so bolshy, I think I would just give up trying. Result? Another "missed" appointment.

I can't quite figure out what is wrong. In the private sector the admin side seems to work so much better. Is it because systems are more streamlined and therefore more efficient? I understand that they aren't so busy and maybe have more time but I have to say that a shortage of admin/receptionists doesn't seem to be a big problem for the NHS.

But there is a shortage of staff, reception and admin. Which is why you don't get to speak to a person but push buttons on an automated system. It hasn't made things easier IMO. It's not people not wanting to move with the times, in many cases The IT system just isn't good enough. This happens in the private sector too. E.g. more often than not when I try and pay my credit card by phone and tap all the right numbers but it still gets "stuck" and can't recognise something or other (voice or keyboard) and I get put on hold for a human.

I don't believe it costs anywhere near this much.

10 mins of a GP''s time costs about £6.50. 10 minutes of an administrator's time costs about £1.30, so that's a total of £7.80. The overheads need to be paid whether people turn up or not. Resources are less if people don't turn up.

It's a totally made up figure. I'm sure a Tory came up with it.

@LadyWithLapdog

Is there a shortage Lady? Maybe there is but it doesn't appear that way. I wonder if it is poor organisation of the staff? So, at 1 hospital I go to, the clinics are arranged in sort of sub waiting areas. Each waiting area has, usually 3 staff. There are 10 waiting areas so approx 30 staff. At this hospital you check yourself in automatically too. What if the clinics were combined and then you could have fewer reception desks? Another hospital the waiting room is enormous with consultation ooms leading off of it. The reception desks are along the sides of the waiting room but again, multiple desks with multiple staff, all in the same waiting room. Surely you could rationalise these desks and cut down on the number of staff?

Always, at every hospital or GP appointment I go to, the reception staff are chatting to each other, having personal conversations with each other, while patients stand waiting. If they stopped the chatting they could work a bit faster. I don't mean to come across so draconian but honestly, when you see this from the other side you realise where some of the waste happens. I think when you work somewhere your view is tainted - if you are working flat out and rushed off your feet you assume everyone else is too. I often see doctors come out of their room and have to wait to speak to a HCA or receptionist while they finish their chat. Numerous times the dr has asked for someone or something and been pointed in the right direction, leaving the dr, in the middle of a busy clinic to scurry off to find what they need, while the nurse and receptionist get back to their chat.

Honestly, I would advise managers to try and visit departments, incognito, and just sit and watch. I'm not saying these jobs are easy and yes, it's nice to build a rapport with colleagues but while such stringent cuts are being made in the NHS, with always the patients bearing the brunt, such obvious inefficiencies really bug me.