About inflexible NHS appointments?

[RedLemonadeNTaytos]

I’m willing to be told AIBU if there are any NHS hospital staff that know better than me, but I am SO frustrated today with the attitude of the guy I just spoke to in the ultrasound department and need to get some perspective.

GP referred me for a scan due to heavy periods & bleeding between periods. I got an appointment within a month but the day before it I was ‘pinged’ by Track & Trace. I phoned the appointments line & the hospital switchboard repeatedly that day and the day of the appointment to tell them I couldn’t make it l, but never got any answer. I also sent an email to the generic appointments address. I think I tried the phone about 30 times, though! (Luckily I obeyed T&T, as I did actually have covid).

Anyway, called GP to explain and ask to be re-referred. Letter came through 3 weeks later with an appointment time but it’s on the first day of my new job. Not ideal, in fact a massive pain, as I am attending a large staff meeting as their new manager in the morning, then going on an expensive and non refundable bit of training in the afternoon.

Finally got through to hospital on the fourth day of trying the ever ringing line, hoping to rearrange l, and was told because I had ‘DNA’ one appointment, this was all they could offer me, they couldn’t give an alternative date, and I will need to go back to my GP to ask to be re-referred, but they may NOT offer me an appointment because I have ‘failed to attend’ two appointments.

I wasn’t expecting to be given any date or time I fancied, just an alternative to my first day in a new job. It just seems so bureaucratic and time wasting, and the reasons the guy on the phone gave were jumbled and didn’t make sense and he was really bloody rude!

Why is the system so inflexible?

The biggest challenge facing the NHS appointment system is DNAs. It makes it incredibly difficult for each department to use all clinic time effectively.
The fact that the service is free (at the point of access) is probably at the root of this. It's a real problem. I really don't blame the service as a whole for a certain amount of gatekeeping and having limited patience for constant rescheduling of appointments.

@opalescent

The biggest challenge facing the NHS appointment system is DNAs. It makes it incredibly difficult for each department to use all clinic time effectively. The fact that the service is free (at the point of access) is probably at the root of this. It's a real problem. I really don't blame the service as a whole for a certain amount of gatekeeping and having limited patience for constant rescheduling of appointments.

But lots of the DNAs are caused by the NHS appointment system. Fix the system and it wouldn't be so overwhelmed but to do that the NHS (and individual people) need to take responsibility for the failings.

Like with the PP who received a letter dated and sent after the appointment offered on the letter ... how did that get through the admin process to the point it was actually sent to a patient?!

PALS can sort this out. I had the same happen a few months ago.

I also phoned the dentist and said DS would have to miss his brace fitting as he was isolating as a school contact (this was in 2020). They threatened me that he would be struck off the waiting list if he got too old to receive a brace on the nhs. And made us wait 6 months until the next available appointment!

If he had to isolate again we’d just have to go to the appointment wouldn’t we? Talk about a lose lose scenario!!

I can only assume that the general disgust towards the NHS on this thread stems from the fact that Mumsnet is largely middle/upper middle class. And therefore people are used to far 'better service' and not having to (gasp) inconvenience themselves to fit around an incredibly overwhelmed and understaffed organisation.

I think most of us just realise that if we were this incompetent and inefficient in our jobs we'd be fired

@BigWoollyJumpers

digital.nhs.uk/services/e-referral-service/helping-patients-manage-their-referral-online

Please all also show this to your GP. We all now (most of us) are using the NHS App, this is the next step. It's there, get your GP's to use it.

This looks amazing. Can any GP surgery use it?

The sheer proportion of appointments that are real DNAs is huge*, it causes so much waste as obviously its too late for another patient to be offered the appointment. I think this is why the policies surrounding it are so strict.

However, in your case you were NOT a DNA, which should be the crux of your communicae going forwards.

Anecdotally, my doctor sister sometimes has 50% DNAs at her clinics. You can imagine how overstretched services are at the moment and the impact that half the patients not turning up has.

@EssentialHummus

You can pay privately and book at a convenient time but free healthcare can’t be as flexible due to the sheer number of people using it. We are very lucky to have it.

This attitude is the cause of so much of what's wrong and as it stands unfixable in the NHS - because it's seen as heretical to complain and we should just doff our caps and be thankful for any treatment at all, any phones answered, anything resembling half-decent service.

We're the clients here. The NHS is not some sort of benevolent overlord that heals the poor ad hoc Mother Theresa stylee, it is an enormous organisation that receives money from gov't and ultimately from taxpayers to provide a service. If no one answers the phone time after time - that's not good enough. If you have an appointment booked but haven't been notified of it (if only there was some sort of communication faster and cheaper than the 2nd class letter...) - not good enough. If as a patient you're routinely kept hanging around for 2-3 hours for an appointment - not good enough. Not being able to access primary care within a reasonable timeframe - not good enough.

What's the alternative, really? "Oh yeah, I have stage 4 cancer that's gone untreated for months and my kids will be left without a mum soon, but it's alright because we're lucky to have the NHS"?

Excellent post

If he had to isolate again we’d just have to go to the appointment wouldn’t we? Talk about a lose lose scenario!!
I wouldn't be surprised to hear people do this because of the fear of not getting another appointment

It's ridiculous. 20 years ago when I moved to Belgium I was gobsmacked to be offered a selection of appointment times with a specialist in the area I needed (no need to go through a general practitioner first if you knew what sort of dr you needed). It was so different to my nhs experience. I got the majority of the cost back from my insurer and paid around £10 myself. The appointment lasted around 45 minutes and the dr made a real effort to explore the issue and my medical history. The nhs is in the Stone Age frankly.

And therefore people are used to far 'better service' and not having to (gasp) inconvenience themselves to fit around an incredibly overwhelmed and understaffed organisation.

I constantly inconvenience myself to fit around this incredibly overwhelmed and understaffed organisation. I can’t do that however when they don’t actually tell you who your appointment is with, or give you any way to contact them to find out. I spent the best part of a day phoning round various hospitals and departments to figure out who my DD was meant to be seeing to no avail, we couldn’t have attended the appointment if we wanted to - or we could have turned up at any one of 6 specialisms hoping we’d picked the right one.

The understaffed, overwhelmed organisation would be much less overwhelmed if they communicated more clearly so people had a fighting chance of actually turning up, or indeed rescheduling if need be.

Anecdotally, my doctor sister sometimes has 50% DNAs at her clinics. You can imagine how overstretched services are at the moment and the impact that half the patients not turning up has.

If 50% of people weren’t turning up, I’d be checking the booking system to make sure they were efficient and effective, and not like mine and others experiences here.

my more than frustrating NHS appt experience today.....my GP surgery uses the 8am rugby scrum phone call technique ( I work in the NHS myself shifts starting before 8am) or the online econsult system.
Duly filled econsult in last Thursday morning..appt given for today, just a date given in econsult reply but a specific time given in patient access app....all good 👍.....erm....no....took annual leave to accommodate early finish from shift got home & waited for call (as rather difficult to take dr appt calls in ICU!)...90 mins later ring GPs....said they had tried to ring me an hour before the appt time....when I asked about the the time I’d been given...they have to put a random time in so the computer can say yes 🤬 & they can’t give a time for the appointments!! 🤬🤬🤬 it can be anytime on that allocated day ! I now have to go through the whole debacle again & either wait til a day off end of next week, take annual leave or perhaps I’ll go with the irony of ringing in sick to stay in & wait for a gp telephone appt! 🤔

YANBU!

Myself and DH (and several others I know,) have had difficulty with the NHS appointments system.

As you say @RedLemonadeNTaytos if the appointment they send is inconvenient (and it often is,) you can't just ring and change it, you are sent another one (which is often inconvenient as well!)

Also, we have had an appointment for say 15th July, and it's OK, as we are off work or manage to get the day off, and then a week before, we get a letter saying 'unfortunately we have had to cancel your appointment, a new one will be sent out in the post!'

AND my DH had an appointment on 10th June this year, and 5 days before it, we got the automated 'let us know if you will be attending' call, and DH pressed 1 for yes! 48 hours later, someone called from 'the bookings team' to say the 10th of June appointment has got to be cancelled.

DH said 'but this was booked 3 months ago, and I only confirmed I was coming the day before yesterday. What on earth has happened in the last 48 hours that means my appointment in 3 days has to be cancelled?!'

The guy on the phone said 'no idea. I have just been asked by 'the consultant' to cancel it. ' DH was fuming, He had got someone to cover his shift at work, and so he lost his 10 hours pay! He couldn't ask the person who covered his shift to just not do it anymore! It doesn't work like that!

DH reckoned the weather forecast predicting lots of sun and warmth the following week, meant the consultant had cancelled all his appointments. We are actually sick to fucking death of this shit now. These consultants act like they are the most important people in the world, and no-one is allowed to question them. Fuck everyone else and how they have been inconvenienced!

Several years ago, DH had to attend a hospital 4 or 5 times, that's 30 miles away from us. On 3 occasions, they made his appointment for 7.45 to 8.00 a.m. The hospital is right across the other side of the city where the hospital is, and they made the appointment for 8.00 a.m! It's an hour and a quarter trip in the car, when it's not the rush hour!

We had to leave at 6.00-6.15 a.m. to avoid the bloody rush hour! Sounds a bit moany I know, but we were pissed off when we were still sat there at 9 a.m. and several people came in for appointments at 9.15 a.m to 10 a.m and they lived 10 minutes walk away! Why didn't they get the bloody 8am appointment?!

As a number of people have said, it IS OK to complain, because the NHS is NOT free; we pay for it, and the appointments system is a shambles. They act like everyone has got nothing else to do in their life, except sit there waiting for appointments, and will not be inconvenienced or bothered if the appointment is changed again and again! The system is not fit for purpose.

Oh and let's not even MENTION the fact that the letter with our appointment on, always has (in BIG BOLD LETTERS) patients missing appointments costs the NHS £200 million a year... (or whatever it is!)

Hilariously ironic, considering they constantly cancel/re-arrange peoples appointments!!!

Just looked, it's £216 million a year, for people not turning up!

Anecdotally, my doctor sister sometimes has 50% DNAs at her clinics. You can imagine how overstretched services are at the moment and the impact that half the patients not turning up has.

But surely if the DNA rate is so high your sister should be looking at why. 50% of appointments missed is very unlikely to be genuinely just people not giving a fuck and not turning up, but an issue somewhere in the system.

Are all patients receiving their letters?
Are they receiving them in a timely manner?
Is their adequate ability for them to reschedule or even inform the clinic in a timely manner if they can't attend?
What is the procedure for filling last minute cancellation?
Why isn't she feeding back to these patients to find out why they didn't attend?

@Jellycatspyjamas

Anecdotally, my doctor sister sometimes has 50% DNAs at her clinics. You can imagine how overstretched services are at the moment and the impact that half the patients not turning up has.

If 50% of people weren’t turning up, I’d be checking the booking system to make sure they were efficient and effective, and not like mine and others experiences here.

Exactly. If that is the case they need to reflect on the cause and change what they are doing, rather than baselessly claiming that 50% of their patients are selfish bastards in order to justify doing nothing.

There is a reliable body of evidence showing why this occurs and what healthcare institutions can do about it. If they fail to do so then that is on them.

In general no-shows I think are wrong, but there are a few exceptions to this, and Covid diagnosis should be one.

The NHS is not the only organisation to set appointment times at their convenience and expect everyone to be at their beck and call, and I would welcome this being changed along with a number of other organisations. Especially 'Morning' or 'afternoon' from utiltities or parcel carriers, which is not an appointment, but an approximation, and a practice government should outlaw.

@AngryWhompingWillow if you know the name of the consultant, I suggest a formal complaint about his conduct to the General Medical Council.

I expect the reputation of doctor's receptionists contributes to people not bothering to cancel appointments, not that is an excuse.

There are thousands of people who need appointments. Even if only 20% of the patients were calling to rebook we’d be inundated! And for lots of people there is never a good date/time. Presumably if we charged for missed appointments/ change of appointments people would turn up no question asks. And to those asking about online appointments. I’m pretty sure that’s what the gp’s did and were lambasted for it. Our system sends our letters, texts and emails and despite requesting that people keep their contact details up to date, A significant portion of patients will swear blind that they never received the information so other then using a carrier pigeon I’m not sure what else we can do!!

There are thousands of people who need appointments. Even if only 20% of the patients were calling to rebook we’d be inundated!

Only because the system isn't fit for purpose. If there was was system of sending a letter and asking people to call and book an appointment with the relevent clinic (in the same way you book a dentist appointment) then people could book the most convenient (or at least the least inconvenient ) appointment and then are more likely to keep it.

And for lots of people there is never a good date/time.

No, not when you are deciding when to send me an appointment for and then make it awkward to reschedule.

Presumably if we charged for missed appointments/ change of appointments people would turn up no question asks.

Not the case.

If I don't get a letter for an appointment on Monday until Tuesday then I'm still not turning up to the appointment on Mondah no matter how much you charge ... though if you charge for missed appointments you would have to prove that the patient was a) informed and b) provided a way to cancel before the chargeable period which would be a better system than the current one.

Our system sends our letters, texts and emails and despite requesting that people keep their contact details up to date, A significant portion of patients will swear blind that they never received the information so other then using a carrier pigeon I’m not sure what else we can do!!

Maybe believe them? If they haven't kept their details up to date, whilst they are to blame for not doing that they are also not wrong to say they didn't receive the information.

But, for every patient who doesn't keep their information up to date there are hundreds who have and still get messed around with appointments.

As PPs have said they have received letters after the appointment day, not at all, without relevent details (such as different venue) etc and then are the ones blamed for DNAing. I

Maybe if the system stopped blaming patients for the systems failures then we could start to overhaul it to a functional one? And, if the system stopped treating patients like they're an inconvenience for daring to do anything but grovel at the honour of being allowed to use the NHS then patients might have more respect for the system they can see is trying to improve.

I can only assume that the general disgust towards the NHS on this thread stems from the fact that Mumsnet is largely middle/upper middle class. And therefore people are used to far 'better service' and not having to (gasp) inconvenience themselves to fit around an incredibly overwhelmed and understaffed organisation.

Like a PP I suspect it's that we're a literate and generally middle-class bunch, some with experience of different healthcare systems, who recognise the gross inefficiencies inherent in the NHS. A patient should not have to routinely "inconvenience themselves to fit around an incredibly overwhelmed and understaffed organisation". We're not here to protect the organisation, none of us.

Medical secretary here who manages team waiting list and sends appts out. Our waiting list is at something like 4 weeks just now. I do feel like a hairdresser sometimes but always try to accommodate if I can. However it's all about to stop and the appointment team is taking over. I fear for "my" waiting list and the poor patients ...

@melj1213

There are thousands of people who need appointments. Even if only 20% of the patients were calling to rebook we’d be inundated!

Only because the system isn't fit for purpose. If there was was system of sending a letter and asking people to call and book an appointment with the relevent clinic (in the same way you book a dentist appointment) then people could book the most convenient (or at least the least inconvenient ) appointment and then are more likely to keep it.

And for lots of people there is never a good date/time.

No, not when you are deciding when to send me an appointment for and then make it awkward to reschedule.

Presumably if we charged for missed appointments/ change of appointments people would turn up no question asks.

Not the case.

If I don't get a letter for an appointment on Monday until Tuesday then I'm still not turning up to the appointment on Mondah no matter how much you charge ... though if you charge for missed appointments you would have to prove that the patient was a) informed and b) provided a way to cancel before the chargeable period which would be a better system than the current one.

Our system sends our letters, texts and emails and despite requesting that people keep their contact details up to date, A significant portion of patients will swear blind that they never received the information so other then using a carrier pigeon I’m not sure what else we can do!!

Maybe believe them? If they haven't kept their details up to date, whilst they are to blame for not doing that they are also not wrong to say they didn't receive the information.

But, for every patient who doesn't keep their information up to date there are hundreds who have and still get messed around with appointments.

As PPs have said they have received letters after the appointment day, not at all, without relevent details (such as different venue) etc and then are the ones blamed for DNAing. I

Maybe if the system stopped blaming patients for the systems failures then we could start to overhaul it to a functional one? And, if the system stopped treating patients like they're an inconvenience for daring to do anything but grovel at the honour of being allowed to use the NHS then patients might have more respect for the system they can see is trying to improve.

You do realise that tax payers pay for NHS dentists through taxes and then we pay again. Some dentists charge for late cancellations and DNAs. Should we have that system?