NHS Appointment System Screw Ups causing wasted appointments

[Teentrauma]

Our area uses an online system for appointments where you receive a text from which you can download the appointment letter and have the option to confirm, rebook or cancel. You then receive a text reminder a week before the appointment where you get the same options again. Initially I thought it seemed all very efficient and time saving but now I'm not so sure.

My son had a follow up appointment booked in May for something non urgent. A week before, something unavoidable came up which coincided with the text reminder so I clicked "rebook" which was acknowledged. A week later a new appointment was texted through for a couple of months later which I accepted. A few weeks later we received a letter from the consultant saying we'd failed to attend the original appointment and, having reviewed the file, they were happy no further appointments were needed and were discharging him. We were happy with this as didn't feel the need to attend to be told what we already knew but felt bad they didn't get the cancellation and wasted an appointment which they said was worth £160. I assumed the rebooked appointment would automatically be cancelled

It clearly hadn't been as several weeks later we received a text saying they needed to reschedule it, offering a new date for November. I clicked "cancel - no longer required" and received a confirmation. Then yesterday, I received a reminder for the same appointment (it's next week) so it clearly hadn't been cancelled! I clicked cancel again and received confirmation but hope it actually has been cancelled this time! While I'm tempted to call and confirm to be sure the appointment isn't wasted, I can't be bothered to sit on hold for ages!

No idea whether this is a human or system error but, either way, it's not helping what is already a service in dire straits, assuming this is a common occurance.

Anyone else experienced this?

The DNA statistics must be an absolute joke

I can sympathise OP. When our Trust went to a centralised booking system we had a huge rise in missed appointments and the clinical staff were no happier than the patients about it.
Personally, I think that disassociation of admin and clinical sides of the NHS is a fundamentally bad idea because we are dealing with people not making ball bearings. Through most of my Consultant career I had a fantastic Secretary who was the glue who held our department together. Not only did she know all the staff inside out, but she would pick up on things about patients like if when she was typing up clinic letters she heard that a patient had disturbed sleep, she'd make a note not to give them an early appointment next time or if she recognised the address as being in a village where public transport was poor she'd pick an apppointment time that fitted with the buses. But that's not an efficient way to do things apparently. In the brave new world, letters are typed in a pool, not even necessarily by someone in the same department, and bookings are made in a call centre that not only isn't in the hospitsl, it's not in the same town. So nobody joins the dots and patients are reduced to being their NHS number on a list. And our fantastic, experienced medical secretaries are a dying breed sadly.
I'm sure I'm just an old (now retired) luddite and that IT has marvellous potential to improve some things, but I think people will always appreciate dealing with people. And getting to talk to an actual human being at all, never mind one who actually knows something about you, is getting increasingly difficult these days.

Yep, NHS admin is a fiasco, but it's nothing new, it's been like this for a decade or two. I can remember similar happening when I was first diagnosed with diabetes in the late 90s, i.e. appointment letters received on the day of the appointment or the day after, and a GP rollocking me for missing an appointment a couple of weeks before that I'd phoned up to cancel and re-arrange, the receptionist had made a new appt, but didn't cancel the original one.

It's happened frequently to me and my OH over the past 20 years too. OH has cancer, so has been having loads of appointments over the past 5 years, for scans, x-rays, blood tests, his own consultant, other consultants, etc. You get an appointment letter with a phone number at the top, but either it's just an answerphone they never respond to or sometimes it's a disconnected line so you can't contact them to cancel/rearrange. So you have to phone the dept directly (rather than appointments dept), who transfer you to someone to make you a new appointment, but can't cancel the original one, so you get the dreaded "FTA" against your record, even though you've tried your hardest to cancel it!

The best/worst is where you get two conflicting appointments that you can't make, i.e. same place same time, or different places not enough time between for travel. You try to re-arrange and get the appointments clerk from hell who won't listen to reason and tells you that you'll be put to bottom of the list if you re-arrange or don't turn up, even after you've explained the conflicting appointment is also with the NHS - they don't care, and just tell you to change the other one! We even had that once where we ended up talking to the same person (it was a hospital with an appointments office that dealt with multiple departments) and she couldn't actually give us an answer as to what to do when we explained we'd just spoken to her a few minutes ago and she'd told us to "cancel the other one" which we were now trying to do, but she told us to "cancel the other one" again, so same person telling us to cancel the other and not allowing us to cancel either without being put to the bottom of the waiting list!

The "NHS" is digitised but there are so many different systems, which in theory could communicate with each other, but no one will pay for that to happen. It is completely inefficient.

I the area I'm in, there are 8 different trusts plus all the GP surgeries using 7 different clinical record systems, and none of them link to each other. Add in social care and that's another record system which doesn't link.

Plus, for each person that wants all those providing care to be able to see their whole record, there's another who refuse any sort of record sharing, so even if on the same system, different services can't see what other services have done. And if you want something by email, every different system needs to have approval that you have a verified email address. It needs £££ that no one is willing to spend, even though in the longer term it would probably save money because of ongoing efficiency.

Combine all that with IT kit which often isn't fit for purpose, and it's a digital disaster.

@cuteasaduck sorry about your dad. You'd think they could at least get it right for cancer patients.

The only benefit of the computerised system it seems is that letters can't get lost in the post, but they can still cock up the appointments wasting everyone's time, not least the doctors who could be treating someone else. It's more than 4 months since I first cancelled that appointment, ample time to offer it to someone who needs it. Now they have less than a week assuming they do actually cancel it this time!

@AgeingDoc

Through most of my Consultant career I had a fantastic Secretary who was the glue who held our department together. Not only did she know all the staff inside out, but she would pick up on things about patients like if when she was typing up clinic letters she heard that a patient had disturbed sleep, she'd make a note not to give them an early appointment next time or if she recognised the address as being in a village where public transport was poor she'd pick an apppointment time that fitted with the buses.

Yes, personal service is sadly long gone is all walks of life. At least my OH who has cancer has got to know some of the many admin staff he has to deal with in our local oncology dept. It's taken him 5 years or so, but now has a general idea of "who does what" and they're finally getting to know his preferences. After 5 years, the staff now know that he picks up his monthly chemo drugs from the local hospital pharmacy - apparently it was impossible to set it up as "default" on the system, so every month he had to phone around trying to find the right person to tell to issue the prescription at the pharmacy and not the cancer ward at the hospital in the next county which is where it ended up every month! Likewise with appointments, it's taken forever but they now give him an early morning appointment for his monthly oncologist telephone appointment so that he can go to work without missing too much of the day.

I do think that some times there are too many admin staff involved which dilutes things and makes the organisation harder and reduces efficiency. Once he had to have a private MRI scan and he must have phoned a dozen different people trying to get someone to tell him how to get the report/cd to the consultant - i.e. the oncology out-patients receptionists didn't want it, his "named" cancer support nurse didn't know, oncology day treatment centre didn't want it, the oncology ward staff didn't know, etc etc. He finally got through to the consultant's secretary (who seemed to be guarded by a ring of steel as no-one would give OH her phone number or transfer him to her on the phone), who was literally sat in an office next to oncology reception - her answer was quick and simple - just drop it off at reception! Why did it take multiple phone calls for someone to tell him that (after the receptionists had originally said not to!). At least now he has her name and number so has a point of contact when no one else will help!

It would be soooo much easier and more efficient if their new systems had fields in the database for that kind of thing. How much time is wasted on re-arranging things that could have been done better in the first place? Databases are fine for basic data storage and processing but they don't replace the "human" capital of staff knowing long term patients and staff knowing other staff and what they do!

I had a text about a telephone consultation booked for July (not on a smartphone, no email letters etc). I text 'confirm'. They didn't phone me. I reported this to my GP surgery and also the hospital department.

The hospital had no record of an appointment ever being made and the GP surgery refused to liaise with the hospital to ensure I didn't get wiped off the waiting list for non attendance (not answering the phone to a phone call that didn't happen and apparently wasn't even booked!).

I contacted the hospital again to see if I could get a new appointment, but they said I had to be re-referred by the GP surgery.

I had another text message through for a telephone appointment this afternoon. I originally requested a referral to the hospital from the GP surgery back in late December last year. I've moved from an area where I had direct contact with hospital specialist nurses and consultant secretaries to an area that just constantly sends me round in a loop with no communication between departments and no clearly defined chain of who to contact to arrange care that requires additional funding.

My God. All the above ought to be sent to the Minister for Health.
It's broken. :-(

This is what annoys me when someone proposes charging patients for missed appointments - the assumption is always that the NHS appointment system is perfect & patients are in the wrong.

Another example of the NHS failing to help the patient get treatment: a Minor Injuries Unit which is advertised with the wrong opening times & wrong method of access to services. Surely the cost of putting this right is minimal, versus the number of patients who would be enabled to access the service?

Why aren't these things put right? If doctors & consultants know their patients aren't getting appointment letters, why isn't there a way for them to raise this with their Trust?

Hmmm. Thinking I should raise this with my MP or someone. It's happened twice to us (so far!) for this one issue and we actually don't have many hospital appointments as a family so god knows how many hours are being wasted by people failing to attend appointments they didn't know they had?!

I think you should- and possibly some of the rest of us who have had similar experiences. It is a shame that one of the journalists who look for stories here don't pick it up or one of the Health Ministers get pinged a link.
DH and I are both retired HCP and have both worked for the NHS in the past, and understand some of the systems. DH describes himself as a part time unpaid NHS admin clerk, as he really needs to keep tabs on appointments and letters , and often follow up on tests etc.
Having said all that, when he gets to an appointment, the treatment is superb.

I go to hospital appointments with an elderly family member.

Letter arrives with an appointment in 2 days - we go - we are not on the system but the consultant is there so we get "fitted in" for a brief chat - no other patients waiting for her, she doesn't seem busy.

They search - "oh that was cancelled we sent you a letter your appointment is now <10 days later>"

"it's the system, its a new system and people don't know how to use it"

THREE days later we get a letter cancelling the appointment, dated on the actual day of the appointment, and another letter with the new appointment.

@TonTonMacoute you needed to inform the DN that MIL was in hospital so that waste of resources is not the fault of the NHS. Community based services are totally different to the local hospital.

My OH got an appointment letter to see a consultant in a hospital an hours' drive away for a potential stem cell transfer (he has blood cancer). We got to the oncology dept bang on time, and "checked in" reception. Then waited, and waited, and waited. Other patients were coming and going. After an hour or so, he went to ask at reception to be curtly told to wait his turn. After another hour, he went back, a different receptionist, who said she'd ask the nurse about timing. Then, the nurse came out and asked to see our appointment letter, and then told us the consultant wasn't there at all, in fact didn't work on Wednesdays and hadn't a clue why we'd been given an appointment for a Wednesday as he'd never worked Wednesdays! To say we were annoyed is an under-statement. She just rolled her eyes and said things like that happen a lot as the appointments aren't done within that department! What annoyed us even more is that the stroppy receptionist allowed us to "check in" when she must have known the consultant wasn't there!

What annoyed us even more is that the stroppy receptionist allowed us to "check in" when she must have known the consultant wasn't there!

DS went to a mental health appointment at which the receptionist first scolded him for being ‘late’ (2pm as on his letter, rather than 11 am as on her system) and then told him the person he was seeing was on holiday all week.

You should.

My MP hates me, as does the CEO of our local health trust, as I've written to them multiple times about this exact issue.

I'm lucky - I'm a SAHP/full time carer for my DD, I have a car, can afford the petrol (hospital is 40 mins away) and parking last minute, and have easy childcare for my other children - so when an appointment text reminder hits for an appointment tomorrow, that no letter has come for, I can make the appointment. Many people can't do that.

This year DD has had 9 appointments where the postmark on the envelope has been after the appointment date.

She's had 4 letters warning us about DNA's even though on three occasions the department was phoned and informed that she was in hospital and 1 where no letter or text ever appeared.

The DD of a friend of mine works in admin for the hospital and they are absolutely drowning because of staff shortages and extra appointments being crammed in to try and catch up after covid.

This is what annoys me when someone proposes charging patients for missed appointments - the assumption is always that the NHS appointment system is perfect & patients are in the wrong.

Same here. Its annoying enough to be berated for not attending or being late when you've either cancelled the apt or been given a different time etc, but I'd be even more pissed off if I was fined for something that wasn't my fault. Although since the system doesn't consistently work for actual appointments I can't believe they would have the resources/system to issue and chase up fines

I also regularly get correspondence from the NHS urging me to book a smear. Telling me about all the awful things which happen to women who miss smear appointments. Lots of leaflets. Stuff about counselling if I am nervous about the process.

Lovely. Except I had my cervix removed 6 years ago and despite repeated phone calls and letters, nobody can stop the letters.

I used to be horrified by the missed appointments statistics, how can people be so wasteful etc? And then my Dad became ill and the amount of appointments we've theoretically missed is ridiculous. We haven't received letters, messages haven't been passed on, letters have arrived after the appointment, home visits have been scheduled for when Dad is still in hospital (yet they are impossible to cancel). Two physios even arrived on different days, neither appointment was scheduled.

Same here too

The head of our NHS Trust did an interview with our local paper who posted a link on their Facebook page. There were hundreds of people commenting to say they’d received appointment letters too late or with the wrong date or time, or a DNA letter for an appointment they’d changed or cancelled, or they’d turned up to an appointment to find the consultant was on holiday. Of course, there’s a significant amount of people who just don’t turn up/forget/miss an appointment because they’re running late/whatever, but there’s a huge amount of people missing appointments through no fault of their own.

In a surprise to no-one, the hospital did not phone me. I phoned the hospital to be told that there aren't even any consultants scheduled this afternoon for that type of clinic...

Thankfully, when I explained the situation to the receptionist, she escalated it. They telephoned the GP surgery and stayed on the phone with them until somebody at the surgery sent through a referral request. I'm now on a list for short-notice cancellations.

They are stumped about the random text appointments. They have stated that any appointments will now be sent out by post and telephone call.

The 'who rang me' services seem to think it's supposed to be a genuine NHS number, so maybe it's been spoofed?

Also DP had a weird one.

He had a phone call the other day from an admin person saying she was looking at closing his file with the surgical team as he'd cancelled his pre-surgical appointment in December, and she was just (very fortunately for us!) checking why.

He said he hadn't cancelled his appointment on the 4th December - it was incredibly important to him, he had waited a year. She said she couldn't see an appointment 'on the system' for the 4th December, just an appointment for the 1st December that he'd cancelled.

He told her he had an actual hard copy letter from the hospital with the 4th December appointment. He'd drive there right now and let her see it if she wanted.

She said no that's OK can you come in next week, we can 'fit you in' because (wait for it) 'we've had a couple of cancellations'. So he's now got an appointment - but someone else may or may not have had theirs 'cancelled' and know nothing about it. And he's half expecting to turn up and find out it's all a complete shambles at the clinic. It's so stressful for patients and staff.

To update. I received a text this morning with a link to a letter confirming that the appointment was cancelled and that they would inform the GP. Never received that last time, so I guess that's where the system broke down - the human who picked up my cancellation didn't process it.