To think the government needs to stop selling online GP booking systems as an improvement as they’re not particularly when they’re switched off for most of the day

[Gr3yStar5]

Like many GP surgeries ours switched to an online system and no longer takes booking calls. This was some time ago so it has had time to bed in. You fill in a form which gets triaged and it’s decided if you need urgent or a 2 week wait. It was sold as improving patient care and a better booking system except it isn’t. The system is supposed to be open from 8.30-3.30.In reality the system mostly actually seems to close by lunch time until the next day due to being “overwhelmed”. So basically if you don’t get on first thing you’ve had it, you can’t even ring and you have to keep checking to see when it reopens. It’s worse not better and most of the time you can’t see a doctor for 2 weeks if you do get to fill out a form. There is now no in between. You are supposed to say when you can’t do appointments but it just ignores that. It’s nigh on impossible to get a doctor of your choice. If they don’t get you in for a 2 week appointment or you can’t do the time they’ve allocated you have to resubmit your form for the next batch of 2 week appointments( if it’s open). The setting up was dire with condescending staff on the phone just basically shooing the bemused elderly off. My mum has told me of several of her elderly friends who have been reduced to tears by the whole process. I thought this was maybe just our surgery but it isn’t. Lots online with similar tales particularly re the “overwhelm” switching off of the booking system. Oh and now apparantly our GPs can't do gynaecology appointments, that has to be in gynecology clinic and booked separately which is actually currently closed and not taking appointments. Back in the day you could request a female GP and have female issues treated by your GP, not now, being female is an extra loop to jump through.

So AIBU to think that the government needs to be honest and concede that the new online system is actually shite for patients and getting a GP appointment has never been so hard and stressful particularly when they’re apparently going to be investing in extra spaces at GP surgeries. Thanks but no thanks I’d rather have more GPs and a better booking system that actually benefits patients and gets you an appointment in a timely fashion.

Glossy pointless IT systems are more efficient. The NHS app is more efficient.

OP, if you previously hung on the phone for hours, then you have time to fill in a 5 minute Econsult and receive a text or phone call back.

Of course whether you like the booking system or not it will be being employed to save cash. You can bet your life they cost less to acquire and run than receptionists/telephonists cost to employ.

These are businesses, they have a bottom line. They provide NHS services. They are not the NHS.

Would it be better for you to pick up your prescription from the GP's pharmacy?

Ours uses that system too - open 8am to 7pm for you to fill in a form asking for an appointment. They'll send a link to available appointments, and if there aren't any you have to keep checking back or request again a few days later.

At least before I could go on the NHS App and choose an appointment time.

They sent out a questionnaire recently asking for feedback, I said it was awful and made booking an appointment more complicated, not less.

It's not just the money - I know of drs going to Canada and Australia because they offer a much nicer, low stress working environment.

This is the GP s pharmacy 🙈

I think one of the (many) problems with NHS appointment booking systems is that they are developed by people who have too little in common with the intended users. They're developed by well-educated professionals in full possession of their faculties, who mostly mix with people of similar backgrounds. This applies to the systems for getting a GP appointment, choose-and-book for treatment, getting consultant referrals, and selecting the most appropriate service (Out-of-hours, urgent care, minor injuries, A+E, etc) when you develop a health issue when the GP surgery is shut.

All of these are perfectly simple to navigate if you're calm, not in pain, have good English literacy, you're not currently suffering with mental illness, you don't have any diseases that cause cognitive deterioration and you're not on medication that causes brain fog, and you're not pressed for time when reading the directions. Or in other words, you're in the best of health.

If people were in the best of health, they wouldn't be trying to get an appointment!

The bulk of people needing medical treatment themselves are going to be in pain, anxious, elderly, or struggling with mental health and so on. People booking on behalf of family members will be anxious and panicking. The end result is that people just go to A&E because that's the department they remember exists.

And let's not even get on to what percentage of staff in the care sector speak English as a second language or the percentage of native English speaking staff who have poor literacy. They need to be able to book appointments on behalf of service users and residents.

Oh no!!

Ours opens at 7am (econsult) and is usually at capacity by 0800 with no appointments available.

However, if you ring 111 they can book you an emergency appointment with GP, minor illness/injuries or A&E

i agree the system doesn’t work and is difficult to use if you are unfamiliar with using IT, cannot access at 0700 or unable to receive a call back because of work etc. And I totally agree with PP it’s a nightmare to answer all the questions asked and must be virtually impossible if you don’t speak English, are confused or feeling unwell.

You have to log all your symptoms and say what you think is the matter on ours with about 5 pages of shite, it opens at 7:50 and is full and not accepting any more requests today by 8, then you have to go through it all again the following day - no way to save your answers. I did finally get an appointment after having bloods done (waited 2 weeks) repeat bloods just in case they were wrong (another 2 week wait) and now finally have an appointment- next month

I nearly asked the senior partner last week. Come on own up how many of you are doing private GP work?

I'm old enough to remember when the partners did have private patients who sat in the same waiting room but paid. There's no private practices near us. The Spire don't name the GPs it's a central booking system.

I bottled it in case he was offended.

My GP surgery gave me a bowel cancer screening kit. They or the local NHS Trust has an arrangement where the GPs can issue them when appropriate and I posted it to one of our city's hospitals for testing. So, it appears to be a lottery of where you live in the UK as to the kind of sevice you can get.

One senior partner was a computer whizz. He could fix the glitches. Cut down his surgery time rolled his sleeves up and went through patients records which were out of date. We started getting asthma clinic, diabetes, etc all very organised. Unfortunately he took early retirement. There's no-one oiling the machine any more.

This is unlikely to be entirely representative but here is one GP practice in England explaining how much money they receive per patient and what that has to pay for: https://www.glebestreetsurgery.co.uk/practice-information/gp-earnings/

It gives a flavour. No wonder they’re cutting costs with tools like online booking, keeping appointment capacity down etc.

A £73 per patient fee for unlimited (if required, and crucially, available) appointments every year. Deduct all your staff, building and other costs.

That’s why they don’t want to employ staff to take phone calls. That’s why they’re reluctant to hire more clinical or other staff.

And no wonder individual GPs are topping up their pay with private work.

Maybe it’s the GP system itself that’s outdated? The current model of care delivery by independent GPs is virtually unchanged since the inception of the NHS.
Maybe more urgent care/community diagnostic centres with on site testing, X Ray facilities etc is the way forward and GPs could transfer to this model within the NHS.

Yabu because the problems you are perceiving are not because of the computer system that you are blaming, and would still be there but worse without the computer system.

Yes your GP practice is underfunded. The computer system is cheaper than the human call handlers they used to employ.
Yes it's annoying that it reaches the cutoff point by lunchtime. The same would be true with human call-handlers, but you'd have to wait in the queue for 45 minutes before being told "nothing available".
Yes it's annoying that they run out of GP appointments. They wouldn't have any more appointments available with human call handlers.
No you don't get to pick and choose when your appointment is. That's fine. Also everyone knows that this is the case so other commitments can usually be juggled to allow you to attend the inconvenient appointment. If your issue isn't very important and you'd rather delay your appointment rather than rearranging other things, that's your choice.

It's important that they have a cutoff. If they accepted all requests into the triage queue, the triage queue would grow faster than the triage process and something urgent would be missed. There has to be a cutoff for the number of cases that can be seen in a day. If you are having urgent issues that mean you can't wait till next day you can call 111 and let them do the triage - the call handlers at 111 can book you an urgent gp appointment if you need it.

The computer based system means that the important work of triage can quickly be done by a more highly trained professional than used to be the case. Human call-handlers spent 80% of each call on nom-medical admin tasks/information gathering and it would have been a very poor investment of a qualified and trained medic or nurse to do that work so you ended up with a thoroughly inadequate triage process. With a computer system the triage gets done properly by someone who knows enough to spot the urgent cases and to deprioritise the hypochondriacs,but who can just focus on the relevant info and can assign a priority level with a single mouse click before passing the record to a junior staff member to do the admin, whereas with human call handlers you can't split the task up like that, so it all gets done by the same much less qualified person.

Our GP surgery is terrible, so so difficult to get an appt, particularly in person. You can either
Fill in online form (at restricted times only so not at your convenience) it asks lots of irrelevant questions multiple times, often tells you to ring for
an ambulance!
Once you've done that the surgery ACKNOWLEDGES your form 2 days later.
Then you have to wait another 2-3 days to see if you will be offered any type of appointment. Which IF offered is always a telephone appointment.
They can phone you anytime between 8am-6pm.
If by any chance you miss the call as on the loo, driving, don't have phone glued to your side then you've missed your appointment and have to repeat whole process again.
When GP rings it's very clear they haven't even glanced at the form it took you ages to fill out.
There is also a fictional book an appointment online service but there is NEVER any appointments available to book.
Or you can be posed to ring at 7:59:50 and still get engaged tone then if you do get a line you are number 20 in the queue, 45 mins later to get through to receptionist who tells you all appointments are gone for the day.
Or you start to queue outside surgery at 7.30am in hope you can secure an appointment for the day.
Of course this will inevitably mean being late for work then needing to leave work at 2pm for a 3pm appointment.
On top of this my GP surgery is actively advertising for more patients even though it can't meet the needs of the ones it currently has.
Advanced appointments are also a myth and are never available. They've "all gone" and appts are not available more than 2 weeks in advance. And they can't tell you when more will be released. Phone us back at 8am tomorrow.....

What they don’t include in that figure are

Extra payments for completing Government tick boxes (QoF points) A few examples are every time they ask a patient if they smoke, a BP recording is entered, statins are prescribed, running programme is run to identify people who may be vulnerable even though nothing is done with that information and payments are made for targets are achieved for chronic illness reviews even if the information is submitted on line by patients without them being contacted to discuss.

Extra payments for baby/child immunisations, some travel immunisations

Payments for services classes as “ extras” - family planning, minor surgery, travel clinics.

Private payments for employment medicals, firearms licence approval, letters to solicitors, pilot medicals, employers, health declarations etc.

I feel the above quote is rather misleading in terms of GP income, as it does not take into account all these extra payments which make up a large proportion of GP income.

Our surgery's online booking opens at 8am and by about 20 past, it's closed. I believe we can still ring at 8am but those appointments go really quickly.
Before covid there was a different online booking system where you were given a choice of GPs and times. The supposed improvement has made things 10 x worse.
The practice frequently change the way things are done, but don't pass the information on to patients.

I changed surgeries and new one is brilliant. You can do things online but also phone up. The staff are fantastic.
My last surgery was always empty but you could never get an appointment. The e-consult was always closed. It would be interesting to see how many doctors appointments there actually is now compared to pre COVID.

It’s in the link. They take £109. I didn’t use that figure because:
a) I’m certain it will vary from practice to practice
b) it is additional, though I’m sure prevalent.

The basic fee appears more comparable. I acknowledge that £109 is a jump on £73 but it still illustrates that it’s a minor sum. I’ve paid more for a meal out but it’s supposed to cover all of my primary care for a year.

Assuming their maths is right - I haven’t verified it - that’s about 30p per day per patient for primary care.

I agree, it’s crap. I went through a longwinded process of pointing out why to a practice manager, but the GPs concluded that as they always have spare appointments each week there was no problem. Funny that they have spare appointments when people can’t actually get one... While I am on the subject of shit triage systems, my Dad died because of the one at his surgery, when he tried and failed to get an appointment for more antibiotics.

I'm so sorry about your dad x

As others have mentioned, GP practices are private businesses, most of which are owned by the partners. The business has an NHS contract to supply services to patients within specified guidelines. However, as a business it is up to them with the practice manager they usually employ to organise the administration of that business. This will include the salaried GPs they choose to employ and the locums they need, especially if they don't have enough full time salaried GPs.

The problem, for patients, is that more and more GPs choose to work part-time for child care or work/life balance. Given their full time salaries, why not go part-time if you can afford it?

Then coupled with a shortage of trainee doctor places for UK citizens as universities can charge heaps more for foreign students, then if trained why work in a UK GP surgery when you can work in a hospital with more prospects or go abroad where you can get paid heaps more? No wonder with the lack of sufficient numbers of full time GPs and the online triaging system in place, a sicker population are struggling to access a GP when needed.

Because they can earn enough on 3 days a week.

They keep complaining about pay but they earn enough to live comfortably on 2-3 days a week working :-(