Why does the NHS (or at least in my experience) create this kind of admin?

[laurellas]

Went for a gastro appointment with a consultant I had waited months for. Finally prescribed the medication I need. Consultant said they would write to my gp. Cue message from GP asking if I want the medication and to fill in a form to confirm I still want it (why wouldn't I want a medication that was confirmed by a consultant 3 days ago?). Before this I had to keep filling in forms to ask whether I still wanted to stay on the waiting list for the initial appointment. I missed one of them by accident and didn't confirm on time so they took me off the list so I had to call them and ask to be put back on, but I was put to the back of the queue again (my fault but annoying as it delayed my treatment significantly). My grandmother turned up to an appointment that had been cancelled because she did not confirm she wanted it, she's 84!! She doesn't check emails and she can't read her text messages properly.

I am guessing this is so people don't take up appointments they won't turn up to? Maybe it would work better asking people to cancel if no longer needed rather than auto cancelling if they don't confirm? Or maybe it's just something they do in our area and not others?

Am I just being a miserable sod? 😅

Sadly when you see and hear of the number of people who don't show up i think its a great system. Why waste 10-20 minutes of a highly paid and in demand person's time several times a week (let alone the costs of heat/light/equipment going to waste also)

Whilst its difficult for older and less technically educated people, its a necessary evil

I was a GP for 32 years. The NHS has become so inefficient. Consultant told our GP he would put my husband in for his clinic on 5th October as I complained about the lack of communication and good management. 6 days on and the appointment still hasn't materialised. We've phoned the hospital but nobody knows anything about it so I've written to his poor GP so he can email the consultant about it. It's so stressful. The condition my husband has needs to be managed in secondary care but I feel he's become a set of blood results with drugs altered accordingly rather than a patient who has symptoms.
Even some GP practices are becoming less patient centered. I am totally against telephone appointments other than a quick review but they should not be used for first presentation of an illness. They aren't quicker for the doctor and often involve the patient coming in for an appointment afterwards which means two appointments rather than one.
I'm totally disillusioned with the profession we have become.

sorry YABU.

The NHS used to send letters about appointments and assume you were coming unless you cancelled. For obvious reasons they now communicate digitally wherever possible and dont assume you're coming if you don't confirm.

It sounds as though your mum needs some help with her emails and text messages. Has anyone shown her how to increase the font size?

Not checking emails in 2026 is a bit like not opening post in 1996.

HOWEVER yes there is a lot of waste and illogical practice in the NHS system.

I would hope that a team in the NHS has looked at the evidence from different approaches and have settled on the most effective methods to ensure that people keep their appointments.

But it sounds as though the approach used varies.

I was working away a couple of years ago on sabbatical and was emailed about a missed mammogram appointment, which I knew nothing about. When I returned home, there was an appointment letter with a fixed appointment date and time allocated, which I hadn’t requested so I knew nothing about.

A lot of specialist services operate on "opt in" basis. We have it for some of our appointments to manage long waiting lists. Yes, in ideal world, patients would call to cancel. In reality, they don't. We now have a digital system set up which emails you and texts you to remind you of an upcoming appointment several times at regular intervals with the last reminder coming out three hours before the appointment time. This is in addition to a letter send to home address. This reduced but did not entirely eliminate no shows.
Sometimes a new patient will not show to their appointment and upon checking their GP records it transpires that their symptoms resolved so they just didn't bother letting us know that they no longer wish to be seen. So, unfortunately, it is also necessary for some services to confirm if you still wish to remain on a waiting list. We don't love this admin load but what's the alternative?

My elderly friend missed her appointment because the letter arrived after the appointment date. She is deaf and cannot use technology. She has deteriorated alarmingly and her GP has asked the hospital to see her but they have refused. I think she will die before she gets seen. Yes, she is old, but she suffering terribly and deserves care and management.

Not quite the same, but when I make a dental appointment, I get an email and text reminder a month in advance, then the sane a week in advance and then the day before. They must have so many no shows to have resorted to sending so many reminders!

My mother is in her late 80s and has got rid of her lap top (so no email) and hasn't had a mobile phone since about 2006. (and even then she kept it turned off and in the bread bin 🙄).

She gets letters and does not have to confirm appts. Maybe there is a system where for the most elderly this isnt made necessary.

To add: Personally i find the texts and reminders really helpful.

Cue message from GP asking if I want the medication and to fill in a form to confirm I still want it (why wouldn't I want a medication that was confirmed by a consultant 3 days ago?)

Minor point of pedantry, but people changing their mind on medication happens frequently, most often because very few meds come without any side-effects whatsoever and some people are reluctant to start even when it's likely the medication will tackle their symptoms. Little point in the GP auto prescribing something which may well be an expensive medicine, only for you to go and pick it up/have it delivered and then watch it sitting gathering dust for months.

Consultant told our GP he would put my husband in for his clinic on 5th October as I complained about the lack of communication and good management
Oh no, didn't manage to jump the queue by being put on the next clinic....

Sorry but as a GP, I can't believe you have the audacity to complain that you didn't get confirmation that he was trying to cheat the system because your a GP. He was probably intending to see him as an addition to his clinic so had to arrange it via his secretary rather than the outpatient service team.

Surely you know all this???

It's rationing of treatment. The more people they put off, the better for them.

I have to have regular blood tests every 3 months for ever. The palaver involved in getting hold of the all important blood forms (which they attach to the samples to tell the lab what to test for) is unbelievable. You would think it was all on file but no, the hospital post (post!) me 3 of them. When they run out, I send an email into the void and hope to receive some more, sometime. Generally I have to chase with several phone calls that nobody answers and a more panicked email.

The medication one is a bit stupid, but hospitals are also not supposed to send prescriptions to GPs.

The waiting list one is because people change their minds!

@MulledjuiceMy MIL is 98 and registered blind/severely sighted impaired. She lives independently. She was managing just fine using the telephone and receiving letters but now struggles with the new AI services brought in by the NHS. She needs to speak to a person and it's nigh on impossible to get past the voice chat. She can read letters (very slowly) as she has a very large magnifier she can put them under. She can't do that with emails, nor can she read text messages or operate a Smart phone. It's not acceptable to expect that someone of her age and impairment just falls in line with the new technology. Nor should she have her independence/privacy removed by having to ask someone else to deal with things for her. The system still needs to cater for everyone.

I completely agree - accessible alternatives should absolutely be available when people need them.

that's different from "doesn't read her emails"

@Mulledjuice MIL does get emails and will also confess to not checking them very often as a) she doesn't expect to get anything important in them and b) it takes her so long to try and decipher them even with the font set to large. She sure as he'll won't have opted in to receiving emails from the NHS knowingly though - by that i mean she may well have been asked if she's got an email address and given it, but she would not have expected to received communication about appointments that way, and any healthcare worker with an ounce of common sense would realise that it is not the way to communicate with her

and any healthcare worker with an ounce of common sense would realise that it is not the way to communicate with her

To be fair to "any healthcare worker" they are likely working on the assumption that a 98 year old with clear issues concerning independent living is receiving the typical care and support any person of that age in those circumstances normally would.

Just because you appear to regard support as "having her independence/privacy removed" does not mean it isn't required or that is what it would actually mean.

You are suggesting the NHS should be making exceptions for extreme outliers, including people who are actually suffering because either they or their relatives simply refuse to take up the offer of assistance which would resolve the issue in the first place, and frankly, that's a nonsense.

@XDownwiththissortofthingX Then the healthcare worker would be making an incorrect assumption. MIL does not have carers. She has a cleaner (as she has done for many years) but other than that she manages by herself.
Anyone who thinks it's OK to exclude people from a system that they've used for many years needs to redo their disability awareness training.

Because people who don’t see the cancellation are then left to get sicker at no fault of their own…

My husband is disabled by his condition and cannot look at screens. If he didn’t have me, by your rule he should just be allowed to rot and die.

Except screens aren’t paper and not everyone can look at them

Our trust messages or emails with appointment details and says if the message is not opened within 48hours, they will send a letter (which will then take 2 weeks to get to you).

Not my rules but if people don't cancel abd simply not rock up, what do you expect the nhs to do. Yes is frustrating but don't blame me or the system blame the self centered selfish fuckers who ruined it for your husband and others

Except the whole point is that the health service must be accessible to its vulnerable users. Not cutting costs in a way that harms service users. The selfish fuckers didn’t rewrite the policy and I highly doubt most people just don’t go because they can’t be bothered after waiting months and months. Many probably never got bloody told that they even had an appointment finally come through.

I once got a letter telling me off for missing a GP appointment I never made, wasn’t told about and didn’t appear on the app. So the numbers are likely inflated by such ghost bookings.

It’s such a crap system, I was sent a text about my upcoming appointment saying DO NOT COME TO HOSPITAL, my appointment comes & consultant phoned me up and tells me off for not being there.

I received a letter whilst on holiday informing me of an upcoming appointment, they phoned to confirm a week before & I said I was on holiday so they rescheduled. Got home to a letter confirming my new appointment & then a few days later a letter saying due to failed attendance I was off the list. I had already confirmed electronically twice that I still needed to be seen.

How older people are meant to navigate it I have no idea.

Exactly how many people go to the effort if booking to then not turn up? Very few.