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? 😅

Ha ha. Would’nt it be great if it were very few!

As is usual on here, any issues with the NHS get blamed on the sick, vulnerable or elderly people who are desperately trying their utmost to use it.

Reminders are great, easy 'click here to cancel' is great, autocancel is absolutely not great and not patient-centric or accessible and inclusive at all.

When I used to work in NHS outpatients, we had about 20% of the appointments missed, over years, no matter what was put in place to remind people to cancel/confirm. There were services where missed appointment rates has been lower or even higher.

I agree it's annoying and ineffective, but with massive waiting lists, all this admin is unlikely to change. My previous dentist used to charge for missed appointments, not sure if it helped...

@mumumental I genuinely don’t understand why someone would go to the effort & not bother to turn up? The only people I think do actually do that are ones with addictions, chaotic lives, mental health issues etc.

DS is under one hospital for an ongoing problem - communication is great, easy to use patient website, all letters and appointments, confirm attendance, get text reminders etc. Obviously if people struggle with technology then there would be issues but as it's a children's hospital I guess most parents can manage it ok.

I'm under a different trust for an issue and it's awful. Had an appointment text come through late on Wednesday night, go on the web app, no letter, no info. 30 minutes I was on the phone yesterday trying to get through to someone who could help tell me what it was for and where it was (the trust uses 3 different sites). Apparently I'll get a letter at some point with the details 🤷🏻‍♀️
I can see why appointments get missed and people get fed up with it.

Given the state of the NHS it's not unreasonable to assume that the increase in no-shows might be related to people getting worse while they wait and having acute admissions or even dying.

I recently had this with a terminally ill relative, he was admitted to hospital yet the very same hospital kept sending him texts and asking him to come to his outpatient appointment at the same time. This was AFTER we had visited their department and informed the receptionist of his hospital admission and told her he couldn't attend unless a porter brought him down from the ward. I had hoped she would sort it out but nothing was ever arranged.

Surely the IT wizards can make the computer pop up with a red flag to show when a patient is lying in bed in of their wards so they don't waste time booking them for outpatients appointments?

Agree with previous posters re the absolute inefficiency of the NHS these days.

I often think that all the supposed technological advances don't make things better.

I'm not in the UK, I'm in Canada, but we are having similar problems with out health system and they are looking at some similar solutions.

We now have more phone appointments. You can do an online appointment with a strange doctor. Pharmacists can prescribe for more things. Walk in clinics are being used a lot because people don't have a GP.

I've had occasion recently to see the pharmacist for a long sinus infection. I'm not totally against some of the changes - I can now get antibiotics for a UTI which I am prone to. This makes sense. The sinus infection - well lets say it was in no way a medical appointment, even though they tried to set it up like one. It was like a guy playing doctor.

More worryingly though my daughter came down with a raging UTI including bloody urine on a long weekend, and had to use the online doctor. IMO it was totally unacceptable, it was not even a phone call, it was by text and he didn't ask her anything that he should have, given that she is an 18 yo woman who just started living away from home.

I think it's all going to result in a real degradation of medical care.

Plus all these online doctors and docs at the walk in clinic don't provide follow up or anything else people need - and most could actually be working as GPs instead, and giving people appropriate care.

I never understand why it takes soooooo long for clinic letters to be typed up and sent. My partner has regular oncology appointments, the letters that are sent to us and the gp surgery are usually dated at least a month after the actual appointment, quite often by the time the letter arrives the information contained is obsolete as treatments/dosages have been changed. Why does it take so long. I guarantee pre computers letters probably arrived typed on a typewriter by the doctors secretary within the week. More technology seems to equate to an increasingly inefficient system.

I’ve had the hospital ring me to remind me of an appointment that I had emailed, phoned, been to PALS about (as the original booking was to far away and it was a two week suspected cancer referral). Of course the person ringing (or emailing a form) doesn’t know that. You’re just a name on a list.

As everything is done via computer these days with AI edging in, why can't they do letters for over 60's and texts for younger? It surely doesn't take much to run that as a method of contact into a system?

I am trying to pay for an MRI because I have been told the wait might be up to a year from the private consultant who suggested I urgently need a head and neck MRI. I dutifully paid to have an unknown GP read the letter and confirm it would be an MRI I needed, but for some reason he needed to re-confirm this with me by phone, despite me being the one paying, the one who initiated the appointment and typed out all of the symptoms etc. After 2 failed attempts at calling on a number flagged as SPAM that went directly to my voicemail, they now want a further £11 for a video consultation as they refuse to call again. It doesn't seem to be much better when you pay tbh!

Try dealing with multiple departments. Some use the app, some don't. Some only send letters. Some require a confirmation, some send texts, some don't. Some are on the system others aren't. Some require referrals on hospital discharge, some don't like that and ask for you to ask your GP to refer "as its quicker"! Some referrals just get missed, and you spend hours on the phone between the GP's and the specialities. That's my daughter after a severe spinal injury. We have mostly given up and gone private for rehab. The specialist NHS rehab appointment is next week, her injury was in June.

DH had an urgent referral several months ago, was put in a "ghost" clinic, 4pm on Xmas eve. He did a freedom of information request and was bumped up the list, only to be moved back to this bucket clinic. He complained again, and was magically found an appointment recently. He is now on the 2 week cancer pathway, with the consultant noting that if they had seen him sooner.......

Its terrible, and I won't be told otherwise.

Over 60, how old are you? We grew up with computers. Over 80 maybe.

Ask about the reasonable adjustments digital flag to be added to records - can specify things like printed letters (not text shite), large font etc and they SHOULD be able to do that now - if our shite patient records system can manage this - the ones with actual functioning IT that doesn't try to run on a toaster can.

Most our admin were made redundant so 99% of letters and phonecalls are now shunted onto overworked clinical staff as an additional sideline/gesture of love and how valued we are. It's crap.

As a hospital consultant, if the consultant wanted you to have some medicine, they should have provided the first prescription. This means that the patient starts the treatment and there is time for the GP to get the letter, read it and change your prescription.

I agree that admin in the NHS is often a real pickle - they often don't manage the poor performers, so the good performers get fed up with having to do more and more, while being included in the berating emails, and leave.

I went from somewhere with fantastic secretarial support to somewhere with abysmal support - a patient would phone up and ask about their scan results. My old secretaries would look at the record, and say to the patient "the consultant wrote to you with the results, the letter must have got lost in the post" read my results letter to the patient word for word (I have written it for the patient), and would only contact me if the patient had further queries. My current secretary just emails me "Mrs Jones wants to know her scan results"

I do - although a "add this to your calendar" would be a great option too.

However for my mum, she has her mobile phone because she might break down in the car and need to call someone. She uses a computer a few times a week but not every day.

We have to make reasonable adjustment for people. Asking what their preferred method of communication is would be a start.

Some older people can be very forgetful. I’m not, obviously 🙂

Sometime people who have very busy jobs can forget. It’s not just people with chaotic lives. When I worked in the NHS there were meetings about the “DNA rate”. (Did Not Attend).

I had to attend A&E last week. Luckily issue has been resolved. The receptionist looked a bit confused when I gave my details. Apparently I was already an in-patient and had been there for the last 18 months.

So instead you just cancel peoples appointments and shove the most vulnerable and unassisted into a longer wait to decay and die? Great work.

Annoying? No. Life ruining.

Yes my DH was referred urgently in February. He was finally given an appt date this week… Nov 27. He has been housebound since. And lost his job. Government Mandated SSP doesn’t even cover enough time for him to reach this initial appointment date.

We also went private. Spent every penny of our savings. Great job NHS.

I've been trying to help my elderly mother keep track of her many hospital appointments and it's been eye-opening how often her appointments get cancelled, re-scheduled, moved location or otherwise messed around with over and over again. Add in the complication that she is severely mobility impaired so we also need to book transport which also can get cancelled at late, or even no notice, and I no longer am surprised that so many appointments get missed.

But what effort? People are talking about secondary care (hospital) not GP appointments that you make when you need them and (if you're lucky) get seen within a few weeks.

The GP refers you to the hospital and you wait for your appointment from the hospital. This generally takes so long that some people forget they're on the list/ change their mind/ get better/die during the wait, so the appointments get missed. This will only get worse as waiting lists get longer.

Or they just can't be arsed to turn up (had a lot of these, bizarrely, when I worked in the NHS. Then they'd phone the next day saying they were in terrible pain and needed another appointment immediately). Never underestimate how weird people can be.

My late DH continued to be sent appointments for hospital tests for over six months after he died. I think the opt-in system is essential to avoid wasting consultants time, but really the whole system needs to be better to avoid all the unnecessary appointments being made in the first place.

My consultant calls GPs "a glorified referral service".

Although it can backfire. My dentist does this and I was getting so fed up with all the reminders I just deleted them all.

Anyway, I thought the appointment was a Friday lunchtime.
Wednesday, the phone goes, I'd got the day wrong. Fortunately they didn't fine me and they did have a slot for the Friday so I didn't have to wait very long.

Funnily enough they don't send as many reminders anymore so maybe they realised people were ignoring them.

I don't think any of this is a necessary evil to discriminate against the disabled and elderly though. They can phone you to confirm an appointment, it doesn't have to be via some app you need several steps to log into.