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? 😅

I've never understood this as a problem.

Everyone checks in when they get there. You call them and if they're not there then tough.

Book more people in. When some don't show up the doctors can keep working.
If everyone turns up (heaven forbid, as apparently we're all no shows) then you have a problem.

Reminders are great but have to be patient appropriate.

Ask those who don't show why. I asked my GP surgery what research they did on the no-shows to establish reasons/problems and patterns. They declined to answer.

@LathkillDale has hot the nail on the head. Nobody calculayes the cost of NHS failings against GDP and the waste in accordance with productivity notwithstanding the complete lack of respect for patient time.

I'm 60 and don't want a letter. I prefer WhatsApp tbh

I'm not far off 60. I don't care if I get notifications via text, NHS app, email, post or whatever. What I hate is that I get some notifications as texts, some others through the NHS app, others via one of several third party sites, some letters and everything in between. And these can be from the same clinic. It makes it really hard to keep track of ever-changing appointments and information.

One of the big issues is that my GP uses the NHS App, the hospital a different system and the blood test bookongs on yet another system. If I try to book a GP appt on the app, I've never yet found an available appointment. Appointments are only released afyer submitting the triage form!

Agree the booking efficiency varies hugely between specialisms and geographical areas, it seems to about how on the ball the person coordinating is.

@Notonmyland the issue with overbooking is that it creates significant delays when most of the patients turn up. If I have an 11am appointment, I expect to be seen within 30 minutes of it, not 90 minutes. It would be more palateable if there was ever an apology. Patients are expected to arrive on time and are refused if more than 10 minutes late and there has to be mutuality to retain respect on both sides.

The dna's are a symptom of a service that is free at the point of delivery.

No joined up communication and tech.
Traces back to the establishment of individual NHS Trusts.
The chaos we now experience is the end result of the visions and policies of Margaret Thatcher.
See also postcode lottery on access to healthcare, rivers full of shit and no council houses.
I could go on...

Well I'd say much of the issues relate to the explosion of pfi under Tony Blair and the failure of governments since MT to go back to the drawing board and introduce a social insurance co-pay system like those in Continental Europe. The NHS hasn't been fjt for purpose pretty much since its inception and no other country has copied it. In the UK we have chosen to worship it and exercise gratitude for a sub-optimal system that provides inadequate service for chronic condituons with a concomitant impact on quality of life.

Too often we forget it is free only at the point of delivery.

No, it’s a symptom of a system that sends out appointments, without checking patients and families can get there at that time! DD1 used to go to a hospital, where at the end of an appointment, the consultant said

“Come back in..,”

Then you went to see the booking clerk, who offered you times and dates for the next appointment. So, as in our case, it’s hard to get DD1 up and ready, due to learning disabilities, we’d never agree to an appointment before 10 am. Most hospitals just send out appointments at say 9 am, totally oblivious of our difficulties in getting her there; then they wonder why they have DNAs?

This is ageism at its worst and results in some people not being able to access care when they need it. Special provision needs to be made, even if it is a person to person phone call.

There is a lot of this sort of attitude about.

This. I have had invitations to flu jab from 3 different sources. Separate invite to covid jab, followed by another message from one source to have both jabs together from source B but source A can't do that. However source B is a much longer wait.
Then sent an invite for shingles jab in a different clinic.
The messages are a mix of texts, emails and notifications on the nhs app.
I had to go back and check everything several times to figure it all out.
I have ended up with 3 separate appointments, one jab at each. I am very grateful, but what a faff.

I was at our GPs on Thursday morning around 8.30. An elderly lady went to use the electronic log in before me and it didn't recognise her name.
She went to the desk and was asked what appointment she thought she had. She was been seen about diabetes and copd. Her appointment had been cancelled she had not been informed, even showed the receptionist her phone to prove she had not received the text message the receptionist was saying she would DEFINITELY have received.
There was no apology or let me look into this and she was given an appointment for next thursday so an extra 8 days wait, and a totally wasted journey. Respect for services and time etc works both ways.

I always said there are too many managers generating stats, inconsequential directives and not enough workers on the front line.

The day our ward clearer was contracted out, was the day I gave up hope. I could see where the deterioration of the NHS was going.
Management now know the cost of everything and the value of nothing !

Former NHS waiting list manager here - you would be very surprised the number of people who confirm they will definitely be attending their appointment......& then don't show.

Hmm, or can't rearrange.
I once had an emergency arise four hours before an appointment (child, horse, broken collar bone). I spent 54 minutes ringing in and nobody answered my call.

I wrote with proof so I wasn't taken off the list. Sent screenshots of the phone calls too - I got a new appointkent but no apology for the failure to answer the phone.

Perhaps there are reasons why people can't cancel.

Also, I once failed to attend a 20 week maternity scan and the clinic phoned me and gave me an absolute bollocking about wasting their time and how important the scan was. By the time the woman drew breath I was in floods of tears. The baby had died at about 7 weeks, caught as an MMC at the 12 week scan. The midwives assured me the cancellation of the 20 week scan would be automatic. I complained and got an NHS speak "We are sorry to hear that you perceived the call and its tone to be unhelpful".

DNA's are not always the fault of the patient. Bad manners and information/discourtesy in the NHS is always the fault of the staff/NHS who take responsibility for nothing.

I am so sorry that happened to you and so sorry for your loss. That was inexcusable.

I have recieved a text meant for my deaf and partially sighted housebound elderly mum saying she has an appointment AT THE SURGERY on 5 November at 11.40am. No one in the family has any idea what its about so now im going to have to fight to get through to the surgery on the phone to find out what its about and try to cancel it

I’d asked my GP surgery for an emergency appointment for DD1, as she needed a prescription asap, before the drugs ran out. They probably weren’t her own GPs at that time, as she was with the GPs, local to her residential school, but she was home for the school holidays.

Just as I was leaving the house, she had a tonic clonic. She was unconscious afterwards and you are not supposed to wake people up, after a seizure anyway. I rang the surgery to say we were going to be a bit late. They didn’t half complain about how people weren’t supposed to be late for emergency appointments!

Because the hospital has increased the number of clinics and doctors but not the secretaries, plus a lot of the letters are edited by the secretaries promptly but then left for weeks waiting for the clinician to sign off. Being a medical secretary used to require skill and knowledge and years of learning terminology. You had to be experienced. Now they recruit anyone out of school and with speech recognition+untrained secretary often not able to tell the difference between brain and vein or mixing up a referral to audiology instead of cardiology , you can see why the clinicians need to check the letters.

That’s really fucking obnoxious.

Maybe your consultant should spend a week with a GP and see exactly what they do. Might learn a bit of humility and understanding. They would have a fuckton more patients to see if GPs didn’t do what they do and just referred everyone who saw them.

How is this better for "them" exactly? You do realise that funding is based on how many patients we see. If we "put you off" we are aren't paid for seeing you and we are also likely to lose funding in the next budget round. Which means losing our jobs, freeze on recruitment with existing staff either picking up more patients in less time or dealing with even longer waiting lists. Some services close all together. Explain to me how we benefit from "putting you off".

Unfortunately it’s becoming a ‘survival of the fittest’ type of service. Absolutely agree people should take responsibility for their own health and check appointments and communicate. However there are elderly people and those with learning disabilities or significant mental illness who aren’t able to. As a society do we just leave them without access to medical treatment?

This is no excuse for a DNA. You can call and cancel or rearrange an appointment. My patients do this all the time, it's perfectly possible to let someone know either by phone or email.
You also need to update your daughter's hospital passport so information like your inability to get to an early appointment is available on her records. We can hardly be expected to guess/remember every patient's preference.

The thing is these action are totally justified in some cases
the wait between be referred and seeing consultant could be considerable
personally I got referred for a chalazion by the time the appointment came through it had settled down so cancelled it
as for meds again people go away and research them and decide against them
it’s easier to ask everyone rather than try and guess who it would be relevant to