Health Centre Appointments

[spangles]

An article in the Courier this week states that last year 3117 patients who had booked appointments failed to turn up.

There is no excuse for that but is it possible that there may have been reasons for at least some of the failed appointments.

Too ill to attend or maybe the appointment was at 3pm and still waiting to be seen at 3.30 led to someone with a short leave of absence from work to just get up and go.

I personally have lost wages in a scenario where I was late back because I was late being seen. I wonder how many just can't wait and leave. I'm sure it is nowhere near the number stated above but it seems to be a predictable part of the visit that you are going to be late taken in to be seen.

Is it really just the patients who are to blame?

I have never had a problem getting an appoinment but I don't recall a time that I was ever taken on time.

The Courier goes on to say that consultants appointments are often not kept either. Maybe the patient has got better or died while waiting for an appointment. One of the consultants told me that they would visit more frequently but lack of space in the Health Centre meant that there was only 2 rooms available for them when they visited and they had to wait their turn to come down to consult.

Would a set time laid out each day by the surgery where patients turned up and were seen on a first come first served basis work in these days of trusts and targets?

A bit off topic but is it my imagination that every second NHS staff member appears to be a manager?

S

[spangles]

Duncan I was trying to post a reply to your post and I deleted it by mistake I tend to carry the quote into the PM and then delete before I send it.

Could you post again please with your question and I will answer it. Thanks

S

[Malky]

Before anyone goes off half-cocked on this I moved the original of this topic to the Holding Pen as it clearly wasn't working. I have asked Spangles to repost it here to see if the Topic Mod will work. The Topic Mod only works in Speakers Corner.

Lets see if we can have some responsible debate.

Malky

[The Real Boss]

Spangles, As someone who works in General Practice (as a practice nurse and practice manager) I see a lot of the problems that the Courier article was commenting on. Our Practice does a combination of turn up and be seen sessions and booked appointments. That works for a wee place like ours, but bigger surgeries have hundreds of patients phoning in every day wanting to see a Dr or nurse THAT DAY.

Government guidelines state that appointments are supposed to be for a minimum of 7minutes. Of course some may take less time, if you only need a Blood Pressure check for example, but the vast majority take much longer. Most practices recognise this and make their appointment slots for between 10 and 15mins. It's not the best solution to the problem, but things usually even themselves out over the working day.

For Campbeltown the lost appointments equate to an average of a 10 day wait for a free appointment every month. Now I happen to know from the practice manager in Campbeltown that at the moment the average wait to see your own doctor is about 2-3 weeks. You can often see someone else sooner, but that doesn't help you get continuity of care as it takes much longer to explain everything 'yet again' to the next person to see you. That is often why the appointments run late.

The other problem is that if you think you need to talk over a complicated issue with your Dr that is going to take a long time, then you should let the receptionist know that you think you may need a longer slot. You don't have to tell them why you need to see the Doc, but just that you think you need a bit of extra time. We tend to give those patients the last slot of the day. It goes without saying that if that patient is the first on the list then the Doc will run late for the rest of the day.

If all those non-attenders were to cancel their appointments, just by phoning in that morning or telling the girls at the front desk that they can't wait any longer- that would mean the folk of Campbeltown would get seen by their Doctor nearly 2weeks sooner.

[spangles]

Hi Boss

I am only making observations and commenting on the Courier article which I am sure gives a fair assessment of the situation but as someone who is not associated in any way with the health service other than when I visit the surgery I felt that maybe a viewpoint from a patient may have balanced the article.

You are right in saying that the town surgery is obviously busier than a more rural one but I'm sure you will agree patient care is paramount and it shouldn't matter the size of the practice. I am certainly not in any way decrying what we have. I was just making a point about never being taken on time as maybe one reason for a small portion of the failed appointments and speculating from the patient’s point of view why they may have decided not to keep the appointment and leave.

There is of course no excuse for the amount of people who just don't turn up without cancelling their slot.

I hear what you are saying on continuity of care and explaining things to a different GP but patients are registered with the practice not the doctor so the notes should be explanatory

I would imagine also that if a GP to be late starting his surgery then most of his appointments will feel the knock on effect of that. I am sure there could be several reasons for this but one of them isn't because he was out on a house visit. The GP's in Campbeltown to my knowledge don't do home visits.

How do you think a turn up and be seen session would work here in town or do numbers prohibit that?

S

[Lel]

At our surgery, if you miss 2 appointments within 6 months (without phoining to cancel) you are sent a warning letter explaining if you miss 1 further appointment (within 6 months) you will lose your registration at the surgery.

This is written on the application form when you go to register with a GP and you must tick a box agreeing to it.

This week there were only 11 missed appointments.

Obviously there will be some people who have a good reason as to why they were unable to cancel however this is taken into consideration on an individual basis.

The appointment system works like this:

There are a number of appointments set aside for 'on the day appointments'. (I think there are about 10 and you have to phone at 8.30am to make an appointment)

There are also telephone consultations where if you need to talk to a doctor, you call before 9.30am and a doctor will call you back between 11am-12pm to discuss.

If there are no appointments left and you require to see a doctor (as an urgent case) you are asked to come to the surgery at 12pm and sit and wait to be seen.

I have had to do this with my son before and i was only left waiting for approx 20 mins.

It seems to work up here - there are 4 doctors on duty at one time in the surgery and also 1 practice nurse and 1 health visitor.

How do you think a turn up and be seen session would work here in town or do numbers prohibit that?

Spangles, im not sure of exact numbers that attend my surgery but i think it is approximately the same as the Campbeltown surgery. Maybe a small number of appointments could be set aside for 'turning up on the day'

I have never had to wait more than a couple of days to be seen at the doctors and it seems to work here.

[spangles]

I wonder if managers from different centres liase to compare tactics when something like this is ongoing and causing issues.

It would raise the question in my mind what tactics have the management here put in place to try and alleviate the situation? I don't think that was mentioned in the article. (Courier went on the bonfire yesterday so I can't look it up)

I am not defending patients who don't turn up but as I said in a previous post, is it really all down to the patient that the situation has existed for over a year and it is still ongoing.

Never heard of telephone counsultations here but then I have never asked so maybe that service is available. I am sure someone will know.

Not everybody reads the Courier and I posted this to make our "out of Kintyre" members aware of the situation here and hopefully add their input. Sounds like a very well run centre you have access to Lel.

Just like to add that we have 2 full time and 2 part time practice nurses. Never been taken on time with them either. Possibly again lack of space?

S

[The Real Boss]

Spangles, I hear what you say and Lel is right

Obviously there will be some people who have a good reason as to why they were unable to cancel however this is taken into consideration on an individual basis.

As far as know Campbeltown does offer 'on the day' appointments for sudden acute illness, but I'm sure like most places they are often taken up by those 'in the know' who are frequent attenders. It would not be appropriate for the receptionists to ask leading questions as to how important or essential your appointment is. That is often the crux of the matter - what is serious to one person is often just an inconvenience to someone else.

As to your other comment

I wonder if managers from different centres liaise to compare tactics when something like this is ongoing and causing issues.

We have Practice Manager meetings, held at Tarbert Health Centre, about every 6weesk for all the PMs in the Argyll area where we can discuss things like this and all the changes the Government keeps making to the new GP contract. Because we all work so far away from each other, we can't all manage to go every time, but it is a great forum for us (pardon the pun!). I have 3 Practice Manager colleagues in Glasgow who meet up every week for lunch cos they all work on the same Road! I think we forget just how isolated we are here sometimes.

I'm not making excuses for the Health Service, just giving you a bit more insight that a short newspaper article could.

As a practice Nurse (sometimes there are benefits in having two roles in the NHS - you get a wider perspective of the problems it has), I also have the problem of running late. From my experience it often stems from the 'While I'm here' syndrome. When folk have to wait several days/weeks for their appointment, they tend to save-up their worries. That can be really difficult to deal with. If you try to deal with all the issues - you run late. If you tell the patient you only have time for the one problem - that they booked in for - your classed as unfeeling, uncaring or worse. Sometimes it's a case of dammed if you, dammed if you don't. I have to be honest and say that there also some days that just seem to go wrong no matter how fast you work. I suspect everyone has days like that.

No matter what Practices do though, there will always be those who are not satisfied with the level of service they receive - but that's life...

[spangles]

I have to be honest and say that there also some days that just seem to go wrong no matter how fast you work. I suspect everyone has days like that......

....like ploughing through a field of treacle. Think we have all had days like that

I suppose it all depends on what side of the fence we sit as to how we see things. Working with the public is never easy.

Having invited the Karma in by starting this post I will likely be taken on time the next time I go...Aye right

S

[spangles]

Just a thought before this thread disappears off the bottom of the page.

How long do you think it would take the manager to address this issue in some way if they were told that their wage would be docked if it persists. More than a year is long enough for some progress to be made by manager.

I think the Courier should do a follow up on it. If the practice has highlighted it in the local press then they should be glad of the opportunity to let us see what they are doing about it. Yes/No

S