^^
Where was that comment from?!

DrP

Try living in a town full of the nearly dead . All appoitments booked up really quickly as the old have nothing else to do and a trip to the docs is the highlight of the day .
The coffin dodgers love it in the waitng room as its like the social club and all their aged friends are there waiting to speak to a nice young Dr.

My GP’s practice uses Emis Patient Access for booking appointments and repeat prescriptions on line,they deliberately keep blank slots for one of the gps in a 4 til 6 surgery every weekday,the receptionist has never asked me what is wrong with me,her question is “Do you need to see a doctor today,or will it wait until the next working day?” and she will then tell you what appointments are available.If you are not happy,she will get a GP to ring you at home.They run separate clinics for things like annual flu jabs,and seem very efficient.

Where was that comment from?!

Oops, sorry. Copy’n’paste failure. 😳

It should have been

From this point onwards let’s all agree to only post proposed, workable solutions

I’m actually quite lucky in that my GP Surgery is pretty good and do at least try to accommodate patients with urgent needs for appointments.

I’ve got a Asthma and when it’s about to cycle out of control due to a honking chest infection that’s arrived at the speed of an express train from nowhere the surgery are pretty good at getting me in that day for a check up and medication.

They will also prescribe over the phone i.e. you phone them, say you need to speak to a doctor, they take your number and the doctor rings you at a given time – particularly helpful if you’re already at work – the script can then be picked up from the surgery after the docs have all gone home.

Having said that, the system that my surgery operates appears to be the exception rather than the rule. My experience of other surgeries, and the experience of other local friends and family across the UK is that most surgeries:

– haven’t ever thought about their booking process from a patient point of view
– designed their processes at a time when most patients lived and worked round the corner and haven’t felt the need to update them since
– operate a set of stupid inflexible and arbitrary rules on repeat prescriptions e.g. requests have to be made in writing and posted through their letterbox, some accept faxed requests, most don’t do emailed requests
– don’t address staff absence / lateness. When GPs are strolling through the door an hour late for their first session it’s in most cases nothing to do with home visits and just a lack of organisation
– operate most processes on the principle that endless visits to the surgery by the patient is better than using the technology that other surgeries have adopted.
– still operate on a 9-5 rota and won’t operate 8 till 8 which is actually what’s needed to keep the working population well. Obviously in a small partnered practice that’s more difficult to resource, which is exactly why we should be pushing for larger practices (not to mention the fact you’re much more likely to get bad care in a small / single handed practice due to the lack of peer review and learning).

There’s also an issue with some surgeries clearly taking on more patients on to their list than they can service with the actual working hours of the GPs – who in many cases are working significantly less hours than 10 years ago.

Dr P you are often on here proposing various rides and invite others to join you. May I suggest that you organise a specific consultation ride where we can come along and each get a 5 minute turn at the front with you while quizzing you about our various ailments. At the end of the consultation the rider can then peel off and as they go back down the line will have the chance to get random second opinions from the STW peleton. Any DNA’s will naturally be replaced by the next in line. The route should be carefully considered to pass various hospitals, minor injury clinics and specialist units where you can drop riders as necessary.
I look forward to our discussions regarding my elevated potassium levels if I can be arsed to turn up. 🙂

^^

It would be an incentive for me to really push my limits of ‘breaking away from the peleton’ I think 😉

Oh, avoid bananas, prunes, and tinned tomaoes as your ride snacks (to name but a few foodstuffs high in potassium!!! (I’m such a geek! I love metabolic disorders!))

DrP

I’m off the bananas already, greater hardship is hard to imagine, everything I like eating, in fact everything that’s good for you is high in potassium!

Solutions to the problem would include.

Mandating the number of appointments practice must offer per 1000 registered patients. At the moment the practice is only required to provide what it thinks is sufficient.

Stop half day closing. It is ridiculous that where I live all practices are closed Thursday afternoon. Guess what the A&E attendance rate rises for these practices on Thursdays

Match the number of staff answering the phones to the demand. Practices know from their phone systems, or should, when the peak demands are so should rota their staff to match, not have 2 people sat there all day

Offer telephone appointments. There are many cases, such as repeats etc where by a 2 minute phone call with the GP will be enough to either reassure the patient that they don’t need to be seen straight away or to confirm they are ok to have a repeat scrip that they can then just come and collect.

Have all the full time GPs actually working full time hours seeing patients not running additional clinics that they are paid extra for running. The payment for running these extra clinics should be used to fund additional clinicians time so the normal appointment system doesn’t suffer. Unfortunately I know of many practices who staff the extra clinics by reducing the appointments for normal patients. They can do this because of my first point about appointments. Tis allows the fees for running the extra clinics to be taken as pure profit for the practice.

In a previous job I spent 3 years working in practice based commissioning and have seen all of the above, both the positive and negative ones.

OK – solutions…I have AS and need various meds on a monthly basis. I won’t get the meds unless I have a blood test every four weeks. I understand the principles behind this but when I get offered a blood test “next one is a week on Thursday at 9.15am…yes, that’s all there is”. OK – i’ll have to take time off work so can I book the following one at the same time and get a more convenient option? “No, you can only book 2 weeks in advance”!!

Various GPs at the surgery didn’t particularly care. However, I was due a review and a locum called (she was S.African and had no idea why she was calling). I explained the predicament and told her that I had asked for a pack of blood forms from the GPs on numerous occasions so that I could just rock up at the hospital and have the test done there – no taking up space at the surgery or having to call for appointments etc. She simply said good idea and couldn’t believe the resident GPs hadn’t agreed. Two weeks later I had a pack of forms and now its massively more convenient for me and the practice. Moral is – we need more South Africans in the health service.

Match the number of staff answering the phones to the demand. Practices know from their phone systems, or should, when the peak demands are so should rota their staff to match, not have 2 people sat there all day

But in practice, who would want to work a shift that is only 0730-1000? From an HR point of view that’s almost unworkable.

Stop half day closing. It is ridiculous that where I live all practices are closed Thursday afternoon. Guess what the A&E attendance rate rises for these practices on Thursdays

There should be agreed local GP cover in this time.
GPs provide cover, or commission cover, until 1830.

Offer telephone appointments. There are many cases, such as repeats etc where by a 2 minute phone call with the GP will be enough to either reassure the patient that they don’t need to be seen straight away or to confirm they are ok to have a repeat scrip that they can then just come and collect.

I agree.

Have all the full time GPs actually working full time hours seeing patients not running additional clinics that they are paid extra for running.

Do you meant private clinics? I’m unclear, and interested, in what you mean here.

Otherwise, sensible suggestions, but may be impractical to run.

DrP

I’d like to see a better system, but I’m not sure it involves charging for appointments….

Do you mind if we move on from fixating on misquoting what I said? Its not adding anything to the discussion and just confirms the head in the sand type attitude to this real problem within the NHS.

So once more what I actually said was

The self evident answer is that to repeat something that isn’t working expecting a different outcome is indicative of madness. So the answer very simply is try something else, and keep trying something else until you find something that works.

Furthermore,

I merely pointed out that my dentist uses an invoice for a missed appointment to good effect as an example of thing that can be done. Apparently in Singletrackworld a dentist doing so is not a problem, but a doctor doing the same is apparently an insurmountable issue.

So in summary I have never suggested charging for an appointment, I have offered as an example my dentists practice of invoicing patients for a missed appointment, which is an entirely different thing, and is merely an example, not a definitive suggestion for a solution, which was already made. i.e. you will not find a solution by burying your head in the sand or throwing your hands up in despair. Frankly that is a lazy and ignorant attitude and demonstrates the arrogance of many GP’s and which quite honestly is disgraceful.

The serious implication is covered very well here in this quote from acracer:-

I’m one of these men who tends to put off going longer than I should, and have been told that I should have come in earlier…….. Also, exactly how urgent is depression which is sufficiently bad to drag somebody reluctant to see a medical professional in?

Personally, I suspect the truth is that its a covnenient method of guaranteeing that targets for appointments and waiting times are met. i.e. 99% of our patients get a same day appointment. Overlooking to mention that large percentage, are frustrated, give up trying or go to A & E or dial the debacle on 111.

What practice that I know do is that all non clinical staff are on phone duty frm 8:30 to 10:00. That’s all everyone does, receptionists, admin staff, practice manager, everyone. At 10 all but the receptionists go back to doing their normal work.

On Thursdays they commission the out of hours provider to cover for them. But as we both know, ooh providers don’t provide anything like as good a service as the patients GP does.

Other clinics point. I don’t mean private clinics. I mean providing non core NHS treatments to NHS patients such as out patient follow ups for patients where the GP is GPSI in that field, for less than an acute FUP costs. Some do minor surgery where their practice has the facilities under local anesthetic. Others do COPD clinics, ENT clincis there are many more. I have no problem with practices doing them and being paid, it is additional work outside the terms of their GP contract, its better value for commissioners and much more convient for most patients. I do have a problem when they slots these sessions into normal appointments , thus reducing the number of appointments for general GP stuff.

they deliberately keep blank slots for one of the gps in a 4 til 6 surgery every weekday

Which seems like a really handy idea – except if you do after school childcare every day. Sorry I know we’re supposed to be doing solutions, but non-obvious flaws also need pointing out.

So in summary I have never suggested charging for an appointment,

I agree.
But this is an open thread, and not just a conversation between you and I, so I’ve taken into account ideas and options from media and other posters, and also contributed my own ‘thinking out loud’.

i.e. you will not find a solution by burying your head in the sand or throwing your hands up in despair. Frankly that is a lazy and ignorant attitude and demonstrates the arrogance of many GP’s and which quite honestly is disgraceful.

🙄
Yes, because I’m sure you’ve been following myself and every other GPs around to every practice and commissioning meeting we have attended, instead of putting our children to bed that evening, and watched us all burying our heads in the proverbial sand….
Try and separate you own difficult experiences (which are clearly clouded in a difficult time with your wife’s health issues) and not generalise them. I do feel for you and the troubles you’ve been having, but don’t accept your accusations.

Chris:

What practice that I know do is that all non clinical staff are on phone duty from 8:30 to 10:00. That’s all everyone does, receptionists, admin staff, practice manager, everyone. At 10 all but the receptionists go back to doing their normal work.

A good idea, but many smaller practices (with of course, smaller patient populations) only have one (or two at most) phone lines in.
Additional phone lines actually cost quite a lot.

The ability to book online, and see results/request repeats on line, is a step forward to take pressures off phone lines.

DrP

I agree phone lines are expensive, but is part of the cost of doing business and giving the service that is expected. I think part of the problem is the private company status of GP’s which means that many are not keen to invest in their business as they would rather keep the profit given that they won’t receive any additional income from having an extra line. Some do, as they see it as part of their duty and should be applauded but many don’t.

It will be interesting to see if there is a change in contract enforcement now NHS England rather than the PCT’s are now responsible for GP contracts.

I agree.
But this is an open thread, and not just a conversation between you and I, so I’ve taken into account ideas and options from media and other posters, and also contributed my own ‘thinking out loud’.

Er no…. what you actually said was this

I also agree with your statement alluding to ‘ownership of a service you’ve paid for’ (which is one reason why people paying for chiopractor/osteopath services have “great outcomes” – the financial investment made skews their perception of the actual outcome). However, as raised, the idea of charging at the point of service for GP is a very muddy one. I’d like to see a better system, but I’m not sure it involves charging for appointments….

Again misquoting what I said, and I’m pretty sure I can be forgiven for thinking thats directly responding to my earlier post, which was nothing to do with charging anyone, what I was suggesting was that by raising the spectre of an invoice you are giving the appointment the perception of a real monetary value. Just by doing that it transforms attitudes. I even gave two examples, (Catalogue and County Court) where the perception of a cost modifies behaviours.

Okay…
However, I think I can be forgiven for mis-interpreting you.
When you typed:

…Which basically means people don’t value that which does not cost them much to obtain. So the reverse of that coin is give it a value and people then treat it better.
For example putting a price on catalogues is a well know tactic to stop them going in the bin.

You can easily see how giving an example of charging someone for an item (catalogue) can be interpreted, in the context of making suggestions for improving a service, that there was a suggestion of that charging for appointments would “give it a value and people then treat it better”.

Like most political thread in STW, this has probably reached the limit of sensible, non-bickering contributions (it’s about the 3 or 4 page mark), as appears to be turning into a spleen-venting arena.

Which is fine, in a way.

But I’d seriously suggest, for you berm-bandit, a better outcome is likely to be reached by directing your (valid) concerns with your service, and writing a letter to your practice.

Anyways….

DrP

Phone lines aren’t expensive if SIP trunks are used. A reliable internet connection is a requirement though.

You can easily see how giving an example of charging someone for an item (catalogue)

If you look I very specifically said putting a price on it, NOT charging for it, and furthermore referred to it as a tactic.

But I’d seriously suggest, for you berm-bandit, a better outcome is likely to be reached by directing your (valid) concerns with your service, and writing a letter to your practice.

…..and as I’ve already said, I have already done so to pretty much the same response as you have been giving, which seems to be “what do you know, we’ve already tried everything, nothing works and therefore my patients are all wasters, and clearly my time is so much more important than yours”. As anyone operating in a “real world” environment, (and before you lecture me in who much more real your world is than mine, I mean a world where commercial pressures are real as opposed to the pretend internal market within the NHS), will tell you your survival as a business would be extremely unlikely in anything other than a monopoly. Whilst I don’t agree with their philosophy, this is precisely why tories wattle on about public utilities, and why they constantly attack them.

Reason 33

You can’t afford to ring the premium rate number that your local surgery uses.

Incredible isn’t it!

http://www.thetelegraphandargus.co.uk/news/10354745.Doctors_still_charging_patients_premium_rates_for_phone_surgery/

So advertise the fact that missed appointments will be charged, and indeed send out invoices. It won’t take long to get around, and I guarantee that the outcomes will improve.

Hard to see how that can be misinterpreted.

Anyway. Lets take the principle that people who persistently miss appts then forgo some freedom. They could lose the opportunity to choose who they see and when. If a practice has 5 doctors, say, then each of them could run a session each day, taking it in turns, in which persistent poor attenders are double or triple booked. I guess it would make sense to only do this for half the available appts just in case everyone attends. The poor attenders would not be offered a time, just allocated a slot in this session and they might have to wait a bit but they would be seen. That way the GP’s obligation to see the patient is covered but the patient has some sanction against them for their poor attendance. If no-one turns up then the GP can be prepared to do something else, some admin or whatever.

Just an idea rather than a suggestion to try something else. . .

choose to take the ‘pleb mobile’ Astra

it was you that hit Poddy 😯

@DrP, I appreciate it’s frustrating but you’re still getting paid the same whether the patients arrive or not.

I’d personally be happy to pay for a doctors appointment, on the basis I could get one quicker than 3 days and that I could see whatever specialist I wanted rather than a Generalist and that I wasn’t paying so much tax for the privalige of not being able to get an appointment