As I sat in surgery on Christmas Eve, I felt my blood pressure rise and not because I had a medical problem. By the end of the day, seven patients who had called that morning for an emergency appointment had failed to turn up.
This fairly frequent event gave me time to make a video which I tweeted, as part of my public duty to raise awareness about just how disappointing such no-shows are for the wider NHS. I then got back to the long list of “triage” messages which included mainly kids and a couple of frail and elderly patients, all requiring genuine urgent medical attention but who had not been able to get an appointment.
GPs have a triage service which runs parallel to normal clinical work. This can include anything from prescription requests, urgent hospital correspondence, home visits and telephone consultations to ascertain who needs what for that day. Often people who cannot get an appointment or feel they cannot wait for a routine appointment end up on this list to be managed accordingly by the clinician. We usually do this if we are running on time (a rarity) or if the odd patient doesn’t turn up. Generally however we do this work after our routine surgery of 15-20 face-to-face appointments. This is why GPs never leave on time.
The odd missed appointment can occur for many reasons. When a patient with severe depression didn’t turn up on Hogmanay I feared the worst and called. Thankfully they were fine and had genuinely forgotten, a first for them. Life happens, I get it. However, this is a daily occurrence in primary care and there are frequent offenders who take the system for granted and fear no consequence. On days when services are restricted, practices are closing for public holidays and pressures are higher, consideration for others is not much to ask for.
Yesterday NHS England released data showing that one-in-20 GP appointments are being wasted, costing the NHS over £200m annually – a huge sum of money which could go a long way if invested in areas of the NHS requiring urgent attention. What people need to understand is the impact of missing their appointment is multi-system and most importantly affects vulnerable sick patients who miss out. Often these people have to turn to A&E or NHS24 and worse still can deteriorate while waiting their turn. It is not fair.
I worked in NHS24 over the festive practice closures and encountered patients who hadn’t managed to get appointments with their GP and I wondered how many suffered because their peers failed to show up for theirs.
The response online to my video was overwhelming with over 480,000 views. Why? Because everyone, at some point, has been a victim of poor access to care. The majority of responders called for charging and naming-and-shaming patients for missed appointments, but do we really need to stoop to this level? Can we perhaps start showing gratitude to the incredible service we have in Britain and start doing our bit for people who need medical care? Yes, wait times are long and yes there are many flaws but we are living with an ageing population complicated by complex chronic diseases. Patient demands are higher than ever, we have mounting staff shortages and serious funding issues. Everyone has a role to play. All I ask for is that people turn up for their booked appointment or cancel if they cannot attend. It really is that simple.
Punam Krishan is a GP and is on Twitter @drpunamkrishan