IOM DHSC & MANX CARE

[2112]

5 minutes ago, asitis said:

My wife was referred to a pain clinic for severe pain, waiting time nearly three years ! We paid for as much of the interim treatment we could afford privately, but after a wait of 2yrs and 8 months she had a procedure at Nobles to assist with the problem. As others have said Nobles was actually great, the problem is getting there and seeing the right people !

I wonder if 70 million would have helped eh Alf !!!!!!

If £70million was pumped as additional funding into Manx Care I don’t think people would complain. The issue with extra funding being pumped into departments is whether the funding is being utilised correctly and wisely, or like typical IOMG is is being squandered on waste, bloat and empire building?

[Newbie]

8 hours ago, Roger Mexico said:

Providing they remain at a reasonable level (and in percentage terms they can be very low) the truth is that missed appointments don't make much difference, especially at GPs.  Because the time given to see each patient and do the associated admin is so short (10 minutes), they always run late, queues always build up and there will always be someone else to move up the queue.  And it's not as if GPs are short of things to do in the office.  It's not good manners to miss an appointment, but it's not a big strain on resources.

Whenever NHS admin starts going on about missed appointments (even ignoring they're responsible for quite a few of them) I always reckon it's more about blaming the public for their own shortcomings.  

To a certain extent you are correct that missed appointments can relieve the pressure in a busy surgery or clinic, but what it also does is deny the possibility of another patient taking up the appointment. If an appointment is cancelled in General Practice, even at quite short notice, it can almost always be filled. If it isn't cancelled, but just missed, it can't be taken up by someone else, resulting in longer waits for everyone else.

The comment about the NHS being responsible for quite a few missed appointments may be valid as far as the hospital is concerned since they typically send out appointments without any regard to whether they are convenient for the patient. Inevitably, some of those appointment times will not be convenient, and since they didn't actually book the appointment themselves, some patients may not ring up to cancel. Others will ring up to cancel but the administrative problems are such that the message doesn't get through to the coalface.

In Primary Care, which is what is being talked about here, that isn't the case. The overwhelming majority of appointments are booked by the patient at a time that is convenient to them (or at least at a time they are aware of when they book the appointment). To blame the NHS admin for missed appointments in that circumstance is less valid.

[Andy Onchan]

Had to organise a blood clinic appointment (for annual medication review) and was asked when would I like to attend. Never been asked that before. Completely caught me off guard, to the extent that I had to ring back and get them to confirm it again as I thought I'd put it in on the wrong day on my calendar!

[Roger Mexico]

10 hours ago, Newbie said:

To a certain extent you are correct that missed appointments can relieve the pressure in a busy surgery or clinic, but what it also does is deny the possibility of another patient taking up the appointment. If an appointment is cancelled in General Practice, even at quite short notice, it can almost always be filled. If it isn't cancelled, but just missed, it can't be taken up by someone else, resulting in longer waits for everyone else.

The comment about the NHS being responsible for quite a few missed appointments may be valid as far as the hospital is concerned since they typically send out appointments without any regard to whether they are convenient for the patient. Inevitably, some of those appointment times will not be convenient, and since they didn't actually book the appointment themselves, some patients may not ring up to cancel. Others will ring up to cancel but the administrative problems are such that the message doesn't get through to the coalface.

In Primary Care, which is what is being talked about here, that isn't the case. The overwhelming majority of appointments are booked by the patient at a time that is convenient to them (or at least at a time they are aware of when they book the appointment). To blame the NHS admin for missed appointments in that circumstance is less valid.

I realise that admin mix-up are less of a problem with GPs (though not unknown - see above) but I was thinking more about the way that central admin tends to use missed appointments (including in primary care) as an excuse and highlighting it as an important 'problem'.  It's certainly an irritation for those expecting a patient that doesn't come and people shouldn't do it, but compared to the other much greater problems, such as lack of personnel, it doesn't make a lot of difference to the overall service. 

[Newbie]

12 hours ago, Roger Mexico said:

I realise that admin mix-up are less of a problem with GPs (though not unknown - see above) but I was thinking more about the way that central admin tends to use missed appointments (including in primary care) as an excuse and highlighting it as an important 'problem'.  It's certainly an irritation for those expecting a patient that doesn't come and people shouldn't do it, but compared to the other much greater problems, such as lack of personnel, it doesn't make a lot of difference to the overall service. 

Accurate data are difficult to gather, but NHS England have calculated that around 9% of GP appointments are missed. For an 'average' practice with 4 full time GPs, that effectively reduces their capacity to around 3.65 Full time GPs. Not as significant as being unable to recruit a replacement for a retiring GP, but still has a significant effect. Especially when you consider how waiting lists build up. For the sake of argument, if a practice needs to have available 1000 appointments a week to provide a proper service for its patients, and they actually have 1050 appointments available, waiting times will be very short. Conversely, if they only have 950 appointments available, the extra 50 patients will take up the first 50 appointments of the following weeks availability, reducing that further, and so a waiting list builds up. In that context, 9% of appointments missed can have a significant effect.

One solution is to make more appointments available on the assumption that a proportion will be missed (a bit like overbooking airlines), but a feature of missed appointments is that they are very unpredictable and can be affected by all sorts of things like weather, so overbooking isn't so easy. 

Interestingly, one of the strongest predictors of whether an appointment will be missed is the length of time in advance that it is booked. Only 4% of appointments booked the previous day will be missed, whereas that rises to over 40% if the appointment is booked more than 2 weeks ahead. In many ways, that is entirely understandable. Other 'more important' things may crop up in the meantime, self-limiting problems may have gone away etc. The effect of that is that an inefficient system, with long waits for appointments, becomes even more inefficient by significantly increasing the number of missed appointments. Another solution would be to restrict booking of appointments to the following day, but that is understandably very unpopular with patients.

I would agree that the NHS pays lip service to the problem, and hasn't come up with an effective strategy to deal with it. That may well be in part because there is a perverse incentive for them not to solve it - namely that missed appointments do provide some relief and an opportunity to catch up with the daily workload. If you look at dental surgeries (at least private ones), where there is a very real financial incentive for them to minimise missed appointments as far as possible, they are much more proactive, using text messaging, email and phone calls to remind patients to either attend or cancel.

[manxman34]

40 minutes ago, Newbie said:

Accurate data are difficult to gather, but NHS England have calculated that around 9% of GP appointments are missed. For an 'average' practice with 4 full time GPs, that effectively reduces their capacity to around 3.65 Full time GPs. Not as significant as being unable to recruit a replacement for a retiring GP, but still has a significant effect. Especially when you consider how waiting lists build up. For the sake of argument, if a practice needs to have available 1000 appointments a week to provide a proper service for its patients, and they actually have 1050 appointments available, waiting times will be very short. Conversely, if they only have 950 appointments available, the extra 50 patients will take up the first 50 appointments of the following weeks availability, reducing that further, and so a waiting list builds up. In that context, 9% of appointments missed can have a significant effect.

One solution is to make more appointments available on the assumption that a proportion will be missed (a bit like overbooking airlines), but a feature of missed appointments is that they are very unpredictable and can be affected by all sorts of things like weather, so overbooking isn't so easy. 

Interestingly, one of the strongest predictors of whether an appointment will be missed is the length of time in advance that it is booked. Only 4% of appointments booked the previous day will be missed, whereas that rises to over 40% if the appointment is booked more than 2 weeks ahead. In many ways, that is entirely understandable. Other 'more important' things may crop up in the meantime, self-limiting problems may have gone away etc. The effect of that is that an inefficient system, with long waits for appointments, becomes even more inefficient by significantly increasing the number of missed appointments. Another solution would be to restrict booking of appointments to the following day, but that is understandably very unpopular with patients.

I would agree that the NHS pays lip service to the problem, and hasn't come up with an effective strategy to deal with it. That may well be in part because there is a perverse incentive for them not to solve it - namely that missed appointments do provide some relief and an opportunity to catch up with the daily workload. If you look at dental surgeries (at least private ones), where there is a very real financial incentive for them to minimise missed appointments as far as possible, they are much more proactive, using text messaging, email and phone calls to remind patients to either attend or cancel.

Absolutely. I never miss a vet's appointment because there are frequent reminders. Noble's was issuing appointments months in advance, then changing them several times, and all by letter.

[wrighty]

4 hours ago, manxman34 said:

Absolutely. I never miss a vet's appointment because there are frequent reminders. Noble's was issuing appointments months in advance, then changing them several times, and all by letter.

And, if you miss your vet’s appointment without good reason they’ll probably charge you anyway. 

[Roger Mexico]

6 hours ago, Newbie said:

I would agree that the NHS pays lip service to the problem, and hasn't come up with an effective strategy to deal with it. That may well be in part because there is a perverse incentive for them not to solve it - namely that missed appointments do provide some relief and an opportunity to catch up with the daily workload. If you look at dental surgeries (at least private ones), where there is a very real financial incentive for them to minimise missed appointments as far as possible, they are much more proactive, using text messaging, email and phone calls to remind patients to either attend or cancel.

The reason that GPs don't overbook in the same way as airlines is that the 'perverse incentive' is their equivalent.  They know that capacity will still get used.  But it's a sub-optimal way of doing it and reminders by text etc would probably help, including reminding people of Covid-restrictions or whatever.  It would also help sort out admin mistakes from both sides.

[manxman34]

1 hour ago, wrighty said:

And, if you miss your vet’s appointment without good reason they’ll probably charge you anyway. 

Quite right, too

[Newbie]

36 minutes ago, Roger Mexico said:

The reason that GPs don't overbook in the same way as airlines is that the 'perverse incentive' is their equivalent.  They know that capacity will still get used

Coupled with the fact that if they overbook such that there is a very much shorter wait between booking an appointment and the actual appointment they would have very much fewer missed appointments, resulting in unmanageable numbers in surgeries. Unlike airlines, they can’t turn them away and book them on the next flight! It is a circular problem that really requires adequate numbers of GPs who can offer sufficient appointments to keep waits very short resulting in far fewer missed appointments without overwhelming the system. 
It is a whole can of worms that includes recruitment issues, resources, access to secondary care services, patient expectations etc. It isn’t simple, although I agree in the short term texting etc would help

 

[James Blonde]

I found this webpage which makes reference to what the specs were for the 'new' Nobles. 

Quote

The new hospital has been planned to have capacity for a perceived projected IOM population of 85,000 by the Year 2021. By this time it has been estimated that the hospital will be coping with 6,250 surgical operations, 28,000 new cases through the accident and emergency department, 65,000 examinations in radiology, with 2.25 million items processed by the laundry using 22.5 million litres (6 million gallons) of water and 20,000lb or approx. 10t of soap per year.

Source: https://www.hospitalmanagement.net/projects/nobles/

Does anybody know how this stacks up against what the actual figures are being dealt with by Nobles? 

 

£111m seems like a steal when Liverpool is now going to cost similar! 

[opusManx]

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Edited January 13, 2022 by opusManx
addendum

[FSM]

5 hours ago, Roger Mexico said:

The reason that GPs don't overbook in the same way as airlines is that the 'perverse incentive' is their equivalent.  They know that capacity will still get used.  But it's a sub-optimal way of doing it and reminders by text etc would probably help, including reminding people of Covid-restrictions or whatever.  It would also help sort out admin mistakes from both sides.

Not sure if all surgeries on island do this, but  we do send a text confirmation of an appointment when booked and a text reminder the day before. Our computer system does this automatically. Missed appointments are unusual. I personally have     about 115 “routine” appointments per week (and a similar number of urgent extras) and on average about one person per fortnight doesn’t turn up. 

[forestboy]

7 minutes ago, FSM said:

Not sure if all surgeries on island do this, but  we do send a text confirmation of an appointment when booked and a text reminder the day before. Our computer system does this automatically. Missed appointments are unusual. I personally have     about 115 “routine” appointments per week (and a similar number of urgent extras) and on average about one person per fortnight doesn’t turn up. 

Both Castletown Medical Centre and Thie Rosien Dental surgeries send text reminders a day or two before appointments. Excellent service. 

[Numbnuts]

1 hour ago, forestboy said:

Both Castletown Medical Centre and Thie Rosien Dental surgeries send text reminders a day or two before appointments. Excellent service. 

I always get a reminder from Hailwood Medical center to day or so before. Very good service tbh . 

Edited December 14, 2021 by Numbnuts