Missed appointments

[Passing Time]

So in this week’s local rag, hooperman talks about the number of appointments not fulfilled and the cost thereof. In the same breath immediately states they won’t be looking to recover the costs. If people make an appointment then can’t be arsed turning up then bill them. Give them seven days to pay and if they don’t then remove them from the GP list

[Gladys]

Or, make the appointment booking system work.  Don't have people using up their PAYG credit trying to book an appointment (BTW, those who are the most vulnerable also do not have the free minutes of a contract)  or put people in a phone lottery to get an appointment only for that day when they are looking for a non-urgent appointment and are happy to wait for one. 

[0bserver]

Is the booking system the real issue or is it just a symptom of the acute lack of GPs and other healthcare professionals?

 

I'm sure the arrival of Alf's 15,000 new residents will work wonders for the current situation.

[The Voice of Reason]

21 minutes ago, Gladys said:

Or, make the appointment booking system work.  Don't have people using up their PAYG credit trying to book an appointment (BTW, those who are the most vulnerable also do not have the free minutes of a contract)  or put people in a phone lottery to get an appointment only for that day when they are looking for a non-urgent appointment and are happy to wait for one. 

Agreed this needs sorting badly but it’s a different issue from those who have been fortunate to secure an appointment who then fail to turn up.

There should be some sort of sanction for that if they fail to cancel without good reason.

[0bserver]

Do we know how big the problem is compared to the number of people who are seeking appointments but failing to get one? 

I've asked previously and was told that DHSC/Manx Care don't keep a record of the number of people turned away or denied. 

So it's hard to get a handle on the issue. If the missed appointments were cancelled then re-allocated to those needing them, it might help, but I don't think it would make much of an impact. 

Conversely we have a situation where non-urgent appointments can be 4 to 5 weeks away in which time people can deteriorate and go into hospital.

I would say be careful what you wish for. Once they normalise the charging mechanism for missed appointments we'll be going down the Guernsey route of charging for attending A&E and a whole host of other things. 

[wrighty]

I’ve almost certainly posted this before. Missed appointments don’t cost anything more than would be spent if everyone turned up, in fact they probably save a few quid on consumables when these patients don’t get sent for tests. It may be useful to illustrate such stories with things like “the cost of x missed appointments is y” but it implies that money could be saved.

The real cost is in the accessibility of healthcare and making everyone have to wait longer. 
 

The cause is multi-factorial, some admin/system related, some with patients getting better, some not being that unwell in the first place and abusing the system. I don’t think charging is right, as much as I think some of these patients in the latter group ought to be fined. As Gladys says, sort the bookings first, and improve the communication for patients who want to cancel. Once that’s done then start charging. 

[woolley]

18 minutes ago, wrighty said:

I’ve almost certainly posted this before. Missed appointments don’t cost anything more than would be spent if everyone turned up, in fact they probably save a few quid on consumables when these patients don’t get sent for tests. It may be useful to illustrate such stories with things like “the cost of x missed appointments is y” but it implies that money could be saved.

 

It's always struck me that the same applies with the public health messages to "save the NHS money" by taking care of yourself. But how does that work in totality? If I'm a good boy, look after myself, don't smoke, don't get cancer and don't cost the NHS 12 months of treatment before I die, then surely on the other side of the equation I will deprive the government of my tobacco taxes, cost it maybe decades of state pension and perhaps finish up needing who knows what treatment and nursing care as a codger.

Obviously good health and quality of life is worth promoting for its own sake, but as a vehicle for saving money? I'm not so sure.

[HeliX]

14 minutes ago, woolley said:

It's always struck me that the same applies with the public health messages to "save the NHS money" by taking care of yourself. But how does that work in totality? If I'm a good boy, look after myself, don't smoke, don't get cancer and don't cost the NHS 12 months of treatment before I die, then surely on the other side of the equation I will deprive the government of my tobacco taxes, cost it maybe decades of state pension and perhaps finish up needing who knows what treatment and nursing care as a codger.

Obviously good health and quality of life is worth promoting for its own sake, but as a vehicle for saving money? I'm not so sure.

The amount one smoker would pay in tax on their cigs isn't going to cover the cost of their treatment though.

[woolley]

4 minutes ago, HeliX said:

The amount one smoker would pay in tax on their cigs isn't going to cover the cost of their treatment though.

But the treatment and care in later life might far outweigh it.

[HeliX]

2 minutes ago, woolley said:

But the treatment and care in later life might far outweigh it.

Possibly - but one is avoidable in a good way and the other is only avoidable by dying. Maybe we're only one or two rounds of austerity away from the NHS suggesting people dying as a viable cost saver though.

[Apple]

How about following up the non shows and actually asking why they did not attend.

Do some actual research into the stats Instead of just accepting or guessing what the reasons may be lets now actually lets try and find out where it is going wrong. I think we may be surprised. 

The same criticism is made every so often and rightly so. Charging though is not the answer.. We would need a lot more admin staff to be put in place. How would we deal with defaulters for example ? Exclude them? 

[Roger Mexico]

The media run this story with monotonous regularity, mainly because the DHSC/Manx Care keep on putting out press releases.  Here's what I said last time it came up in September:

This is complete bollocks.   It doesn't actually cost anything.  If cancelled appointments are the current low level (about 2-4% I think) then it's unlikely to even inconvenience anyone.  All that happens is that some patients further down the list get seen a little less late than they other wise would have.  This is just the upper reaches of DHSC/Manx Care wanting blame all their problems on the patients.

(corrected for typo)  They don't even seem to have updated the headline figure about the 'cost'.

If efforts need to be made, as Apple says, then they should be analysing why people don't cancel or turn up and the effect of changes over the years.  Do text reminders make a difference and does it matter when they are sent?  Are appointments booked over EMIS more or less likely to be cancelled or forgotten about?  These may lead to minor improvement, but until doctors have long enough to see patients properly, non-arrivals won't make a massive difference.

Of course there will be a handful of patients who 'abuse' the system, often because of mental health difficulties.  But I suspect that every GP Practice will know who theirs are anyway and I doubt fines will deter them any more than they do potential suicides.

[Newbie]

5 hours ago, HeliX said:

The amount one smoker would pay in tax on their cigs isn't going to cover the cost of their treatment though.

It would almost certainly be possible to find individual smokers where the cost of treatment for their smoking related illness is higher than the amount they have paid in tobacco taxes, just as it would be possible to find non smokers whose healthcare costs exceed the amount they pay in tax generally. However, overall tobacco receipts for UK Government are around £10.3 billion annually whereas healthcare costs for smoking related illnesses is around £2.5 billion with a further £1.2 billion in social care costs annually, so that argument doesn't really hold water. There are plenty of reasons why not smoking is better than smoking, but the health and social care costs to society is a weak argument.

[Hoops]

6 hours ago, HeliX said:

Possibly - but one is avoidable in a good way and the other is only avoidable by dying. Maybe we're only one or two rounds of austerity away from the NHS suggesting people dying as a viable cost saver though.

what is this - Canada? 🙄

[0bserver]

How many of these missed appointments were also down to the Bus Vannin shambles/chaos that the public enjoyed this summer?