Appointments Systems Kill Patients

Dr Vernon Coleman MB ChB DSc FRSA

There are many ways in which the National Health Service does genuine harm.

Here’s one you might not have thought about.

The Government in Britain forces general practitioners to run appointment systems even though there is little doubt that both patients and doctors are better off without them.

When I first practised as a GP in the early 1970s, I had no appointments system. Patients turned up at my surgery, sat in the waiting room and waited. If there was a long queue they would pop out, do some shopping, and come back half an hour later. The system worked well. I don't remember anyone ever complaining. I employed one receptionist to take the patients' names and make sure that I was supplied with the appropriate medical records.

And then the bureaucrats decided that I had to organise an appointment system. Patients had to ring up in advance to make a date to see me. Teams of receptionists had to be employed to take messages and keep the appointment book. Emergencies still had to be slotted in and the whole system was a disaster.

I found, to my horror, that instead of being able to see me the day they fell ill, or noticed worrying symptoms, some patients had to wait several days to see me. That can be deadly, of course. Delays in making diagnoses or initiating treatment can kill people.

Patients complained that the telephone line was constantly engaged. I had to install a second and then a third telephone line so that patients could ring up and make appointments without blocking the telephone line used for emergencies.

And then patients started to use the emergency line to make appointments. So I had to install another emergency line for emergency emergencies.

Cancellations and crossings out resulted in the appointment book becoming incomprehensible. Patients who had to wait just 15 minutes (because I was running late) complained bitterly that I was providing a rotten service and that they never had to wait when visiting the bank manager.

I still held `open' surgeries on bank holidays and at weekends. Patients would turn up, sit in the waiting room and be seen in turn. Just like the `bad' old days. There was no receptionist. No one complained. There were no arguments. Everyone knew who was next in line. And the system worked efficiently and well.

The fact is that appointment systems were introduced not to please doctors or patients but to please bureaucrats and to give a sense of order to a service that could never be ordered because there are too many variables and too many unforseeables.

Appointments systems also provide employment for masses of low-grade clerks. I suspect that the bureaucrats who ran the NHS couldn't bear the idea of any aspect of the health service being run without a need for vast numbers of clerks and administrators.

Today, appointment systems have become a major problem and should be scrapped.

The clerks who make the appointments have grabbed as much power as they possibly can and have risen far above themselves.

Health centre receptionists talk glibly about how they use a `triage' system to arrange appointments. Some use the word as though they know what it means. These clerks know nothing about medicine but they somehow assume that they are able to make decisions about whether or not patient A is more needy than patient B. Callers who want special treatment make a special point of being nice to the receptionist and buying them little gifts from time to time in order to ensure that they will be provided with early appointments.

Patients, quite rightly do not like appointment systems and nor do doctors who care about what patients like.

(Incidentally, some greedy GPs have so much contempt for their patients that – until they were banned from doing so – they introduced premium rate telephone lines so that patients ringing to make appointments had to pay huge fees for the privilege of doing so.)

I strongly suspect that any private GP who set up a practice without an appointment system would attract more patients than he could cope with.

If, in addition, he provided an out of hours service (for a fee, of course) he would become the most popular GP in the country.

The problem, of course, is that most doctors wouldn't have the foggiest how to run a private practice, and they know it. They have grown rich and lazy working in the NHS. And, like most millennials, they prefer a work-life balance which puts all the emphasis on `life’ and very little of it on `work’. They are, as a body, light on experience, light on knowledge but heavy on opinions.

But nothing will change within the NHS because the bureaucrats are determined to keep appointments.

Indeed, things are going to get much, much worse.

There are plans to introduce a national appointment service. Patients will ring a single telephone number and (if they get through before they die) they will speak to a faceless, nameless operator (probably working in India) who will (if the computer is working) give them an appointment to suit the system.

Centralised appointment booking will be introduced because it will be convenient and economical for the bureaucrats. It will be chaotic and it will kill people even more efficiently than the present system.

The old-fashioned way of doing things was cheaper and far more convenient for everyone concerned. There was no unnecessary layer of administration between doctors and patients.

Most important of all, the absence of appointment systems meant that patients were diagnosed more speedily, treated more speedily and cured more speedily.

It was bound to be changed.

Vernon Coleman’s bestselling book How to stop your doctor killing you is now available as an ebook on Amazon.

Copyright Vernon Coleman 2018