04 February 2009

Choose and book (yet again)

Now it's official. Patients who use Choose and Book are less likely to show up. Isn't it awful? All that expense and it doesn't work.

If you can be bothered to read one of Grumble's old posts on this topic one reason is here.


Anonymous said...

I was interested to read your post for the following reason - I 'choose and booked' an appt for my son, which is tomorrow. It was quick and easy - I was able to select a date, time and location which were convenient and didn't disrupt his school day.

I don't fully understand how the whole system works but I have read the post you link to. My questions are - presumably you (the hospital) still get a referral of some kind from the GP - otherwise how do you know why the pt has come to see you? Following on from this, if you need to see the pt again, in my experience, a follow up appt is sometimes made in the OP Clinic - is this still the case? Could you not, when you see the pt, suggest to them - if you need to see them again after tests etc, that certain days are better to come back on and advise them appropriately - ie the days when you have longer slots if you need additional time?? My apologies if this sounds like a patronising question!

BTW - I recently attended a appt which was for 0940 - I had to travel quite a distance and left home at 7am. I was seen just over an hour after my appt time... the clinic was running an hour late that early in the day. Frustrating when you make a special effort to be on time....

Dr Grumble said...

Presumably you (the hospital) still get a referral of some kind from the GP.
This bit was a surprise to me. We still get a well written letter from the GP that arrives somehow through the ether. The problem is that we do not read it until the appointment has been made.

Although you might be able to read a letter and know that you might need a long or a short time the truth is that how long you need to spend with a patient is can be unpredictable. I fear that the reason you had to wait for over an hour after your appointment time might have been due to bad organisation but sometimes it is beyond the control of the hospital. What if the first patient arrived 25 minutes late and then took longer than was expected because, say, he didn't speak English. The consequence of that is that every patient from then on will be set back by 25 minutes or more. Some people are always late. Some people are always early. Young people can't get up in the morning. Older people may want to travel off peak. To the doctor patients can appear like buses: none then three in a row.

As for getting patients back to the best clinic I always do that if I can. But some patients have days of the week that are better for them than others and sometimes it is best to see them on their preferred day rather than the day when you have the best set up for whatever their problem is.

I don't think there are any easy solutions to these issues. The only way to avoid patients having to wait is to have slots that are always longer than needed and that would be expensive.

I gather doctors in the US spend twice as long with their patients. But in the US they spend twice as much on healthcare and despite that they have 50 million people without any healthcare.

These things are not easy.

Anonymous said...

Dr Grumble - thanks for your reply which was useful and interesting.

As you say, there are no easy solutions - pts prefer certain days for various reasons. Some people are always late and others always early!

I think the answer to the issues raised by Choose and Book are not easy to solve. These haven't been created by the new system, but appear to be symptomatic of a system which is difficult to fix and has no easy answer!

I wonder if a possible solution for your issues would be to have ALL your appt times the same - ie you would see the same number of pts over a week, but their slots would all be the same? Or can you 'hold back' "follow up" slots from the system so all new pts are seen at a particular clinic, then the follow ups are booked in clinic with longer slots?

From what you say there are no ideal answers and being honest, I don't think that's all down to Choose and Book.

Just out of interest, what's your ideal model for an Out Patient Clinic appt booking system? If Choose and Book is crap, what would Dr Grumble like to see in its place??

Dr Grumble said...

In place of Choose and Book?

Our point has always been that the system whereby a GP sees a patient and decides which consultant would be best for that patient and then writes a thing called a letter to the named consultant has a lot of strengths.

OK. These days the patient should decide but honestly how is a patient supposed to know which consultant is going to be best for their particularly problem (even doctors don't necessarily know)?

In any case with Choose and Book the one thing you cannot choose is the consultant. Surely, of all things, choosing the dcotor is the most important. In the old system that was once possible - but if everybody want to see the same person then the only solution to that is a wait (which is no longer allowed).

You are quite right that many of the problems of outpatient appointments go way beyond Choose and Book and are not much to do with it.