GP Appointments - Breach of Contract?

[alanfromderby]

Okay, I have just spent 80 minutes sat in our local surgery. The appointment was for 5.20pm - I arrived at 5.10pm, and finally got to see the doctor at 6.30pm!

 

Now, I am not moaning about this, as I understand that doctors often get called out of surgery, and I was not in any hurry to get anywhere else.

 

What I was interested with though, was that about three people decided that they could not wait any longer and tried to make another appointment. The receptionist told each one that the next available appointment was APRIL 27th!!!

 

Firstly, I have to say that I found it astonishing that all three basically shrugged their shoulders and made the appointment for that date - despite the fact that one of them said she had waited three weeks for today's appointment.

 

My question though is this:

 

When an appointment is made with the doctor, is this not a contract being made?

 

If that is correct, then surely they should have been willing to offer a replacement appointment at the earliest available time. I should note here, that the surgery keeps slots clear, so that people can ring at either 8am (for an appointment that same morning), or 2pm (for an appointment that same evening). These are done on a first-come-first-served basis.

 

One of the three asked if she could have one of these slots for Monday - to be told that she would have to take "pot-luck" and ring at 2pm Monday. She decided to just make the appointment for April 27th.

 

Something is seriously wrong with this system somewhere!!

[Bookworm]

When an appointment is made with the doctor, is this not a contract being made?

 

I would have thought it was actually a service being rendered. One you're not directly paying for.

 

Are you going somewhere with that question? I'm intrigued. Or has the breach of contract fever grabbed you so hard that you can't cease wondering?

[alanfromderby]

Or has the breach of contract fever grabbed you so hard that you can't cease wondering?

 

One is always wondering........

[Seminole]

The crux of the problem with the NHS is that it is geared around the requirements and aspirations of the provider and not the customer. The fact that the average family pays 5 grand a year for the service is irrelevant because it's deducted directly from their wages and the service is "free at the point of use".

[alanfromderby]

Whilst you have to feel sorry for doctor's receptionists....wouldn't you just like to strangle one of them as an example. LOL

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BTW - my wife used to be one, so I do understand it's not their fault!

[bankoff]

Hi Seminole

 

I am intrigued by your calculation that the average family pays £5K per year to the NHS, then this makes an average of 40 years in work at £5K per year, which is £200K, and rising.

 

If this is the case then one member of that family getting dementia, and having to go into a Care Home etc, has already been covered.

 

Which adds weight to my question "Should we have to pay AGAIN for Elderly Care"?

 

As its been said before in previous posts, "the amount of wastage is what the problem is with the NHS".

[Seminole]

£96bn current spend divided by about 19m families in the UK. Some of the money comes from business tax of course and spending has increased quite a lot in the past few years. However, I'm not sure that there has been a commensurate improvement in the service.

[Bookworm]

I am intrigued by your calculation that the average family pays £5K per year to the NHS, then this makes an average of 40 years in work at £5K per year, which is £200K, and rising.

 

If this is the case then one member of that family getting dementia, and having to go into a Care Home etc, has already been covered.

But the average family will have had 60-off years of midwifes, health visitors, community nurses, doctors visits at home and at the surgery, A&E visits, operations and hospital stays, dental care, physio, etc, etc...

 

Don't get me wrong, I do believe there is a huge amount of wastage in the NHS, and the amount of "managers" beggars belief. But your calculation is over simplistic, in not factoring the ongoing costs of care to the average family above described.

[trundlecat]

It's the same old story, money going to all the wrong places.

 

But the average family will have had 60-off years of midwifes....

 

 

Oh no, I can feel a soap box moment coming on (sorry everyone)......

 

Just 1 example of a HUGE waste of money. If we regarded hospital birth as the exception rather than the norm there would be millions diverted back into the NHS. Why on earth is it not assumed that women will give birth at a birth centre (much cheaper than hospital) or at home (dirt cheap compared to hospital) unless medical history or something happens in the pregnancy to warrant being hospitalised? It's ante-natal care that's made such a difference in mother/baby mortality, not hospital birthing.

 

Just think of the cash it would save & not to mention the hospital space it would free up.

[Bookworm]

What on earth is a birth centre?

 

At home? Let's see...

Because most women actually like the idea of not being in major pain for hours with little relief?

Because most women do not want to have the neighbours, the other children and the milkman around when they give birth?

Because you never know what can go wrong? And that the only way to ensure the minimum or risk to mother and child is to be in an adequate facility. I have 3 children, every one of them would have died if I hadn't been in hospital. There was nothing in my pregnancies to predict things could go wrong.

Because we are, thank goodness, in the 21st century, and women are actually entitled to some care and dignity, rather than drop the sprog, clean up and return to the cooker in time to make dinner.

[trundlecat]

You probably have a birth centre near you. Fantastic NHS facilities. Midwife run, all pain relief available, far more homely & non-clinical atmosphere.

 

As I'm a total wimp when it comes to pain I can only assume that the research must be right & being at home does make you better able to cope with the pain & so you percieve it to hurt less.

 

My neighbours didn't even realise I'd had my 1st baby so I doubt the milkman would either. I was very lucky, had I been in hosptal & decided to take the hours "break" in contractions when I did they'd have had me on a hormone drip then sliced me open & put me & baby at risk...... Although yes, I did have him at 8:30pm & by 6am the next morning I was up cleaning windows lol..... archaic or maybe quite amazing how little it affects you when you stay at home? As for dignity.... being in my own home with 2 midwives who stay till the bitter end seems far more dignified to me than the hospital option.

 

Off the soap box now, apologies to the men who are sat cringeing, I promise there'll be no more birth stories.

 

I still maintain that they cut costs from all the wrong places & in many cases it's bad management & too much patient care time spent on paperwork & target planning that causes the huge waiting time for appointments. We keep hearing that the population is falling so it can't be just sheer numbers that's causing this.... something's obviously not working. A 3 week wait to see a GP is neither use nor ornament if you're ill the day you phone for an appointment.

[mechs]

Whilst you have to feel sorry for doctor's receptionists....wouldn't you just like to strangle one of them as an example. LOL

BTW - my wife used to be one, so I do understand it's not their fault!

Can you tell me did you strangle her as well lolol

[mechs]

But the average family will have had 60-off years of midwifes, health visitors, community nurses, doctors visits at home and at the surgery, A&E visits, operations and hospital stays, dental care, physio, etc, etc...

I have recently had about 15 grands worth of my money back from the nhs in ops I agree unless you are one of the extremely lucky ones that never goes to the docs then you cant say that you havent recieved any form of care for your money

[natalie]

I dont think hospital births are a waste of money, i think sending me a letter and fancy leaflet asking me what hospital I want my son to go to (there's only one in my area) is a waste of money, I believe in choice, but why cant the GP ask if I want a different hospital at the time of referral?

 

I think the bureaucracy (sp, think its right but looks wrong!) its what is wrong with the NHS, get rid of the unnecessary paperwork and the unnecessary managers will follow!

[John L]

The question of GP appointments has vexed me and my family on a number of occasions. In our case, our GP used to have appointments booked from 9:30 in the morning, but consistently did not arrive at the surgery until 10:15 or later. The appointments were then started from 10:00am but still the GP was arriving 45 or even 60 minutes late. The appointment times have moved back even further, but still the GP is late arriving.

 

 

Our GP is the sole physician in the practice, but he has several consulting rooms at the surgery. He will call several patients out of the waiting room and ask them to sit in different rooms. He will then visit one patient, break off before the consultation is over and it seems he will go and visit one or more of the other patients, before returning some time later to continue the consultation.

 

 

Most people regard GP's as being highly trained professionals, and we feel that as a professional our GP fails to respect his patients, by being consistently significantly late, and failing to offer his undivided attention to his patients.

 

 

Is there some guidance on the level performance in these regards that patients should reasonably expect?

[Guest Lueeze]

Blimey, thats awful to keep leaving you in a room whilest he sees to other patients in rooms adjacent...

 

Can you swap doctors? Maybe he is on call and has to make house visits and this is a reason for his lateness? I cannot believe he turns up after 10 all the time cos he's been having a lay in...?

 

I had an advocate which was really helpful (if you get a good one) she st down with my care team and gave them a polite grilling!

 

Lou x

[BotB]

Is there some guidance on the level performance in these regards that patients should reasonably expect?

 

 

Yes apparantly so. If they can tick all the boxes they get paid £250K a year.

Blair's Britain.

[sandrajl]

Hi im new to the site and have just been looking through different forums and come accross this one

Im sorry to here about your long wait at your surgery, but as a NHS Receptionist, and patient myself, (which most people tend to forget when they are screaming at me) i can see it from both sides, as a patient we want to be seen as quickly as poss but now in this day and age of law suits and court cases, from the Dr point he must spend as much time that is needed to ensure he makes the diognosis as best he can (as Drs are humans too and are not perfect) on each patient. They are also under pressure from "Powers Above" to see patients as quickly as reasonably possiable..... they have bosses too(many people dont realise that) .......Ive lost count how many times ive "slotted people in here & popped them in there" & had to take the flack after surgery has finished but thats just part of the job ! When i started the job i didnt want to be one of those "DRAGON" reseptionists like the one in "MY HERO" (standing joke in my family,sorry)so i try as best i can to please as many people as i can & try to smooth things over in thoses stressfull moments for patients & Drs ... so please next time your at your surgery please, please, spare a thought for your Hardworking Receptionist

Take Care xx

[Rich44]

I spare a thought for our nice afternoon receptionist but the morning one is like a dragon guarding its treasure - How dare you want an appointment, lol.

 

What REALLY annoys me is our GP dont let you make appts they just open the phone lines at 830 and its a free for all each day so unless you wake up dead early and sit there hitting redial you're screwed, they dont do afternoon appts either its really aggravating but what REALLY REALLY makes me cross is they let all the old dears have the earliest appts and people who are trying to be honest and go to work even tho they might be ill are told you can have an appt at 11am (even if its something you need to see a GP for but you're not ill if you understand).

 

There should be a policy of offering people who dont need appts before 9am or after 4pm being asked to go later (or just being offered the 10am appts).

 

Also to be fair I used to work in a LOT of GP surgeries supporting their computers and most were ok to me but they were awful to the patients, one particular time this poor timid lad walks in and asks quietly for some condoms and they ritualistically humiliated him I very nearly said something about it it was that bad.

 

I too have been on the receving end of a good few practice managers wrath PMSL it's funny now looking back on it but at the time it was not nice at all

 

I was also working in retail at the same time (covering shops as well as GPs lol) and the difference was shops regarded the computers as an investment in saving time and making money whereas most GPs saw it as another expense.

 

My favourite line from our receptionist is "our system doesnt let us book appointments more than 3 days ahead" Well thats funny I put it in and I know it does hehehehehe.

 

Glad to hear you're not all evil old witches though

[moggy1968]

I dont think hospital births are a waste of money, i think sending me a letter and fancy leaflet asking me what hospital I want my son to go to (there's only one in my area) is a waste of money, I believe in choice, but why cant the GP ask if I want a different hospital at the time of referral?

 

I think the bureaucracy (sp, think its right but looks wrong!) its what is wrong with the NHS, get rid of the unnecessary paperwork and the unnecessary managers will follow!

 

I don't want choice, I don't have to want to make that decision, I want to know that when I turn up at a hospital, GP or go under the knife the standards will be the same everywhere!

[jet_black]

Our practice is awful on the admin side, you can only call up for an appointment on the same day at 08:30 and 14:30, you have to tell the receptionist why you want to see your GP, then you have to wait for the practice nurse to call you back so you can tell her why you need to see your GP. Then the nurse offers you an appointment if she thinks you are worthy. Grrrrr if the GP's weren't so good I'd change practice.

[nearlyoldwoman]

aaah the times i've sat and waited and waited and waited at the local GP's, its enough to drive you insane! gggrrrrr, anyway, not sure if this applies nationwide, but if youi're waiting more than 20 mins at our surgery they have to give you some indication of how much longer you will be waiting, my friend seems to think its in the 'patient charter'??? check with your local surgery..also our emergency app are 10am to 10.45am, you hve to phone first and tell them you're coming, now as long as you arrive before 10.40 they guarentee to see you...so this is how i get seen quickest...instead of arriving just before 10am (as every otherbody does in the hope you get seen first)!!! i arrive at 10.40, by this time most of the patients who have been waiting since 10am are just being seen, meaning i only wait about 10 mins or so, its worked every time, but different surgeries operate differently, so check. with dr's and nurses appointments i've been forgotten about and even discovered the dr has left the building without anyone telling me! i feel sorry for the receptionts:D as if i'm there more than 20 mins i usually start moaning:D doesn't get me anywhere but i feel better for it:D

[mazzab]

I am a GP, so I can tell you how it feels from inside the room.

 

Some cases take 5 minutes, but many take more - how do you deal properly with someone telling you they can't see the point in going on living, or that they haven't slept for a month in 10 minutes? Sometimes it takes 20 or 30 minutes. If you take less people moan that their GP doesn't listen, or they don't understand what has happend and come back the next day.

 

Most surgeries i end up about 20-40 minutes over time - so if you want to be seen on time get an appointment near the start. Don't turn up late - If I'm running to time I then am forced late by having to see you during someone elses slot. Also if you are going to come with five seperate problems book a double appointment - most receptionists will understand this and the GP will thank you for it. tell your GP upfront that there are 2,3 or 4 things you want to deal with - it's more efficient as they can do all the scripts in one go, examine everything at once rather than getting you up and down from the couch or whatever. They also know they gotta go faster to keep to time!

 

 

The problem is that demand is almost unlimited - the easier access gets the more it fills up with stuff that did not need to see a doctor - so many people have a "while I'm here" and "I just wanted to get it checked out attitude" to minor problems. Difficulty in access is the only tool available to stop this, so receptionists end up on the front line of health care rationing without really realising it!

 

Access to any service outside of 9-5 is always going to be more expensive, access when you want it to a service with such unpredicatable demands on it as healthcare is often going to be pot luck. The only alternative is expensive redundacy in the system - doctors sitting idle waiting for patients to appear. With Efficiency the watchword in public services that's never going to happen in the public sector - you can pay to see a doctor instantly in London stations these days, but they charge £50 for 10 minutes last time I looked, probably more by now.

[rincewindrunnin]

I am a GP, so I can tell you how it feels from inside the room.

 

Some cases take 5 minutes, but many take more - how do you deal properly with someone telling you they can't see the point in going on living, or that they haven't slept for a month in 10 minutes? Sometimes it takes 20 or 30 minutes. If you take less people moan that their GP doesn't listen, or they don't understand what has happend and come back the next day.

 

If only gp's did spend more than 5 mins with patients who say they can't see the point in going on living, perhaps then they would understand the problem more rather than throwing antidepressants and zopiclone at patients or phoning Crisis Teams demanding input for people with social problems. GP's rarely serve any more purpose than act as a middle-man for specialist services, and even then, GP's often refer to the wrong or least appropriate service simply because they didnt take the time to listen in the first place.

 

GP's dictate how their practice is run, and frankly, they no longer have an interest in doing the best thing for the patients. it's all about get em in then out the door again as quick as possible. AND DON'T GET ME STARTED ON OUT OF HOURS GP SERVICES.... geting paid a fortune for doing chuff all and passing the book and CAUSING inappropriate admissions to hospital which cost us money, overwork nurses, and crowd wards. THAT is the cause of full hospital wards.... and all because GP's dont have the balls, confidence or skills to identify properly who needs to be in hospital and who doesnt.

 

GP's need more training, to be better doctors and have better people skills. GP's know a little bit about everything, unfortunately, when i see a doctor, i want them to know a LOT about EVERYTHING.

 

Gone are the days of the family doctors..... when i grew up i saw the same gp for the first 18 years of my life (im only 27), there was no problem getting an appointment with him, i didnt even have to ask to be seen by him in particular it was just offered as he was my doctor and i didnt see any other doctors unless he was on holiday.

 

Not all GP'S are bad, just most of them.

 

Breach of contract? What do you want to gain? Money? If so, then bugga off cos that comes out of my taxes. If it's some kind of ruling that GP's then have to stick to appointment times or be struck off, then fine. But they will probably just stop offering appointments and operate a drop-in where it's first come first served and you probably wait all day. Sounds a bit third world dunnit?!

 

Better to have gp surgeries open at weekends so that you don't get the monday morning deluge or the sunday afternoon a&e run for minor sports injuries and such like. There are many better ways of doing things, just the people in charge dont seem to see them.

[practicemanager]

Speaking as a practice manager in support of her staff and doctors, we endeavour to offer the best possible service we can on a daily basis with the resourses we have and taking into account 'we are not a bottomless pit'

Is it any wonder patients cant get appointment, who books them all? will I can tell you who, its other patients of course - those who wake up with a cold (and expect a miracle cure from their GP) and those who wake up with a sort throat (and expext a miracle cure from their GP) and those who are 'just passing' and want to just get their BP checked, no reason but the shops arent open yet, and the story could go on and on and on. Is it any wonder we have no appointments left for those poor patients who are really suffering, (do they need admitting to hospital - could it be a cancer diagnosis - do we need to get the mental health team involved - can we fit you all in - NO. Unfortunately these horrible receptionists that you mention can only do their job (which is very hard) and give each patient that asks an appointment, if they dared mention going to the pharmacy for something we would be seen as 'fobbing' you off, but when all appointments have gone then they have gone, how long do you want the doctor to go on for, we could conitnually book appointments all day long and still never have enough.

I may sound like I am getting on my soap box but I DO care about the service we provide, and I DO care if patients are inconvenienced and I DO care if someone doesnt feel well and cant get an appointment but who is to blame, its not the receptionists or the docs its patients who dont understand that by abusing the service we offer then other patients are being penalised.