Last week I had the fun experience of trying to get through to my son’s doctor. Junior had a rash and I was hoping to ask the doctor what cream would be best to treat it. I was not even after an appointment, just advice over the phone. I phoned about 9:50 am and got the hold music, so far so normal. I don’t mind going on hold, I just put the phone on speaker and go and do some work until the call is answered. Anyway about 25mins later the call was answered by the receptionist. When I explained what I was after she said I was out of luck. You can only book a phone consultation between 8:30 am and 10 am. No problem I said, I am in no rush, the doctor can ring me tomorrow or whenever they get the chance. No can do, said the receptionist, the doctors only return calls that are booked that day. I would need to phone the next day and repeat the whole process all over again. Even then they only have a fixed amount of slots, so even if I did get through there would be no guarantee of getting a slot. At this point, I did what most people would do and gave up and resorted to Dr Google.
Complaints about not getting through to your GP are extremely common on social media:
All gp practices are like that now. Here’s my number of redials a few weeks ago: pic.twitter.com/fSJMiqLQZy
— Alastair Mackay (@alastairam) August 29, 2021
So what is going on? I am friendly with a few GPs and have looked into this issue. The core issue is the shortage of GPs. As more GPs retire or leave their jobs this leads to more pressure on the GPs who are left. The increased workload then burns out the current GPs who then start eyeing the door also. I have written about the GP crisis before; it is worth reading again to understand the issue.
The most common complaint is: why can’t I book online? The main reason for this is the lack of connection between online booking systems and the internal booking systems used by receptionists when you ring up. If someone books the 9:30 am slot online, this needs to sync to the system the receptionists use to make sure there are no double bookings. This is surprisingly complex to do so that is why most doctors don’t offer it.
There is a simple fix to this issue. You allocate time blocks to online bookings. For example, you say the appointments between 9 am -11 am can only be booked online using a system like simply book. The other times get booked over the phone.
Well, why don’t more GP practices do this? There are a few reasons.
The first one is lack of incentive. A GP is paid based on the number of patients they have on their books, not on the number of consultations they do. So it does not matter if they never see you, they get paid either way. From their perspective why would they want to increase their already groaning workload?
The second one is to do with managing demand. The demand for GP time is practically unlimited. The more patients they can see the more appointments they will get. It is a bit like when you build bigger roads, you just get more traffic. If your GP was ultra-responsive you would be contacting them more.
GPs know that most conditions go away on their own. This is the reason you normally get an appointment a few weeks away. They know by the time 3 weeks roll by, your backache has cleared, your sore throat is gone, your weird cough has cleared up – you get the picture.
On this note, it really winds me up when GPs moan about people not turning up for appointments. There is no way to cancel a GP appointment other than on the phone and who in their right mind is going to stay on the phone for half an hour just to cancel? GPs use this time to catch up on paperwork, grab a coffee etc.
In an ideal world, you would get a text message with a reminder of your appointment. If you did not need the appointment anymore you could click on a link in the message and have it easily cancelled or rescheduled.
So what is the fix? In the short term, there isn’t one. In fact, the situation will get worse. More GPs will retire, more practices will close. It will require major structural changes to fix the problem – the very thing we are terrible at doing in Northern Ireland. More private GPs will open to serve the middle classes and the poor will be screwed. But then what is new there?
The people I most feel sorry for are pensioners and people with special needs. I am savvy enough to navigate the Kafkaesque system but your heart goes out to the 86 year old pensioner constantly redialing to get through.
Can I stress most of this is not the fault of the GPs. Many are working ridiculous hours to try to meet the demand. If anything it is a surprise that more of them are not cracking under the strain.
My advice is if you have any history of ill health in your family get private health insurance like Benenden. It is £12 a month, cheaper than Netflix premium. When it comes to your health you are on your own, kid.
I help keep the good ship Slugger afloat by managing the business and techy stuff.