Dear Philippa,

 

At my local GP surgery they have a scoreboard that announces how many appointments have been missed in the preceding month. A year or so ago it was running at over three thousand, but they seem to have got it down to fewer than two thousand, possibly a reflection of seasonal variation. It’s a medium sized practice, with, I suppose 8 doctors and half a dozen nurses. Assuming all the staff, doctors and nurses together, handle four appointments an hour and work 48 weeks a year it works out at over a hundred thousand patient encounters a year, probably more, it means that between a quarter and a third of made appointments are missed without notification, the workload of two to four doctors/nurses depending on how you do the numbers.

 

This is a huge amount of waste, but what to do? You could introduce a system of over-booking along the lines employed by airlines, but that would involve bumping patients at the end of day and it would introduce delays for the compliant without inconveniencing  the delinquent. Or you could fine for the no-shows, which would provide income that the practice could use to buy equipment, but it would introduce an element of financial transaction into the doctor-patient relationship that the doctors I am sure would find unpalatable and resist. My own preferred solution would be to confiscate the cars of the guilty and put them in a crusher but I gather that there are some legal difficulties with this. And there would be an unfortunate side-effect; doctors would increasingly be seen as junkyard dogs rather than relievers of pain and savers of lives, which they obviously prefer.

 

I noticed the latest number when I visited the nurses’ station for my annual blood pressure check (135/75, thank you for asking – the blood pressure of the athlete I never was), which turned out to be rather more than that. After I had passed the BP test with First Class Honours, Sister Helen said, “Would you pop on the scales for me?”  My friend Tim took me racing in York a couple of weeks ago, again as my carer on the disabled rail card, and as we walked along the platform looking for an empty carriage he bawled I WANT YOU TO GET ON THE TRAIN FOR ME. It’s odd how carers and health workers always want you to do things for them. All over the country every day miserable patients are exhorted by nurses to open their bowels “for me” – infantalising, somehow.

 

Anyway, at the weigh-in I got only a poor Third and promised half-heartedly to cut down on the fresh cream slices to which I confessed, rather like the traveller at Customs admitting to an ounce of tobacco over the limit in the hope that such openness would impress the officer and distract his attention away from the parcel of Krugerrands. Then came the question about alcohol. The days are gone when I could with a straight face own up to the occasional sherry at funerals so I put my cards, most of them at least, boldly claiming twenty-eight units, which I think is reasonable. Like Clive of India when confronted with his considerable corruption, I stood there astounded by my own moderation. She tried to negotiate me down to twenty-six units but I held the line. I like it, I said, I can afford it, and no-one any longer expects me to get out of bed in a morning to any serious purpose – apart from the dog at 6.30 – so it’s not going to happen. She gave in, looked at me with a mixture of disgust and amusement and told me I’m as bad as her father. Never met him, but he sounds like a good chap to me.

 

Best wishes

 

Howard