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It's like opening Pandora's box

Someone clever once said that work tends to expand all available space, much like junk does in the house. This is certainly true when it comes to clinic rotas and seeing patients.

By GP For Hire

Someone clever once said that work tends to expand all available space, much like junk does in the house. This is certainly true when it comes to clinic rotas and seeing patients.

Where I am working currently we have a ‘Simple Problem Clinic'. It was designed by one of the Partners a few years back. Essentially, it's a clinic devoted to seeing patients with simple problems (such as sore throat, coughs, colds etc). Each patient has 5mins with the doctor, they book in on the day and it's only meant to be one problem.

The original format was where a senior nurse would see the patient first and do the examination bit, the doctor would waltz in and prescribe whatever was necessary and the patient would go home happy. There were three rooms set up for this and it worked smoother than a freshly buttered banister.

But then the senior nurse retired and we moved onto a different computer system that essentially screwed up the smooth running of the clinic. The new version is a single doc working out of one room, 5 mins per patient, to a maximum of 40 patients (usually 30 patients).

Still the idea seems ok, right? One doc sees all the trivial quick stuff leaving the other doctors to see the more complex cases that are deserving of 10mins. Well that's how it started out. But the Simple Problem Clinic rapidly filled up with patients who really should have self-treated.

We have patients presenting with a cough that they developed that morning. Worried mums bring in their kids to get them checked over ‘just in case' when before they would have stayed at home. Suddenly we have a whole clinic filled with patients that don't even need to be seen.

Not only that, but patients would turn up with multiple problems despite being told it's for one simple problem only. There are no other pre-booked spaces over the next few days so they get irate when you tell them you can only sort out one problem.

The patients that are meant to be using the clinic can't so book into the 10min clinics instead. So we have ended up creating a demand for a completely unnecessary clinic that hasn't actually improved access times for the other clinics. Genius.

In fact, over time, demand has increased but not enough doctors have been hired to compensate. So now some of the complex patients are booking into the Simple Problem Clinic to be seen on the same day rather than wait for a 10min appointment. Argh!


Partners are petrified of losing patients to the Darzi clinic down the road so all patients will get seen regardless of clinical necessity.

There must be a way of designing a perfect appointment system, but this would be based on the assumption of a finite number of patients wanting to be seen. However, as we now know if there are clinic spaces available patients will attend, regardless of how trivial their complaint may be. So if you are considering running a simple problem clinic think very carefully first. Once that Pandora's Box has been opened it will be very, very difficult to close it.

Of course at the bottom of Pandora's box lay hope so perhaps one day our surgery will solve this problem!

GP For Hire is a salaried GP in the north of England

Image of money and stethascope

Still the idea seems ok, right? One doc sees all the trivial quick stuff leaving the other doctors to see the more complex cases that are deserving of 10mins. Well that's how it started out...

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