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Why would we want to encourage patients to book appointments online?

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A government task force, headed by Baroness Lane-Fox, wants GPs to be contractually obliged to increase the percentage of our patients who book appointments online by 10% each year. Despite the fact that GPs have been obliged to provide online access since April, only 2.7% of appointments are actually booked via the internet. It’s the classic DoH algorithm: pay GPs to do something → discover no one really wanted the thing in the first place → penalise GPs for people not wanting the thing → rinse and repeat. This from the same numpties whose response to the nationwide apathy about Sunday opening is to threaten to hardwire it into the contract.

I don’t want to spend March 2019 sweating over whether we’ll lose a chunk of QOF income because Vera can’t get past Level 97 of Candy Crush

Let’s leave aside for a moment the fact that without the guiding hand of an informed human, patients might book inappropriately for things like travel jabs, suture removal or 30-minute DVLA medicals (to quote genuine examples from the past month). I’m no Luddite, but I’m not entirely convinced that we need to make booking appointments more convenient; I’ve got patients who could find their way onto my morning list if the booking form was etched onto a Golden Snitch at the bottom of the Marianas Trench. GPs love a perverse incentive and taking money from us if we don’t prioritise online booking will inevitably lead to the receptionist saying ’I’m sorry Mrs Senescent, we’ve filled our quota of phone bookings today, you’ll have to go on the website’. Now I book flights online because they make it near impossible for you to do it any other way; it takes a zillion clicks to find a phone number on the British Airways website and that’s just a gateway to 90 minutes of hold music. I’m not sure if this is more convenient for me as the customer but you can bet your bum it saves the airlines a ton of telephonist wages. But when Ted and Vera over the road need to visit their family in Australia, they’re knocking on my door with apologetic smiles asking if I’ll do it on my computer. The irony is that the digital revolution has taken away a process they used to manage independently and made them entirely reliant on the help of others.

To be fair the Baroness showed an awareness of the Inverse Care Law in her speech but her proposed solution – ’training and mentorship programmes for staff to ensure they’re confident in recommending technologies’ – smacks of that dread phrase ’GP are ideally placed…’ Frankly I’m worried that my unrequested new role as your nanna’s IT Support will distract me from my core GP duties like checking her boiler’s OK and grassing her up if she looks like she might run off and join ISIS.  

And the idea of a direct link between practice income and how tech-savvy my elderly patients are is very worrying. I don’t want to spend March 2019 sweating over whether we’ll lose a chunk of QOF income because Vera can’t get past Level 97 of Candy Crush. And just think of the potential for complaints! ’You showed my grandad how to use an iPad and now he’s silver surfing the dark web!’ You can be sure that when Skynet becomes self-aware and we’re all enslaved by Terminators the Daily Mail will trace it all back to the day a greedy lazy GP gave Nanna a router.

But ultimately this feels a bit like another exercise in pre-iceberg deckchair rearrangement. The reason it’s hard to get an appointment is we have too few GPs trying to do too much with too little money. No amount of fancy apps is going to solve that.

Dr Pete Deveson is a GP in Surrey. You can follow him @PeteDeveson

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Readers' comments (18)

  • "GPs love a perverse incentive.."

    It's not hard to imagine the patient standing at the reception desk while the receptionist logs into the internet in his or her name to make an online booking!

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  • Bravo.
    And, not to mention that this most precious resource - clinician's time - is then made available purely at patient whim, rather than through use of proper triage. How do they intend that triage should take place? Or will we have an online triage booking list which we then call back to book an actual appointment?


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  • Anonymous | Practice Manager26 Jan 2016 8:06am

    Telephone triage is a huge medico-legal liability on the clinicians either conducting it, or designing pathways for their reception to follow.

    Read what happened to NHS Direct.

    Read today's papers re 111 not picking up sepsis in a baby.

    Stay away from any form of triage for the sake of your clinicians.

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  • Of course it is important to make online booking available, even if only for the non-perverse incentive of having to spend less on telephony staff etc. But making GPs responsible for uptake and linking it to income?
    ...What is this? The Cardy State?!!

    Ditch the contract comrades!

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  • The most expensive resource in a GP practice is the GP. The practice is paid a fixed sum / patient / year. Thus the problem is not one of efficiently booking as many appointments as possible with the lowest margin (ie like booking holidays and flights). The problem is efficiently allocating advice and appointments to the clinicians. Remember our beloved NHS is determined by need and is free at the point of use.
    How dense are politicians that they think busy phone lines are the cause of no GP appointments!
    We (GPs) must take MORE control of our appointments, through telephone consulting (not triaging) for follow ups as well as acute problems.

    'Telephone triage is a huge medico-legal liability on the clinicians either conducting it, or designing pathways for their reception to follow. ' It isn't if a well trained (ie MRCGP GP) is doing it. It is if a numpty with an algorithm is doing it. There is a MASSIVE difference in skill levels, especially if that clinician is the one who is taking the responsibility.

    ' it is important to make online booking available, even if only for the non-perverse incentive of having to spend less on telephony staff etc.' Again it is the GP and nurse time that needs a real person to allocate. The problem is not a lack of receptionists.

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  • Offer telephone consultation appointments on-line, not face to face. Works a treat! Ticked the box but still with some control.

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    I like the remark "quango ornament"

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  • And Lane-Fox's relevant experience, insight and authority to comment on running a GP practice is what, exactly? Where do they get these people and why appoint and commission them? Perhaps she and the the rest of the "task force" ("creation of unnecessary tasks to dump on other people" force perhaps more accurate) should spend some time in GPs' surgeries.

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  • i would argue that the present system of patients phoning on mass at peak times and being dealt with by receptionists under pressure to answer next call is more likely to result in patients in the wrong appointments. Started monday with 50 same day appointments within 45 minutes they had all gone! were left seeing 40 extras between us by end of morning. The only way to process that number of patients in our practice in this amount of time is for staff on the phone to book every patient into the easiest appointment for them ie 'the doctor can see you this morning'.

    My view is that if you can shift more booking on non urgent appointments online it would free our staff to spend more time with patients helping them to access the right appointment for them.

    I think as well a variety of approaches is needed and agree with earlier post about increasing use of telephone for review appointments where clinical examination isnt needed. Another problem we have is patients seeing different clinicians for results than the one who assessed them - we need to be more proactive in following some of these up and consider other ways of communicating results amd what they mean to patients.

    The current model is broken - we only do things the way we do them because we have always done it that way.

    I agree that we should not be pressured into doing things beacaue the DoH says so - GPs need to be released from autocratic micromanaged and be left to provide the service that suits them and their practice population.

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  • Yet another rule gps have to comply with or be threatened with loosing the ever decreasing number of crumbs they are thrown.
    The NHS destruction plan is working, well done Hunt your friends are soon to be in for a bumper profit.
    Do you think Hunt is currently in talks to join either AXA PPP or BUPA or will be more ambitious and start a new one?

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