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

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