My failed attempt to game GP appointments

Nearly 20 years may have passed, but a good number of people will still recall the exchange between a salt-of-the-earth member of the public, Diana Church, and the then-prime minister, Tony Blair. The year was 2005, the occasion a pre-election edition of BBC Question Time, and the issue at hand? Well, plus ça change – the hoops patients had to go through to see an actual GP.

Mrs Church had asked the PM whether something could be done about a system that required her to book an appointment no more than 48 hours in advance. That’s right, no more than (not no less than) two days before. A baffled prime minister professed amazement that something so contrary to reason should be happening on his watch, but other members of the audience chipped in, and a show of hands demonstrated that Church’s experience was widely shared.

It turned out that the 48-hour appointment window was the perverse consequence of a government-set target, introduced – of course – with the best of intentions. Told to ensure speedier access for more patients, GPs were gaming the system. By refusing to let patients book more than two days ahead, GPs could not but meet their target, albeit by playing havoc with their patients’ lives.

Instead, they had to call within seconds of the surgery opening to book an appointment two days hence. They then faced either an engaged signal or an interminable queue to be put through. Some gave up and set off to queue at the surgery instead.

Given the notoriety of this Question Time episode and the curtain it raised, just a fraction, on the perverse effect of some targets, I had assumed that, so many years later, something more patient-friendly might have been devised. In the intervening years, we have seen progress in online services. We have seen the experience of being summoned by text message for Covid jabs, with a choice of date, time and location bookable on your phone. And yet here we are.

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For ten years or so, I had been spoiled by living just five minutes’ walk from the surgery, rarely needing to see a GP anyway, and then popping over of an afternoon to make an appointment as and when. A flat move, and inevitably a GP move, has brought me back to earth with a bump.

The new surgery is very good at summoning you for all sorts of check-ups and jabs by text message, with a choice of dates and times, and following up with a blizzard of reminders. But, oh my goodness, if you want to see an actual, you know, doctor, that’s a whole other story.

You are instructed to call at 8 a.m., when you can ask – well you can, if you get through – for a same-day telephone triage (which may yield a follow-up appointment) later that day. Or you can ask to book an appointment for the same day next week. Only that one day, really? Only that day because they release the appointments just one day at a time a week in advance. If the slots are all taken by the time you call, you have to wait for the next day to book for a week hence.

Woe betide you if you try your own modest bit of gaming by calling in the afternoon. You may be only ‘second in the queue’, hooray, but there aren’t any slots left either today or in a week’s time. The instruction is repeated – call at 8 a.m.

Now it would be remiss of me not to mention that there is a digital option. This had me marooned for an hour, trying to navigate as between the NHS app, a dire service called Patchs (that I hate for its name and have failed to get to grips with before) and the surgery’s own online services – which they have made devilishly hard to find. Give the digital option its due, though, you can avoid the 8 a.m. phone crowd, but the same time restrictions apply. You try your luck either for now or for the same day next week.

So there has been some (small) advance since Tony Blair’s encounter with Diana Church. But two principles remain stubbornly in place. The first is that the system – any system – is designed to work for them rather than you. And the second is that, while the 48-hour window may be less of a fixture, arbitrary time windows remain. Why can’t I at least try to book for, say, tomorrow, or 10 days hence? Both reception and computer say no.

True, there is one outlet for the desperate. If you sound pathetic enough, demonstrate your digital incompetence enough, and insist enough, the receptionist may take pity and find you a slot. Which is how I got my first appointment at all – and how, alas, it was doomed.

The time in my diary and that of the surgery didn’t match up. I was 20 mins late and branded a wicked, time-wasting no-show. A text reminder, such as for check-ups, might have highlighted the discrepancy, but not a word – until just a few minutes after I had been written off, a text message dropped that might have been headed: ‘Gotcha!’. ‘You have missed your appointment,’ it said, ‘and if you do it again, this surgery has a two misses and you are out policy: you will be struck off.’ Believe me, starting the whole booking process from scratch is punishment enough.

So this is my small response to Wes Streeting’s call for the public to offer their ideas for improving the NHS. He is right when he notes that an inefficient, even perverse, system for appointments can cost some people a day’s wages (and the country a day of their work). He is also right when he says there are inefficiencies and inconveniences that he can’t see from his departmental desk. Regrettably, almost 20 years after Tony Blair evinced amazement at the travails of Diana Church, the convolutions that surround GP appointments is still the place to start.