Editorial Comment

Here is your NHS E-Referral Appointment letter!

Where is your Appointment?

These days, Patients are getting used to their GP handing them a letter setting out the details of a hospital appointment. In fact, I suspect that many patients are quite impressed by the doctor’s keyboard dexterity and the speed at which an appointment is offered, although it might be a few weeks to wait, but at least there’s an appointment date and time. There will be a telephone number to ring and a password (I’ve noticed that it always the same password) to use if you want to look at the NHS E-Referral web site to change or cancel your appointment. What is probably missing from the paperwork that is handed to you by your doctor is the name of someone at the hospital to talk to and more likely than not there may not be on the letter the full address of the hospital and outpatient department you are intended to attend, not even a postcode!

It Get’s Worse

So your appointment gets nearer. It could a physiotherapy appointment or an outpatient clinic to see a skin specialist. It could be many things. But it is your appointment and you have patiently waited for the date and time to arrive. However, an envelope arrives through your letter box. Inside the envelope there are two letters. One letter disappointingly cancels your appointment. It says it is necessary to cancel the appointment due to a rearrangement of clinics. The letter is Dated but not signed by a named person. There is a simple apology for any inconvenience, but no real reason given. To soften the blow the second letter moves the appointment two weeks on and you have a fresh time and date.

It Gets Worse Again

Now that might be all very fine once but when a few weeks letter another envelope lands on  your doorstep with an almost complete repetition of the earlier cancellation letter. No named contact. But there is a telephone number for a Booking Centre. No address. Investigations reveal that the Booking Centre is located in another town over thirty miles away – I found the address on the internet, but it was not on the appointment (or cancellation) letter. I telephoned the Booking Centre simply to be told that the consultant had cancelled the clinics (three times). No other substantial reason was given.

What is Reasonable?

Personally, I think one cancellation is reasonable as long as there is an open and honest explanation. Two cancellations is really starting to push your look and three cancellations starts to question whether you are being referred to an imaginary service. Added to that why were you referred in the first place and does the passage of time not being seen increase the urgency of the requested appointment. Once a GP has made the first appointment does that GP get to know about the cancellations and the potential risks involved in delays. Is the patient sensible enough to ask their GP whether the passage of time creates a more urgent situation. Answers on a postcard!!!!!!!

What are the Rules for Cancellation?

Well, so far I have been unable to find any specific rules about how frequently outpatient clinics can be cancelled. There are rules once a patient has been seen and booked in for a procedure or operation, known as the 28 day rule.

Robert Campbell – October 2018


Editorial Comment

Your Appointment is Cancelled! (2020)

Appointment Cancelled but guess where! Hospital, Yes

I do wonder how many patients receive letters telling them that their appointment is cancelled. No reason is given but in the same envelope there is another letter giving details of yet another appointment. The letters by the way are not signed. There is no Authors name on the letter and even more seriously there is no address and post code showing either the origin of the letter or the address to attend the appointment if one is actually given. It’s a complete mystery!

Reasons for Cancelled Appointments

So a hospital consulting session or clinic is cancelled. Would it not be reasonable to say why or is the reason too embarrassing.  Has the clinician been called to a meeting that is more important than seeing patients.  Is the clinician on holiday, playing golf, going to the gym, just ill or what?. I do wonder.

How many times should a Cancelled Appointment be tolerated.

The next point is how many times would it be reasonable to receive such a cancellation letter. Once, twice, three times or more. It has to be said that a patient has been referred for a reason and initially it might not be an urgent referral. However after say two or three cancellations might the reason for referral have become more urgent? Who decides? The patient? Who does the patient asks? Probably the patient should ask his or her GP to review the referral and if necessary ramp up it’s urgency. But does the patient know that that is an approach that can be taken!

Contracting  for Quality

CCGs in their contracts with hospital trusts should insist on a certain standard of both waiting times and only one cancellation and no more. Perhaps it’s an issue that CQCs should look at too!

Updated March 2020