Your Appointment is Cancelled! (2018)

Appointment Cancelled but guess where!

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 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.

Reasons for Cancelled Appointments

So a 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 or just ill. 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 three cancellations might the reason for referral have become more urgent? Who decides? Perhaps the patient should ask his or her GP to review the referral and if necessary ramp up it’s urgency.

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.

If you have any views on this blog contact me, Robert Campbell at

Revised December 2018


Have you had your 2018 flu jab yet?

The Flu Campaign this year has developed into a joke.

In a blaze of publicity, the NHS is sounding off about staff who refuse to have a flu jab demanding to know why. Yet we mere mortals who are in an at risk group can’t get a flu jab in many parts of the country  for love nor money.

There are three vaccines on offer this year depending on your age, but they are being released in stages.

In late September an initial supply hit GP Surgeries and pharmacies but probably because a first come first served system was used to offer jabs they soon ran out.

Now those of use who booked appointments have been told – sorry we’ve run out come later in October. Pharmacies in different parts of Cumbria has also run out.

Why when stocks were limited by numbers did not Practices only book appointments for what they could actually supply. It is beyond belief.

Im my Practice in West Yorkshire we appointed a member of staff to manage supplies.  A close check was kept on how all vaccines were being used and if an appointment had been booked vaccines were set aside. It’s called managing!


Are Electronic Prescriptions efficient and effective? (2018)

 Electronic Prescription Service
When the EPS system was first proposed my understanding was that it would speed up the dispensing of prescriptions. However my continuing experience is that this is not so for the following reasons:1. Patients need to check that the nominated pharmacy is correct, particularly if they have been away from home and changed their nominated pharmacy temporarily.

2. GP Practices are taking longer to issue repeat prescriptions – sometimes more than two days, particularly if the request is for an acute not repeat prescription.

3. Small pharmacies often have stock problems meaning patients might have to wait far more than two days for their drugs. One pharmacy I know has prescriptions made up elsewhere.

4. If a pharmacy is out of stock the patient has the right to take the prescription to another pharmacy. However this means giving the patient a complex code and returning the prescription to the NHS spine so that another pharmacy can issue it. A simple print out of the out of stock item would suffice.

5. GP Practice’s too on a separate issue are changing patients medication without checking that supplies are in stock at the nominated pharmacy. I have had problems with Peptac, Ranitidine and Nystatin.

I would be interested to hear your solutions to these problems.

Robert Campbell

December 2018

Email –


Telephone versus Face to Face Consultations

Are telephone consultations replacing face to face consultations?

As GP Practices battle to provide adequate numbers of face to face appointments I was wondering if other forms of providing consultations are on the increase. I spotted recently a notice in my local surgery which declared that almost one third of consultations in July had been on the telephone. This amounted to a remarkable 40+ per day, and it struck me that that would have taken some dealing with. What it didn’t say was how many telephone conversations resulted in a need for the patient to be seen face to face. What if the patient actually needed to be examined, not just subjected to a telephone inquisition.

Telephone Consultations not effective?

A major survey carried out in 2014 the results of which are on the NHS Choices web site,( suggested that whilst telephone consultations provided an alternative method of consultation they were not necessarily as effective. The survey also claimed that telephone consultations did not reduce a GPs workload. It found that almost 12% of consultations had been carried out on the telephone, representing a four fold increase over the previous 20 years. I do recall that the process of telephoning patients who had requested an urgent appointment or a home visit starting in my Practice around 15 years ago very reluctantly and only a handful of calls were made in the early days. One GP in particular much preferred a face to face contact and had five minute appointments.

Triaging Calls becomes run of the mill!

Nowadays, a system of triaging appointment requests is not unusual, although the personnel that filter the calls may range from a receptionist to a nurse practitioner or a doctor first. In my mind there are always inherent risks involved where a non-clinician becomes involved. To be on the safe side it requires a well trained and experienced clinician to sift and sort the problems presenting on the telephone. I recently came across an example of a telephone consultation being offered by a receptionist in three days time but when the patient needed a referral. So Practices do need to adopt a safe system of filtering calls and allocating appointments. Practices tend to get a GP to phone the patient back, if no offer of an appointment is accepted or simply to be on the safe side!

Seeing today’s patients today

Around the time the Quality Outcomes Framework was introduced the idea of seeing today’s patients today was also marketed, which at the time was a fine aim, but the pressures of demand from patients and the inadequacies of supply from doctors have since created a situation where Practices desperately look for alternatives ways of providing a service to patients. The concept of 10 Minute appointment may no longer be valid or achievable. When we first used a senior Practice Nurse to see patients with minor illnesses I have to say that it broadly failed. The nurse saw less patients than the doctors and there was of course the problem of raising prescriptions. The nurse was not a prescriber. Now the likelihood is that a Practice will have a nurse prescriber, even a pharmacist and better training and qualifications mean that the prescriber will probably see just as many patients as their GP colleagues. I can certainly comment that a good nurse practitioner can become a valuable and effective member of the Practice.

Demand outstrips Supply

However, what happens if the level of demand still outstrips the availability of prescribing clinicians. Here are some thoughts:

• Over the Counter Medicines

Encouraged by CCGs and NHS England practices are introducing widely schemes to not prescribe OTC (Over The Counter) preparations that can be purchased from a pharmacy. So once patients realise that their medical practice will no longer prescribe simple remedies will the demand for appointments reduce. Practices or CCGs might employ a pharmacist to help manage more effective prescribing. According to NHS England 40% of Practices have access to a Clinical Pharmacist. (

• Signposting to Pharmacy

Signposting patients to pharmacies is another alternative. But it depends how well staffed and how well stocked a pharmacy is for such a service to be successful. A recent suggestion that Gasviscon Advance be replaced by Peptac resulted in a 24 mile round trip to a local town to find a pharmacy that stocked. It cost over £3 whilst Gaviscon Advance was around £8. The bus journey would have cost me £11. Practices, both GPs and Practice Pharmacists need to work with local pharmacies when changing either their prescribing habits or offering OTC advice to patients.

• Using 111

Suggesting patients, make a first port of call to the NHS (111) telephone line is another option. In June 2015, 111 received an average of 23 calls per minute. That month approaching 1 million calls were received. Now that takes some managing.

Possible Pitfalls

But nothing in my view replaces seeing a patient. Those answering the telephone to filter requests for appointments need to be aware that patients might not describe their problem adequately. Likewise they may want to tell an unknown voice what they would tell a doctor or nurse. The idea of an experienced and trained clinician phoning a patient back is probably much safer. But there will be occasions when actually seeing the patient and examining them cannot be achieved in a telephone conversation. The question is what is the appropriate balance between seeing patients face to face or talking to them on the telephone.

More recent findings

The BMJ published an article last September (2017) ( which looked at the growing Practice of patients speaking to a doctor first. Even the new Health Secretary is promoting the development of online GP services. But the question remains as to whether it is a better way to provide services or just an alternative. The BMA article states that much of the work of general Practice can be managed on the telephone. The reduction in consultations is compensated by the time spent on the telephone, but around half of the patients still need to be seen face to face. The article goes onto explain that the success of a telephone system depends on how well it is organised. There is an issue of prompt call back and Practices need to make allowances for patients who have problems dealing with telephone calls. Perhaps too Practices need to make clear that the telephone consultation is a new feature of the service being provided and not an alternative caused by lack of doctors and high demand!

Robert Campbell


“It’s not a bottomless pit”!

Steps are being taken throughout general Practice to reduce the prescribing of medications for minor ailments that can be bought at a pharmacy ‘over the counter’.

NHS England have published a leaflet for patients which explains what GPs are trying to do, encouraged by CCGs and Practice Pharmacists.

But are those promoting the non-prescribing of OTC products overstepping the mark. Should they be telling patients that they can no longer prescribe OTC products. Are they simply trying to substitute cheaper products. Are they following national NICE guidelines are using a different product which they regard as just as effective whilst still saving money. What is going to happen to small pharmacies who loose dispensing fees

In my view Practices need to be very careful about the way they introduce these changes and the words and style of language they use when doing so. Each patients case needs to be treated on its merits and reference should be made to clinical letters and recommendations made by consultants.

My understanding is that the shift to OTC products not being on prescription is not a blanket decision and GPs need to be aware of that.



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