Richard Smith: The shambles of the NHS two week urgent appointment system

richard_smith_2014I have a lesion on my chest that could be a skin cancer, one of the slow growing non-lethal ones. I’ve had it for about two years and thought little about it. My daughter, a medical student, thinks I should see a doctor. I visit the GP, where a locum takes less than a minute to say he’ll refer me. The shambles begins.

Because this could be CANCER the NHS insists I should be seen within two weeks. A few days later on a Friday the practice rings me to say that they’ve made an appointment for the following Tuesday. I say I can’t do that because I’ll be in Bangladesh. They say they’ll ring me on Monday before I leave in the evening to make a new appointment. They don’t.

While in Bangladesh I’m sent an appointment by text for a day I can’t make because of an important meeting arranged months ago. When I get home I ring to say that I can’t make the appointment. I spend about 10 minutes listening to a woman against a background of distorted music saying: “Your call is in a queue and will be answered as soon as possible.” I hear it perhaps 15 times. At least she’s not telling me that my call is important.

Eventually, a woman answers. I tell her that I can’t make the appointment and tell her dates I can make. She says she’ll ring me back. She doesn’t.

Two days later I get a text telling me to come to the hospital the next day, on the day I’ve told them I can’t make. My appointment hasn’t been cancelled. I ring the hospital again, and I spend another 10 (possibly 15) minutes listening to the distorted music and the voice. Eventually a woman answers, and I tell her I need to cancel the appointment and retime. I tell her as well that I rang two days’ earlier and somebody said they’d ring me back but didn’t. She doesn’t apologise but tells me they are busy.

This is when it becomes very silly. She tells me that she has no appointments for next week and that as it is now two weeks since I was referred she can’t give me an appointment. I have to contact my GP again. “This is crazy,” I say, “I know it’s not your fault.”

I ring the GP and spend perhaps 10 minutes listening to a voice saying “You are first in the queue.” Eventually I redial and get through quickly and explain the problem. The receptionist says she’ll make another appointment with the doctor. I explain that I don’t need to see the GP again but simply to be rereferred. She says she’ll send a message “to admin.”

A few days later I get a text telling me that I have an appointment with the GP. I can’t face phoning again, so I attend the appointment. When I arrive the receptionist says: “What are you doing here? This is supposed to be a phone appointment.” I say that the text didn’t say that, and she tells me that the system doesn’t have that capacity—it can tell you only that you have an appointment, not that it’s supposed to be by phone.

I see the GP and tell him my story, cutting out all the absurdities, which is most of the story. He glances at my skin lesion and rerefers me on the spot through his computer.

I then begin to receive a stream of texts, telling me both when my appointment is and that my former appointment is cancelled and that I need to get referred again. Then I get two letters telling me to get rereferred. The system doesn’t know that I have been rereferred.

After all this, I reflect on the acute observation that:If there were no patients the system would run perfectly.” I think too how North West Airlines, which I had the misfortune to use regularly, was known to people in Minneapolis as “the F… You Airline.” Sometimes the NHS feels the same.

I’ve now attended the clinic and had my cancer removed, learning when I went that the two week requirement to see patients with possible cancer is overwhelming dermatology (see here). Luckily, the dermatology and surgery was better than the appointment system.

Richard Smith was the editor of The BMJ until 2004.

Competing interest: None declared.