Please turn up

'Have you ever had difficulty getting an appointment?" asks the notice pinned up on the surgery wall. "Then take a look at the figures below." What they show makes depressing reading. In 2002 alone, more than 1400 people made an appointment to see a doctor at one of the Jorvik Medical Practice's two surgeries in South Bank and Peckett Street - and didn't bother turning up.

Last month alone, 104 patients missed their appointment: in February it was 118; in January 95.

On average, says practice manager Dana Homer, about 100 appointments are missed every month - wasting 15 hours of doctors' valuable time.

It's not just the doctors these people are keeping waiting, either: it's other patients, too.

Every one of those missed appointments could have been used by someone who really needed to see a doctor, points out GP Sarah Bottom. And because the doctors' time is being booked up by patients who don't turn up, it means everyone has to wait longer to see their GP.

"All it takes is a phone call to cancel," a clearly frustrated Dr Bottom says. "Or if you've made an appointment, then decide it's not convenient and make a new one, do remember to cancel the old one!"

Many patients who don't turn up have honestly forgotten, and are suitably mortified and embarrassed when they receive a letter saying they missed their appointment, Dr Bottom says.

But there are certain people who make a habit of it, missing appointments again and again. The worst offenders, for whatever reason, are women between 17-24 and men 35-44.

"It is only a small number of people, but they are people who seem to assume that we are constantly available," says Dr Bottom. "It is treating the NHS like a supermarket."

A knock-on effect of missed appointments is that, because patients know it can be difficult to get an appointment quickly, they tend to book them so long in advance that it is easy to forget about them.

It's a vicious spiral, which makes the doctor's job of seeing patients who need to be seen quickly frustratingly difficult.

Patients sitting in the small waiting room at the Peckett Street surgery aren't too impressed by the non-attendees.

Joyce Cowen, 62, had to wait a week to see a doctor just to get her prescription changed. She admits her own case wasn't that urgent - but is angry at the lack of consideration by those who simply don't bother to turn up.

"It just makes everybody else have to wait longer," she says. "It's not very good manners."

Mary Young, 73, agreed. "It's terrible," she said. "They are taking up space that other patients could have. It is very inconsiderate."

The Jorvik Medical Practice isn't alone in having problems. Missed appointments, says Kay Goodwin, director of strategic partnerships with the Selby and York Primary Care Trust, are a problem common to GP surgeries across the York and Selby area and the NHS generally.

"It basically means that people have to wait longer for an appointment," she says. "And also, while the doctor is sitting there waiting, they aren't going out visiting people."

Missed appointments, of course, are just a part of the reason it seems to take ever longer to get an appointment with your GP. Lack of resources and ever increasing demand are also to blame.

Now many practices like Jorvik are taking steps to change their appointments system - so that patients who really need to be seen quickly can be.

For the last six months the Jorvik practice has been operating a tele-consultation system over the 'phone. "If patients are uncertain about something, they can 'phone in," says Dana Homer. "Just an ordinary 'phone call to the surgery saying 'I'm not sure whether I should come in, but I would like to talk to a doctor'." What will normally happen then is that their telephone number will be taken, and the dedicated 'advice doctor' who is not seeing pre-booked patients that day will call back.

He may be able to give reassurance, and tell a patient that they do not need to come in, Dana says. "But if it is urgent, if the doctor deems that there is a problem that really should not wait, then the advice doctor, at the end of his advice session, has an urgent, rapid access surgery."

The practice, along with several others in the York and Selby area, is also looking at a more radical way of changing the whole appointments system.

They are hoping to develop an 'Advanced Access' system for patient appointments, based on a national model. Ultimately, instead of patients having to pre-book an appointment days or weeks in advance, they could ring up and make a next-day or even same-day appointment.

For that to work, practices such as Jorvik need to work out when demand for quick, urgent appointments is at its peak. They can then keep those periods free of pre-booked appointments (which are generally for patients who don't need to see a doctor so quickly) so that patients who do need to be seen quickly can be.

"Let's say the biggest demand for quick appointments is on a Monday," Dana explains. "We could ensure that on Mondays we had no pre-booked appointments at all. Monday wouldn't be open access, but patients could just 'phone up on the day to make an appointment.

"And if the demand is less on Tuesdays, Wednesdays and Thursdays, we could still have pre-booked appointments then."

The details of just how it will work at Jorvik haven't been thrashed out yet - but already staff are beginning to monitor patients to get the information they need to decide what are the times of peak demand for urgent appointments.

Eventually, it should help ensure if you genuinely are ill you can get to see your doctor more quickly.

In the meantime, if you have booked an appointment and no longer need it... pick up the phone and let your doctor know. Everybody will benefit.

Updated: 12:00 Monday, April 14, 2003