Missed NHS appointments
NHS website 2.01.19 (https://www.england.nhs.uk/2019/01/missed-gp-appointments-costing-nhs-millions/): More than 15 million GP appointments are wasted each year because patients do not turn up.
1/20 or 5% of appointments are missed without enough notice to invite another patient.
This resulted in 1.2 million GP hours not being used for patient contact. This is the equivalent number of hours as 600 GPs working full time for a year without seeing any patients. Each appointment costs an average of £30 making the total cost to the NHS more than £216 million that could be spent on GPs and nurses salaries, operations and treatments.
DrDoctor is a system to help minimise the number of missed appointments by sending out reminders to patients by text or email and giving them access to reschedule appointments. It has been used in 10 NHS trusts in England.
It should be taken into consideration that General practice is not funded on a fee-for-appointment basis. Salary costs and overheads don’t change because some appointments are cancelled. Cancelled appointments allow extra time for other patients and for doctors to get back on schedule.
(Ref: BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l545 (Published 12 February 2019)Cite this as: BMJ 2019;364:l545 and Ref: https://www.theguardian.com/society/2019/jan/04/nhs-england-makes-too-much-of-cost-of-missed-gp-appointments )
None the less appointments missed do still incur a cost. We can see from this information the importance of patients turning up for their appointments and the knock-on effects both on monetary resources and on the resource of the doctors time (knowledge and expertise not being used to its full capacity of supporting all the potential patients in a day).
NHS appointments missed for a deaf person
If a patient is deaf British Sign Language (BSL) user then a BSL interpreter needs to be booked. A Call out fee for London is recommended at £100 from NUBSLI (Ref: https://nubsli.com/guidance/interpreter-fees/).
If an NHS appointment is missed by a deaf person this then costs the NHS an extra cost that if the deaf person still needs that appointment at a later date then this money is lost/used for no service given. Well, the interpreter showing up and leaving again.
NHS appointments for a deaf person missing an interpreter
The BSL user then has a choice. They can suffer the communication issues of writing on paper, trying to lip-read and hoping they have understood the prescription, how many times a day, how much each time, any contraindications of any medicines already being taken or any already existing health issues that could be contraindicated, as well as when to take it for example before, after or with food or drink or a specific drink, for example, milk or orange juice. Or they take the information sheet they get with the prescription and any notes passed between themselves and the doctor and ask someone who has a good grasp of both English and BSL to explain what they could not have access to in-person at the doctors.
The other side of the choice is to cancel/reschedule the appointment. BSL interpreters are often booked up in advance so to find one available at short notice is difficult. This results in the deaf person having to wait even longer to see a doctor due to the interpreter not being booked in the first place.
Incorrect NHS locations are given to the interpreter
This would appear to the BSL user as the interpreter not showing up. So the result for them is the same as above. The cost is the same as above also in the effect that the cost of the service has been incurred and yet not been able to be used.
NHS and or patient rescheduling appointment
This would not be an issue if the interpreter were informed at the same time that the appointment was rescheduled. Otherwise, this results in the same loss of money with an interpreter showing up for an appointment that is no longer happening on that date or time.
Summary of Improvements
NHS interpreter bookings team to consistently book interpreters for deaf patients. Perhaps an alarm needs to be set up on their system for patients who are BSL users to ensure this is done.
NHS bookings team to be aware if an interpreter has been booked and if an appointment is changed to cancel the interpreter. This could also be an alarm system set up when cancelling an appointment for a BSL user that it reminds the person cancelling the booking to cancel the interpreter.
NHS bookings team to use an automated service (potentially DrDoctor) to send a reminder text, email to the deaf patient about their booking including deaf-friendly way of responding e.g. through replying to the text or email if the booking needs cancelling.
NHS bookings team to have a regular double-check system of address’ where one bookings team deals with more than one site. This could be a once a week check that does checks on all the following weeks appointments. This would include checking the interpreter booking has been given the correct email address.
This could save the NHS millions of pounds, save the deaf person stress and give them a better experience and better health care.