A few weeks ago, I wrote an article for Hospital Doctor about the difficulties surrounding flu immunisations. Last year, we received lots of complaints because there was not enough vaccine to go round. That was because we stole half the NHS allocation of vaccine and re-sold it to the private sector making a huge personal profit. It is hard to get by on £250,000 a year especially when, with our two day week, we have so much leisure time. Or that is what the government would have the public belief. Forget the rumours that Patricia Hewitt (remember her?) had miscalculated the amount of vaccine required.

The second commonest complaint we had last year was from people who had had to queue, some for as long as twenty minutes. We did our best. All the partners and practice nurses came in on three separate and well advertised Saturday mornings and immunised all comers. Despite our best efforts, the queue went out into the car-park, and the weather was not good.

Others said, "Why can't you do the immunisations during the week?" They found it "inconvenient" to come at the weekend. I would prefer to do that but the weekdays are too busy to fit in a massive immunisation campaign.

It is easy to forget that most patients with genuine illness are either old or very young, and none of them work. They prefer to come during normal working hours. It is only the pretentious, middle-class, focus-group attending, Rolex wearing, alfresco dining, BMW driving, foreign-holiday booking ("Do you know how much the safari is costing? Why should I have to pay for those Malarone tablets?"), BUPA subscribing, well-off "worried well" who demand the "right" to see a doctor in the evenings and at weekends. Sebastian is 27 and wants to "pop in" on Saturday afternoon to discuss the merits of regular PSA monitoring. His partner, Harriet, is with him and wants to know if intestinal yeast is a possible cause of her Irritable Bowel Syndrome.

Sebastian and Harriet are destroying the NHS with their inappropriate demands and attract no sympathy from us. We are, however, sympathetic to our elderly patients, for whom queuing is onerous. So this year we decided to have an appointment system for the immunisations. Five minute slots for each patient, bookable in advance.

Last year the complaints came in after the immunisation sessions. This year, they started to come in before the sessions. "Why do we have to book in advance? Why can't we just turn up on the day, as we always did? That's a much better system, isn't it doctor? As long as we don't have to wait too long like last year."

We did the first session last weekend. The doctors, nurses and this year, reception staff, all attended. We immunised 789 patients. And eventhough the session took much longer than last year, there were no queues out into the car park. An anecdotal straw poll of those who came suggested that they preferred the new system.

There was one problem.

83 patients with booked appointments did not turn up. EIGHTY THREE. That is over ten percent of those who had booked. One or two of them telephoned on Monday to apologise. Most did not.

And that epitomises the problem we have with the NHS. If there were a charge of, say, £20 payable in advance but refundable to those with genuine financial hardship (provided always they turned up) the problem would be solved.

As would a number of problems if a similar system could be adopted across the NHS for all health care. Posted by: Dr John Crippen    Source

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