Abstract
Sir: The studies by Rooney et al. 1 and Carlin et al., 2 demonstrating that not all patients want to be seen within 48 hours, are important and timely. Access and choice agendas need evidence upon which to base appropriate standards and/or targets.
Our data, from our mixed urban/rural clinic, are remarkably consistent with those of Rooney and Carlin. Our clinic operates an appointments-only system, which is demand led. We monitor demand constantly and flex capacity by putting in additional slots/clinics, when demand dictates.
The local commissioners and Strategic Health Authority (SHA) questioned our genitourinary medicine access monthly monitoring (GUMAMM) data as to why the number of patients offered appointments within 48 hours was ‘good and increasing’, but the number seen within 48 hours was static. To answer the commissioners' questions, we collected data prospectively from all patients requesting appointments over three separate working weeks: weeks beginning 17 September 2007, 3 December 2007 and 10 March 2008, respectively.
Our results are presented in Table 1.
Prospective audits over three separate working weeks with respective GUMAMM data
GUMAMM = genitourinary medicine access monthly monitoring
Various reasons were given by those who declined an appointment within 48 hours, including wishing to see a specific doctor, wanting an evening appointment etc, but the majority (23–31%) specified individual choice of a specific date and time to fit in with personal commitments.
In order to achieve the seen target, patients must be offered the appointment, accept it and attend the clinic. A paradoxical finding in our clinic is that as the ease of making an appointment has increased, the number of non-attenders has also increased. The number of new patient non-attenders in the months of September, December and March according to the GUMAMM figures ranged from 9–14%.
Like Rooney and Carlin, we have found that when there is sufficient capacity for patients to express real choice, then they will do so and, not unreasonably, they wish to be seen at times convenient to them. Undoubtedly, appointments within 48 hours should be offered to patients accessing GUM services. However, the SHA 95% seen target will never be achieved unless clinics move back to ‘walk-in’ services (which the majority of our patients have said they do not want) or unless choice is unacceptably restricted. Clearly, the 95% seen target needs to be rethought on the basis of emerging evidence.