NHS ‘puzzled’ by high numbers seeking GP appointments in Lerwick

Concerns have been raised about the length of time it is taking for Lerwick patients to be able to see a doctor, with the local NHS board admitting to being puzzled by the “unusually” high number of people seeking out GP appointments in the town compared to other areas of the country.

Speaking at a meeting of Lerwick Community Council on Monday evening, NHS Shetland board chairman Ian Kinniburgh said the town’s health centre was under a lot of strain. The health board is carrying out research to try and get to the bottom of why the practice is treating one third more patients than would be anticipated in comparable areas on the mainland.

Based on the size of the town, the practice would expect to see in the region of 3,000 people a month but the actual figure in Lerwick is just in excess of 4,000. “Quite frankly, we don’t understand why,” said Mr Kinniburgh.

A new “triage” – meaning to sift or select – system was brought in two months ago, whereby those phoning to make an appointment are called back by a doctor to assess whether their needs are urgent and must be dealt with face-to-face that day or can be addressed either over the phone or by appointment at a later date.

But isles MSP Tavish Scott issued a statement saying he had been contacted by several people concerned at the difficulties they were encountering in making appointments. He said: “Shetland has had a wintry snap so GPs’ appointments in Lerwick are bound to be busy. But the weeks people are waiting for a standard GP appointment is not a new problem. Again, I have had constituents in touch worried and puzzled by the way the health centre is operating their appointments system.”

Mr Scott said he had raised the issue with NHS Shetland on a regular basis, most recently in early December, and he appreciated that they understood the problem and were trying to address it. “But people are still waiting an unusual amount of time for a GP appointment in Lerwick. We all rely on the NHS, especially at this time of year, so people need to see a shortening of these waiting times.”

Lerwick North councillor Caroline Miller said she had also spoken to constituents who were disgruntled by the new system and the situation appeared to be “pretty dire”, although she accepted the high demand was placing an “enormous strain” on the health centre and she was “sure they’re doing what they can” to address it. But she noted that some people felt particularly uncomfortable at being asked by a receptionist to explain the reason why they needed to see a doctor.

Speaking during Monday’s meeting, Mr Kinniburgh said he believed the triage system – not widely used in the isles previously – had been working fairly well so far. “It seems to have quite positive results,” he said. “The feedback is that it seems to be helping.” It is being run on a trial basis until the end of March, after which it will be re-evaluated.

Director of clinical services Simon Boker-Ingram said that as well as receiving two letters from people congratulating the practice on its new system, a patient survey NHS Shetland had carried out appeared to contradict the representations made to politicians. Out of 110 people surveyed, 100 said they preferred the new appointments system and 103 said it had met their needs.

Referring to the high demand on the service, Mr Kinniburgh said there was nothing to suggest that there were more ill people here than elsewhere. He said people living in rural areas but working in town would not be allowed to register in Lerwick for ease of access because you are now only allowed to register with a practice if you have an address in that area.

Mr Boker-Ingram said there had been 340 missed appointments in the past three months, which equated to three and a half weeks of a doctor’s time. An additional GP was put into the health centre last year and he hopes that extra capacity, along with cutting down on the number of “did not attends” and allowing the new system to bed in, should help to shorten waiting times.

“Everybody who phones up on the day gets spoken to by a GP,” he said, adding that the triage system was important to “help people understand whether they do need to see a GP or not”. He said receptionists were fully trained and would not go into any specific medical conditions but “if somebody says they’d rather just speak to the GP because it was of a personal nature, that wouldn’t be a problem”.

While one particular root cause of the high demand has not been identified, Mr Kinniburgh said the practice was encountering a small number of people making repeated visits to different GPs “until they get the answer that they want”. “This kind of behaviour doesn’t help when it comes to making GPs available to folk.”