"Booking an appointment for an ultrasound scan"

About: Devon Access and Referral Team (DART) Royal Devon & Exeter Hospital (Wonford) / General medicine

(as the patient),

The process was very convoluted and wasteful involving many people. Money could be saved if this was improved.

The GP told his secretary I needed a scan. She sent me a letter containing a password asking me to book via the Devon Access and Referral Team. I rang them and they offered me appointments either at a hospital 30 minutes drive away or another 45 minutes away.

When I asked for an appointment at the major hospital 5 minutes walk away they could not do this. They told me they would contact this hospital (the Royal Devon and Exeter) and I would then hear - they were unsure whether this would be by letter or phone.

I then got a letter from my hospital of choice asking me to ring and make an appointment. I rang and made the appointment which was then confirmed with me by letter.

So this involves 3 letters and 3 or more people plus significant delay between the GP and the appointment being made. Multiply this by the number of people attending hospital and this system represents a lot of waste. Like most people these days I use email - why can't the NHS do so?

I would also add that I discovered at the end of this process that I needed to attend with an empty stomach and full bladder so a 45 minute drive would have been impossible!

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Response from Project Support Manager - Devon Referral Support Services, Devon Access & Referral Team (DART)

Dear 'HazelR',

Thank you for telling us about your experience of booking your ultrasound scan, I can only apologise that it was not a positive one.

I would like to look into this further with the Radiology Team and colleagues at RD&E to find out exactly what happened here. I will be able to provide a more detailed response by Friday (18th July).

Thanks for your time.

Gemma Smith

Response from Project Support Manager - Devon Referral Support Services, Devon Access & Referral Team (DART)

Dear ‘HazelR’,

I have taken some time to speak with my colleagues in the RD&E Radiology Team in order to fully explore what happened with your referral based on the information you have given us. I am sorry your experience was not a positive one and that it felt convoluted and wasteful, this is not the experience we want our patients to have.

At DRSS we are here to offer patients a choice of location, date and time for their first appointment based on the information given in the referral. We firstly offer the services with available appointments (this may not always be your local hospital) and then any other suitable services, in this case the process at the RD&E for scans is managed internally because the clinician in the department needs to review the referral before an appointment can be booked. The RD&E do this is to make sure you are seen in an appropriate appointment and this varies depending on which scan you have been referred for.

However DRSS should have explained this clearly to you during this choice conversation, and can only apologise that this was not the case for you.

The referral process starts with your GP who sends you the appointment request letter to contact DRSS. DRSS is guided by confidentiality policy which states we cannot initiate conversations with patients about their healthcare using e-communications. It may be useful to know that the majority of hospital departments can upon request send appointment reminders via text or email and you will be offered this wherever possible.

I hope this goes someway to answering your queries, if you would like to talk your experience through further please feel free to contact myself of my colleague Susan Pearce from Monday to Friday 9am to 5pm on 01626 883712.

Best Wishes

Gemma Smith

Update posted by HazelR (the patient)

Thanks for explaining the system but this doesn't really answer my concerns at all.

The system you describe is undoubtedly wasteful - what is the process for getting it looked at and improved? Why was I offered appointments 45 mins drive away when I was expected to attend with an empty stomach and full bladder? What is the point of DART when it can't make appointments at major centres?

Response from Project Support Manager - Devon Referral Support Services, Devon Access & Referral Team (DART)

Dear ‘HazelR’,

Thank you for the additional information and queries, I apologise if I was not able to answer this as best as possible.

I understand and agree we do not have the level of information you felt you needed in order to make an informed decision about your onward care and appointment, and would like to apologise for this.

DRSS relies on the information given to us by hospitals and services to make sure you are correctly informed when you call to book. I understand it would have made a great difference to your experience had you known all the details up front. Your comments have informed us of a gap in our service we were not aware of and would like to thank you for this.

I will be reviewing the booking processes for Ultrasound clinics with the RD&E to make sure DRSS can tell patients about the potential preparations that might be needed for their appointment. I have set a target date for this to be completed by the end of August 2014 and will update you with the changes we have made as a result. I hope this outlines clearly what DRSS will do to address your comments.

If you have any queries please do not hesitate to contact me or my colleague Susan Pearce from Monday to Friday 9am to 5pm on 01626 883712.

Best wishes,

Gemma Smith

Update posted by HazelR (the patient)

Thank you very much for looking into this further and for responding publicly on Patient Opinion. I hope you will be able to improve things for future patients.

Update posted by HazelR (the patient)

The second update promised has not materialised.

I have subsequently needed two further hospital appointments via this service. They were unable to make either. The first, an appointment with a consultant was eventually sent to me by letter from Bristol (I am in Exeter). I am still awaiting the second appointment for a gastroscopy which I was also unable to make via choose and book.

It does make me question the point of this service if it doesn't allow me to book an appointment.

Response from Gemma Smith, Devon Referral Support Services

Dear HazelR,

Thank you for continuing your discussion with us about your experience of our service, it’s very useful to us to have an on-going dialogue like this.

I’m really sorry to hear that your subsequent appointments were not able to be booked directly either. It won’t be a lot of comfort to you but we are able to book the majority of appointments directly but some departments in some hospitals (and it’s different departments in each) choose to not let us book directly. As we’ve said before this is to ensure that you get the right appointment first time, however, I know that this is of little comfort when you’ve phoned an office expecting to get an appointment and then don’t get one. Patients are asked to phone us because we (as part of NEW Devon CCG) are obliged to offer all patients choice of hospital for their treatment and had you chosen a different hospital for whatever reason, it’s likely we could have booked your appointment, as you experienced with your ultrasound appointment. There are also times when departments become temporarily fully booked and in those cases, we can only add you to a waiting list until further clinic dates are released by the hospital.

We do agree with you about the information that should be given out before appointments (such as needing a full bladder for example) and we are still trying to come to a suitable resolution with the Royal Devon and Exeter on this matter.

If you would like to discuss anything further, please feel free to contact me on 01626 883712 or my colleague Susan Pearce on 01626 883702 (Monday-Wednesday) or post back on here again. Thanks again for your continued input, we do appreciate the time and trouble you’ve taken.

Best wishes,


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Response from Royal Devon & Exeter Hospital (Wonford)

Thank you for taking the time to share your experience with us. The Devon Referral Support Services (previously Devon Access Referral Team) is commissioned by the CCG and the GPs/RDE are not able to bypass this service. The RDE have chosen to book the scans ourselves once the relevant Clinician has reviewed the referral letter so we can ensure the patient is booked to the correct service and we operate a partial booking service so patients can call in and book an appropriate appointment agreed with them to reduce the number of patients who do not attend. We confirm all appointments by letter as the letter will contain specific appointment details or relevant Trust details which may not always be given by telephone at the time of booking. The Trust is in the processes of acquiring a new booking system, which we hope will have the option of emailing patients where appropriate. With regard to the requirement for an empty stomach and full bladder, this is a necessary preparation for the investigation. However, patients are welcome to arrive early and fill their bladder once in the hospital to save any discomfort while travelling.