A clinic that is fully booked a week ahead has no room for the person who woke up feeling wrong.
When the booking system went in, the obvious thing to do was put every hour of every doctor on it. We did that for a month and it was a mistake.
Within a fortnight the diary was full four days ahead, which looks like success and is not. Somebody who woke up feeling wrong could not be seen, and so they did what people do: they went to a hospital emergency department with something that was not an emergency, or they waited and it got worse.
So four slots a day are held back, two in the morning and two in the evening, and they are not on the form. Reception gives them out on the day, and reception rather than a form because a person can hear how somebody sounds on the telephone and a form cannot.
The cost of this is real. Four slots a day is a doctor's worth of appointments across a week, and on a quiet Tuesday some of them go unused. We think it is the right way round. A diary with no give in it is a diary that pushes its own patients somewhere else.
What we will not do with those slots is pretend they are a triage service. Reception can tell you what is free; nobody here gives medical advice by telephone. If something is urgent, a hospital is the right place and they will say so.