This is a slightly abridged version of a painful experience I had recently when trying to book a Covid vaccination for my 5-year-old daughter, and some musing about what went wrong (spoiler: IT systems). It’s absolutely not intended as a criticism of anyone involved in the process. All descriptions of the automated menu process describe how it was working today.
At the beginning of April, vaccinations were opened up for children aged 5 and over. Accordingly, on Saturday 2nd, we tried to book an appointment for our daughter using the NHS website (https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/book-coronavirus-vaccination/). After entering her NHS record and date of birth, we were bounced to an error page:
There’s no information on the page about what the error might be – possibly this is reasonable given patient confidentiality etc. (at no point had I authenticated myself). I noticed that the URL ended “/cannot-find-vaccination-record?code=9901” but other than that, all I can do is call 119 as suggested.
Dialling 119, of course, leads you to a menu-based system. After choosing the location you’re calling from, you get 4 options:
- Test and trace service
- Covid-19 vaccination booking service
- NHS Covid pass service
- Report an issue with Covid vaccination record
So the obvious choice here is “4”. This gives you a recorded message “If you have a problem with your UK vaccination records, the agent answering your call can refer you on to the data resolution team”. This sounds promising! Then there’s a further menu with 3 choices:
- If your vaccination record issue is stopping you from making a vaccination booking
- If your issue is with the Covid pass
- If your issue relates to a vaccination made overseas
Again, the obvious choice here is “1”. This results in you being sent to the vaccination booking service.
The first problem I encountered (in the course of the day I did this many times!) was that many of the staff on the other end seemed to be genuinely confused about how I’d ended up with them. They told me I should redial and choose option 4, and I kept explaining that I had done exactly that and this is where I had ended up. So either menu system is not working and is sending me to the wrong place (although given the voice prompts it sounds like it was doing the right thing), or the staff taking the calls have not been briefed properly.
Eventually I was able to get myself referred to the slightly Portal-esque sounding Vaccination Data Resolution Service. They explained that my daughter did not appear to be registered with a GP, which surprised me because she definitely is. So, they said, I should get in touch with her GP practice and get them to make sure the records were correct on “the national system”.
This I did. I actually went down there (it was lunchtime), the staff at the surgery peered at her records and reported that everything seemed to be present and correct, with no issues being flagged up.
So, then I had more fun and games trying to get one of the 119 operators to refer me back to the VDRS. This was eventually successful, and someone else at the VDRS called me back. She took pity on me, and gave me some more specific information – the “summary case record” on the “NHS Spine portal” which should have listed my daughter’s GP did not.
I phoned the GP surgery, explained this, various people looked at the record and reported that everything seemed fine to them.
More phoning of 119, a third referral, to another person. He wasn’t able to suggest anything, sadly.
So, at this point, I was wracking my brains trying to work out where the problem could lie. I had the VDRS people saying that this data was missing from my daughter’s record, and the GP surgery insisting that all was well. The VDRS chap had mentioned something about it potentially taking up to 4 weeks (!) for updates to come through to them, which suggests that behind the scenes there must be some data synchronisation between different systems. I wondered if there was some kind of way of tagging bits of a patient record with permissions to say who is allowed to see them, and the GP surgery could and the VDRS people couldn’t.
Finally, on the school run to collect my daughter, I thought I’d have one last try at talking to the GP practice in person. I spoke to one of the ladies I’d spoken to on the phone, she took my bit of paper with “NHS Spine portal – summary care record” scrawled on it and went off to see the deputy practice manager. A short while later she returned; they’d looked at that bit of the record and spotted something in it about “linking” the local record with the NHS Spine (she claimed they’d never seen this before1), and that this was not set. I got the impression that in fact it couldn’t be set, because her proposed fix (to be tried tomorrow) is going to be to deregister my daughter and re-register her. And then I should try the vaccine booking again in a couple of days.
As someone who is (for want of a better phrase) an “IT professional”, the whole experience was quite frustrating. As noted at the top, I’m not trying to criticise any person I dealt with – everyone seemed keen to help. I’m also not trying to cast aspersions on the GP’s surgery – as far as they were aware, there was nothing amiss with the record (until they discovered this “linking” thing). My suspicion is that the faults lie with IT systems and processes.
For example, it sounds like it’s an error for a GP surgery to have a patient record that’s not linked to a record in the NHS Spine, but since many people took a look at the screens showing the data without noticing anything amiss, I’d say that’s some kind of failure of UI design. I wonder how it ended up like that; maybe my daughter’s record predated linking with Spine and somehow got missed in a transitioning process (or no such process occurred)?
It would have been nice if I’d been able to get from the state of knowing there’s some kind of error with the record, to knowing the actual details of the error, without having to jump through so many telephonic hoops. I presume the error code 9901 means something to somebody, but it didn’t mean anything to any of the people I spoke to. In any case, I only spotted it because, as a developer, I thought I’d peep at the URL, but it didn’t seem to be helpful from the point of view of diagnosing the problem. It feels like there’s a missed opportunity here – since people seeing that error page are directed to the 119 service, it would have been helpful to have provided some kind of visible code to enable the call handlers to triage the calls effectively.
In terms of my own development, it was an important reminder that the systems I build will be used by people who are not necessarily IT-literate and don’t know how they work under the covers, and if they go wrong then it might be a bewildering and perplexing experience for them. Being at the receiving end of vague and generic-sounding errors, as I have been today, has not been a lot of fun.
1I found this curious, but a subsequent visit to the surgery a couple of days later to see how the “fix” was progressing clarified things somewhat. My understanding now is that the regular view of my daughter’s record suggested that all was well, and that it was linked with Spine, and it was only when the deputy practice manager clicked through to investigate that it popped up a message saying that it was not linked correctly.
Obviously I don’t know the internals of the system and this is purely speculation, but suppose that the local system system had set a “I am linked with Spine” flag when it tried to set up the link, the linking failed for some reason, and the flag was never unset (or maybe it got set regardless of whether the linking succeeded or failed). Suppose furthermore that the “clicking through” process described actually tries to pull data from Spine. That could give a scenario in which the record looks fine at first glance and gives no reason to suppose anything is wrong, and you only see the problem with some deeper investigation. We can still learn a lesson from this hypothetical conjecture – if you are setting a flag to indicate that some fallible process has taken place, don’t set it before or after you run this process, set it when you have run it and confirmed that it has been successful.
Postscript
Sadly, I never found out what the underlying problem was. We just tried the booking process one day and it worked as expected (although by this point it was moot as my daughter had tested positive for Covid, shortly followed by myself and my wife). A week or so later, we got a registration confirmation letter confirming that she’d been registered with a GP practice, which was reassuring. I’d like to hope that somewhere a bug has been fixed as a result of this…