“In Greek myth, Procrustes offered travellers a bed. If they didn’t fit, he would stretch them or cut them until they did. It was always the person who was wrong — never the bed.”
It’s a crude story. But a familiar one.
In today’s NHS, it isn’t the patient who defines the care. It’s the pathway, the template, the tick-box or the recall logic hard-coded to a month of birth as if disease progression respects birthdays. We don’t shape systems around patients anymore - we shape patients around systems. And if they don’t fit neatly into the defined criteria, we twist the record, edit the timeline, or back-enter the code until it looks like they do.
This is the modern NHS: Procrustean not in name, but in logic. A service where templates dictate timelines, where codes are mistaken for care, and where the only thing that matters is whether the numbers are green on the dashboard - not whether anything real was done.
The core issue isn’t that we measure things. In a system this large, some form of measurement is necessary. The problem is deeper and more insidious: we’ve begun to treat the metric as the outcome. Clinical work is now judged not by its quality, its completeness, or its actual impact on patient health, but by whether it satisfies the parameters of a reporting framework designed decades ago. A patient with diabetes may receive fragments of their annual review (less than 50% of patients get all checks recommended in national guidelines) and yet, the system will count it as complete, because a clinical code exists somewhere in the ether.
But we all know what really happens behind closed doors in practice. Patients fall through the cracks. Reviews are left incomplete, scattered across months. Bloods get filed without follow-up. Administrative staff are left to guess the next step in a care pathway they were never trained to manage. And when capacity runs short - which it always does - surgeries prioritise the easiest wins: the high-value QOF targets that can be satisfied with minimal input. Not because they don’t care. But because they’re trying to survive.
This isn’t deception. It’s system failure. A clinical workforce forced to perform care theatre because the real thing has become operationally impossible. And yet the illusion persists, because as long as the right fields are populated, the system believes the patient has been seen, heard, helped.
That’s the real danger of metric-driven care. It doesn’t just distort the workflow. It distorts the truth.
BookYourGP wasn’t built to optimise that illusion. It wasn’t designed to help surgeries game the dashboard or smooth over care gaps with clever recall logic. It was built to do the actual work. To see a patient through from clinical need to clinical resolution, in a way that respects both the complexity of general practice and the chaos in which most of it happens. We started with the physiology, the workflows and not the frameworks. With the real-life schedules of nurses, HCAs, duty doctors, and part-time clinicians, not with a fantasy of how care should be delivered in theory. We designed it for surgeries where the blood clinic is only open on Tuesdays, where smear appointments are limited to one afternoon a week, and where the admin team is expected to operate with zero clinical oversight and make it all look seamless.
And then we went further.
We built the infrastructure to make the whole loop traceable. From the moment the patient becomes eligible, to the point the care is delivered, the document uploaded, the code entered, the safety-net triggered. Every step is known, recorded, auditable. Not because we’re obsessed with tracking, but because if you don’t know what happened, you can’t know what didn’t.
Most recall systems aren’t built like that. They chase codes, not care. They follow calendar logic, not clinical logic. They produce letters that look official but tell the patient nothing about what’s due or why. And when the recall fails, there’s no alert, no escalation, no accountability. Just silence. Followed by a tick in a spreadsheet that says everything went fine.
It’s a performance. A very expensive, very well-meaning performance. But a performance nonetheless.
We at Hummingbirds refuse to participate in that. We do not believe in pretending the care happened. We believe in ensuring that it does. That’s why our platform doesn’t allow you to set arbitrary recall dates based on month of birth, unless you have a clinical reason to do so. That’s why we don’t send one-time invitations that disappear into the void. That’s why we built our appointment engine to map real-life staff skill to actual patient need and not just to slot someone in for “QOF: CHD” and hope they happen to do the right thing.
Because the patient doesn’t care whether a code was entered. They care that care was given to prevent complications such as heart attacks and strokes.
You don’t fix that with another spreadsheet. You fix it by redesigning the system around the actual delivery of care.
Procrustes had one bed. Everyone had to fit it. The NHS, at times, feels no different. Standardised templates. Uniform recall cycles. Fixed review dates with no room for nuance. And yet, general practice is anything but uniform. Every surgery is different. Every team works differently. Every patient arrives with their own history, preferences, complications, and fears.
The answer isn’t to keep building tighter beds and sharper blades. The answer is to abandon the Procrustean mindset altogether and start building systems that reflect the real complexity, messiness, and unpredictability of care.
BookYourGP doesn’t ask patients to fit a rigid pathway. It asks what the pathway should become to serve the patient. That’s the difference. And in the long run, it’s the only thing that will matter. Because the NHS doesn’t need better metrics. It needs better outcomes.
And you don’t get there by measuring harder.
You get there by caring better.