Ideally you should focus on the acute problem during the visit and have them follow up either with you or the PCP for the remainder of the issues...dont ignore them, but don't try to tackle them all in one visit or you will be perpetually behind. Up to 4 patients an hour should be reasonable for an urgent care facility - even in primary care appointments every 15-20 minutes is pretty standard. Agreed, you need to have an enforced late policy - exceptions of course as warranted. You have to work to create a culture of accountability and responsibility for health care - they can learn to come on time and keep follow up appointments and regular checkups with the PCP.