Missed GP appointments – are they really a problem for the NHS?

The BBC carried a story on 2nd Jan 2019, that 15 million GP appointments were missed last year and that this costs the NHS £216 million each year. The article goes on to say that these missed appointments have a cost the equivalent to employing 2,325 GPs or doing 58,000 hip operations. Actually the BBC numbers here are a bit fishy anyway, because they quote the cost of a GP appointment as being £30 but if that were the case the missed appointments by would have cost as much as £450m each year. (£30 x 15m).

But in NHS terms what really is a missed appointment? It turns out that it’s just a no-show by the patient but there is no reason to think this represents lost time for GPS because:

• GP surgeries know that a significant proportion of appointments will be missed so they overbook accordingly, as anyone offering something for free should do, and GPs have enough experience that they can do this pretty accurately.  Using computing power, they could increase that accuracy by weighting the chance of an individual showing up based on known facts, such as their past record in missing appointments.
• People are expected, quite reasonably, to wait in the surgery waiting area for their appointment and this means that there usually isn’t a specific slot that is wasted.  If the person isn’t there the Doctor just moves on to the next patient.
• Doctors who have spare time in cases of a spike in missed appointments don’t twiddle their thumbs but they do other useful work such as required paperwork, looking through notes, talking with nurses and phone consultations.

There has been some interesting experimental work on how to reduce the frequency with which people miss appointments. One surgery put an indignant notice up at the door of their surgery which said, “65 appointments were missed last week” (or whatever the number had been). The idea was to shame more people into showing up, but it had the opposite effect. It seems that patients took this as justifying a no-show so that they thought, “oh well, everyone’s doing it so if it’s not convenient I won’t bother”. Not surprisingly this approach was dropped. One way of reducing missed appointments which seems to work is getting the patient to sit down with someone at the surgery and write out on a well-designed reminder card what day, date and time their appointment is. It’s important that they themselves write it down: in their mind this seems to create a sort of contract that they have agreed to – as well as providing them with a useful reminder card.

The whole cost-of-missed-appointments story fails to put the patient first. Missed appointments may be something of a problem in some situations but generally this smacks of “blame the victim” – many, many people live chaotic lives and they need help not blame. It may be, in fact, that the BBC article will actually increase, not decrease, the incidence of missed GP appointments in 2019.