It seems to be becoming a bit of a new year tradition – the 2nd of January this year saw widespread press coverage that “NHS England loses £216m a year to missed GP appointments” – enough to pay 2,325 GPs (that is, if you could actually recruit any). Last year, also on 2 January, the Chief Nurse Professor Jane Cummings was featured asserting that NHS appointment no-shows “cost the health service £1bn” in a year, enough to fund “nearly a million cataract operations”.
Clearly the self-denying post-Christmas month is a good time to capitalise on guilt and reforming intentions to change people’s behaviour. These campaign statements, which they evidently are, come in a slightly hectoring and remonstrating tone. It’s time to stop being irresponsible. The message may be falling on deaf ears as the problem is increasing – 15 million appointments in 2017 up from 12 million in 2014.Visit Sit
A couple of key points emerge for me from this new, New Year tradition. Firstly, there is the difficulty, dare I say nonsense, of assigning a cash equivalent to a missed appointment. Yes, it is true that professional time costs money, but if the resource cannot be reallocated, then equating it to something else that could be bought is fairly meaningless. If everyone attended their appointments would we really be 58,000 hip ops or 220,00 cataracts better off?
One in twenty practice appointments are missed. What does this mean in real terms? The average standardised practice has a total of 85 face to face contacts per 1,000 patients per week, 56 of these by a GP. With the average practice list size now at 8,279 this gives an average 700 total (460 GP) appointments a week or around 140 total (93 GP) per day. A one in twenty or 5% DNA rate means for the average practice 5 GP misses and 7 total misses in a day. Spread across the day and the total practice staff are we really talking about a sizeable chunk of time that could realised in any other way? Some practices may overbook to soak up any lax. The average consultation time in the UK is 10.6 minutes, the second lowest of 11 countries surveyed in 2015 by the Commonwealth Fund –so an extra space in the schedule may quickly be absorbed by appointment overruns.
The public perception of the non-attending miscreants may well be that of wanton selfishness and flagrant irresponsibility – “majority of Britons support fines for missed GP appointments, survey finds”. The reality is not as simple as this. As is often the case, finding evidence is not necessarily easy but a key study of half a million Scottish patients published in 2017 has thrown some light on the complex behaviours of socio-economically vulnerable patients who serially miss whilst having significant health needs. For many GPs additional work is required to follow up why patients don’t attend and when a no-show becomes a cause for concern.