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Of course, averages are pretty meaningless – the issue is not uniform; some practices and some populations will be much more affected than others.  Which brings me on to my second point – the need to think more about why people miss appointments in the first place and the most significant cost, which may be to their health rather than directly to the public purse.  

Gender and age are also factors and there may be a host of local things affected by practice and GP reputation, length of waiting time, attitude and behaviour of receptionists and other practice staff, ease of getting through on the phone and how you might be treated when do. When  we start picking through these we see it is not as easily resolved as it might at first seem.

And this leads on to thinking more generally about how we interact with health and health care, what we expect of ourselves, our own attitudes to expertise and knowledge, responsibility for ourselves and for others.

Since this was originally written on 2 January,we have had the publication of the NHS Long Term Plan. How will the move to online appointments affect things? We may well be pleasantly surprised but in the meantime,I still have the 2nd January 2020 marked in my calendar to check for any pronouncements from the centre.

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