Missed appointments cost NHS over £162 million UK

Main Category: Public Health
Article Date: 24 Aug 2004 - 0:00 PDT


Missed appointments are costing the NHS (National Health Service) throughout the UK over £162 million a year as more than 911,000 GP consultation slots and over 264,000 practice nurse appointments are wasted every year because patients fail to turn up.

Findings from the latest Developing Patient Partnership (DPP) and Institute of Healthcare Management (IHM) survey of missed appointments revealed that almost 9 million appointments are missed each year.

Nearly all GP practices taking part in the survey agree that missed appointments waste NHS money and resources. A massive 72 per cent also believe they increase waiting times for those people who need GP appointments.

Responses from GP practices across the UK show that 16-34 years olds were the most likely to repeatedly miss appointments whilst only 8.5 per cent indicated the 55 plus age group.

The survey marks the launch of the DPP's annual 'Keep It Or Cancel It 2003' campaign which aims to reduce the number of missed appointments in general practice. The findings mark the launch of the annual Keep it or Cancel It campaign which includes new guidance for GP practices to help them manage missed appointments as well as posters to remind patients to cancel unwanted appointments.

Dr Greg Graham - a GP in Pontypool said: "This figure is totally unacceptable. Missed appointments are a serious problem for all GPs throughout Wales. Every month, my practice alone has around 200 missed appointments from a list of 7,200. That is equivalent to one doctors' scheduled appointments for the whole week. The few that genuinely forgot apologise, but most are just dismissive of our remonstrations. We publish the numbers in our waiting areas and the 'good' patients are shocked and would have them fined! I find that young men are the worst.

"Whilst we are twiddling our thumbs because a patient has failed to turn up, the receptionist is turning someone else away because the diary is full for the day," he added.

Dr Andrew Dearden, a GP in Cardiff said: "We have recently introduced a system where people can either come into the surgery in the a.m. and we'll see them up to 10.30 or they can pop in or phone in to book a same day appointment later in the morning. We also have appointments which can be prebooked at any time in the afternoons.

"DNAs can be a problem when they are wasted. I have three missed last Monday afternoon but could have used them all. I often have people come in when urgent to sit and wait to fill one DNA if it occurs.

"The problem is that patients always feel that it is "all those others" who waste the appointments but they have a good reason why they did so do not see themselves as part of the problem.

"In the past we have tried putting up posters to inform patients of the numbers of appointments wasted each week - mentioning to each patient that has missed an appointment the problems they cause by doing so; stopping people who miss three in a row from booking any further appointments, but asking them to come in the morning to our open access clinic to avoid continued wasted appointments - all of which have had little benefit. I have heard that those who do not allow booking appointments more than 1-2 days in advance have few DNAs but that is variable in its acceptance by the patients.

Dr Charles Allanby - a Cardiff GP says that this surgery has gone back to virtually open accesss 'book on the day' approach for virtually all appointments - an overnight success with doctors, staff and patients alike.

Welsh Secretary of the BMA, Dr Richard Lewis and a former Maesteg GP emphasised that patients also have a key part to play in primary care. "They must assume responsibility not only for their own health but also for the National Health Service itself.

"These staggering figures show a needless waste of time and resources when the health service is already stretched to its limits.

"Considering the strain the NHS is under to meet demand, the cost of missed appointments is unacceptable. Each missed appointment robs a patient on the waiting list of an earlier appointment. Missed NHS hospital consultants and very late cancellations mean that staff and facilities go unused when they could be used to shorten waiting lists.

"The message is simple. Keep the appointment or cancel it in good time. Taking responsibility in this way will ease the strain on an over-burdened system. It is vital that people are more aware of the impact this has on valuable hospital time. Patients can make their own vital contribution to cutting waste in the NHS by keeping - or cancelling appointments in good time. A pound spent on healthcare can only be spent once and too many are wasted by missed appointments".

Dr Lewis said: "Patients want to know that they can quickly get an appointment to see their GP or practice nurse. If a patient fails to attend their appointment, then it means that another patient will suffer by having to wait for an open appointment. Some patients believe they are doing the practice and other patients a favour by failing to keep their appointments.

This is definitely not the case. Simply calling your GP practice to let them know you will not be able to make the appointment is the easiest way to improve health care services for everyone."

Dr Tony Calland - Chairman of the BMA's Welsh Council said: "BMA Cymru Wales welcomes any initiatives that helps to reduce missed appointments. GPs are already frustrated at the lack of time they have to devote to each patient, and patients who fail to turn up for their appointments simply add to the problem. They may not realise it but they are denying other patients the opportunity to see their GP.

"Far from wanting to discourage patients from making appointments, GPs are committed to encouraging better access for those who need it. Doctors do not want to see patients punished for missing appointments. All they want is for patients to call and cancel if they can't make it."

"Having a good health service depends on the way people use it as well as the people providing the service," he added.

Practices too have a responsibility to do all they can to minimise the problem. Most agree that patient education is the key when it comes to addressing the problem of missed appointments. Some patients may be unaware of the cost of their appointments in terms of practice resources and the subsequent potential cost of inefficiencies and appointment waiting times.

The cost of a GP appointment is at least £18, making a costing of £9 million appointments missed in the UK the equivalent of around £162 million.

"Communicating to patients information such as the cost of their appointments - £18 - and the numbers wasted through missed appointments can help to raise awareness of their value," added Dr Calland.

Fifty five per cent of health professionals believe that the main reason for people missing appointments is that they forget. Twenty two per cent also believe that people DNA because they feel better by the time of their appointment.

Hospital missed appointments

Missed appointments is also a big issue for Welsh hospitals.

Jon Osborne, chairman of the BMA Cymru Wales's consultants committee said: "Patients who do not attend for their hopital appointments prevent other patients on the waiting list for recieving prompt treatment. The new prebooked clinic system which involves patients choosing an appointment from a selection of dates should help to reduce this problem. It is being introduced at Glan Clwyd in the very near future."

The University Hospital of Wales in Cardiff has managed to reduce the DNA rate using a system introduced last year of "partial booking" for outpatient clinics whereby patients get a letter asking them to ring the outpatient booking centre to fix a date and time to suit them rather than having an appointment chosen for them.

It has already reduced the number of patients who fail to turn up at outpatient clinics.

Instead of a letter telling them the date and time of their appointment, most patients referred to Cardiff and Vale NHS Trust now receive a letter inviting them to telephone a Booking Centre.

The operator taking the call is able to arrange the appointment for the date and time most suitable for the patient.

The new system began in April 2003, and, after a successful trial, has now been extended so that patients in all major specialties can benefit, including some with the longest waiting lists? Dermatology, ENT and Orthopaedics.

The number of patients failing to keep outpatient appointments has been a major headache for the Trust, which has estimated that up to 1,000 appointments per week are lost. However, non-attendance rates for patients able to take advantage of the new system have reduced dramatically since its implementation. One of the earliest specialties to adopt the new system was ENT, which last January had a non-attendance rate of 17%. By August, this had reduced to just 5%, and with other large specialties like Orthopaedics having changed to the new system more recently, hospital managers are optimistic of further improvement.

For more information please contact:

John Jenkins
Tel: 029 2047 4611
mobile 07788 565216
pager 04325 638059
Fax: 029 2047 4621
Email: jjenkins@bma.org.uk

BMA Cymru Wales
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Telephone: (029) 2047 4646
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