The cost of not turning up

There was a news story this morning highlighting the cost of missed appointments in the NHS. Apparently it cost the NHS approximately £650 million between 2007 and 2008 for missed appointments. For every person who failed to turn up for their appointment in hospital or general practice, it cost about £100.

Working in general practice, there is a fair share of missed appointments, on average 5-6 per week. Often no explanation is given and when the patient does turn up at a later date there never seems to be much bother about it. Is it really that surprising? Offer someone a free service and people will take advantage. It's no cost to the patient not to turn up, so if they can't, they won't. When I mention to my patients that they missed previous appointments, it's usually met with a shrug and mumbled excuse about how they couldn't get to the phone cause they dropped it in the toilet or something!

The NHS is attempting to address this by trying to setup a text/email service to remind patients about their appointments. In GP-land, different practices have different policies. For example, in my current practice, we tend to phone the patients who have made emergency appointments to make sure there hasn't been an adverse event preventing them from attending. For standard appointments, it is documented in the system and then for the doctor to discuss the missed appointment at the next consultation.

Although it may sound like I'm complaining about missed appointments, it's actually the opposite. I quite like the chance of free 10 minutes in the middle of my surgery - it's like a free gift. If it's busy it gives me the time to catch up, otherwise I get a 10 minute break to relax and get ready for the next patient. During my hospital time, it was even more valuable as all the clinics would overrun and missed appointments would seem like a blessing and allow valuable catch up time. There's mention of hospitals over-booking, but I hope they're careful about how much they overbook - if there's even 60-70% attendance then it will get chaotic.

There was no surprise to read that the worst offenders were young men in their early 20s. They obviously have better things to do. However, in my experience there doesn't seem to be any particular age group - across the board, people miss appointments without giving a reason.

I believe when it comes to missed appointments, there should be a more ruthless approach. A system needs to be developed where patients pay a fee for missing an appointment without at least 24 hour notification (allowing for certain emergency situations - having the plumber run late at home is not an emergency situation).

How you implement this fee is the difficult part. When it comes to health care - charging for the care of someones health is an extremely alien concept in this country. Refusing to see patients unless they pay their fee for missing a previous appointment won't work, especially if the patient has a serious medical problem. Asking the patients to pay out of their own goodwill won't work - patients don't have goodwill. Perhaps getting the patient to pay a deposit prior to the appointment, which is then returned if they attend could be an option. It will be fiddly to say the least and time-consuming, but if patients know there are repercussions for missing an appointment perhaps they won't miss as much.

Finally, whilst we're on the topic of charging, here's one report last month, which looked very interesting. Charging to see a GP? Don't worry, it's not something I support, access to health care should always be free in this country - after all, what are we paying taxes for? Interesting however to see a think-tank have the courage to display such ideas, don't see it taking off somehow. Can you imagine the political damage it would cause if it was backed by the Tories or the Labour party? They wouldn't survive.

Take care all,
Thoughts just flow, when do they have to make sense?