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The Missed Appointment

“Missed GP appointments cost NHS England £216m” was the headline revealed by NHS England last week.  With the NHS currently drowning in funding issues, the amount wasted was not only eye-opening but extremely concerning.  With £216 million lost across 15 million missed appointments in the last year alone and with each missed appointment costing the NHS (and by proxy the taxpayer) £14.40, is there anything the NHS can do to avoid such enormous wastage?

The NHS has certainly recognised the issue and has done it’s best to not stand still but it is unfortunately a large ship to turn.  Much work has been undertaken by countless NHS surgeries, with heavy investment in new technology, with email and text reminders one of the more popular additions to prevent the issue.  But, whilst having some impact, these investments do not appear to be wide-ranging or hard-hitting enough and do not appear to be having enough of the desired effect.

Via a recent LinkedIn post we came across, a variety of GPs and Practice Managers were discussing reasons given for missed appointments. The most popular response from patients seems to have been that they had 'forgotten'- even when booking appointments for the same day. With an NHS that is currently underfunded and heavily understaffed, we felt that this kind of response was unacceptable. It certainly begs the question whether there would be as many appointments missed if our health service wasn't free… or if there were a charge for DNAs - we're going to go out on a limb to say that there wouldn't be.

Guernsey is an excellent example of how a more hard-line approach has succeeded in cutting DNAs. With a GP appointment costing £50 on average, coupled with a cancellation charge (barring exceptional circumstances), Guernsey’s DNA percentage is almost nil. 

A further excellent comparison would be with Dental Surgeries across the UK.  A similar style of medical appointment to the mind of the public, yet Dental Surgeries across the UK see around 13 million fewer cancelled appointments with just 2 million missed.  With ~12000 (2018) dental surgeries it is a much smaller number of missed appointments on a per surgery basis when compared to GPs… are there other discernible factors that I’m missing? Or could it be down to Dental Surgeries’ notoriously tough stance on DNAs with the enforcement of fines and the blacklisting of patients for missed appointments?

However, although these may look like attractive proposals when the raw DNA figures are looked at, would these solutions simply solve another issue and create another, larger problem?  No solution is ever a straight line…

Firstly, would a hard-line cancellation policy even save the NHS money?  Although DNA percentages are down on Guernsey, is the time saved simply re-invested into dealing with those cancellations?  How much time is required and how many resources are utilised in processing, sending out and collecting fines for missed appointments?  What constitutes an acceptable “Exceptional Circumstance” for missing an appointment and who is dealing with DNA patients who have fallen into the grey area of “exceptional circumstances”?   We’re all aware of the large waiting times to book an appointment with GPs currently, but would this booking procedure be further strung out if people know a fine will be waiting if they don’t call ahead to cancel? Are people more willing to wait in a queue to cancel an appointment if they know it will ultimately save them cash? 

Additionally, are these missed appointments even truly costing the NHS?  This £216m cost assumes that a Doctor will simply cease working for 10 minutes (standard appointment time) in the event of a missed appointment.  I think we all know that this is not the case, with many GPs using the time to catch up with their clinic or complete paperwork that would otherwise need to wait.   If we chased missed appointments, would we in fact be placing even greater strain on our already over-stretched, under-resourced GPs?!

As always, we’d love to hear what your thoughts are on the matter.  Are DNAs the bane of your life?  Do they need to be clamped down upon and eradicated? Or do you feel the potential solutions we’ve outlined unworthy of the additional admin? Are there any solutions we haven’t mentioned? Or do you find that, in their own way, DNAs provide a much-required pressure release for GPs?  Whatever your view, it is vital that an underfunded NHS eradicates any non-essential costs… how would you tackle it?  

McGinley Healthcare Ltd is a company registered in England and Wales. Registered number: 7216155. Registered office: 56 Clarendon Road, Watford, Hertfordshire, WD17 1DB.

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