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Call for charges as 13 million GP appointments missed each year

23 August 2007

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More than 13 million GP appointments and nearly 6.5 million practice nurse appointments are missed each year, a new study shows.

The Developing Patient Partnerships (DPP) report reveals that 97% of practices believe that missed appointments are a massive waste of NHS resources.

And the study shows that 72% of GP surgeries support the idea of striking off patients who are regular offenders, while 68% back plans to charge patients up to £10 if they fail to turn up.

But Dr Laurence Buckman, chairman of the British Medical Association (BMA) GPs committee, said more needs to be done to understand why appointments are missed, and that striking off patients should only be considered as a “last resort”.

He said: “Whilst we understand the frustrations that other patients and doctors feel when some people persistently fail to turn up for GP appointments, we think it is important that practices find out why this is happening before taking precipitant action.

“Many practices have a process to deal with the situation and help these patients use NHS services more appropriately.

“Removing a patient from a list for misuse of the service should be absolutely the last resort taken after the patient has had some opportunity to explain what has happened.

“As for the idea of charging patients who do not attend, the majority of GPs do not support charging patients who miss appointments. They have demonstrated this by repeatedly voting against the idea.”

Copyright © PA Business 2007


Should practices get tough with patients who miss appointments? Tell us what you think. (Please supply your comment, name and location in the feedback box below. Your details will not be published if you so request.) (Terms and conditions apply)

“Much as I agree that we need something like this in place, I don’t agree with it ethically or financially. At our surgery, the main defaulters are the young often unemployable and the DSS would pick up the tab for them (as always) and they would object if we didn’t see them. The other category of defaulters are OAPs who can be forgetful, again many on benefits. Would we see patients while waiting for the DSS to pay for their non-attendance? Who would collect the money and how would we account for it? How would it be deducted from our income, would we see patients who presented an “emergency”?  Possibly a better solution would be a small charge for seeing your GP as patients might value the service, though again questions arise concerning those who can’t afford the fee. Would the DSS limit the number of visits they would finance? If patients arrived with no payment would they be seen?” – D Elder, Saltcoats

“This subject has always been a difficult one to resolve – if ever!  Our practice introduced Emis Access which allows patients to make their own GP appointments, which means they have the facility to also cancel them. However, this still does not always happen, but can go someway to reducing DNAs. I would be happy to see a charge made of say £10, after all within the dental contracts this is possible, so why not for GP contracts. There will need to be some give and take, as sometimes a patient may try to cancel, but cannot get through on the phones – which is why Emis Access is so good as it’s a 24hour service for the patients – Kath, Stoke-on-Trent

“We had 266 DNAs last month (including nurses). This is equivalent to 1 week’s GP appointmnets. It is theerfore galling when patients complain they cannot get an appointment and we should get more doctors. We will look at more doctors to satisfy a true demand but not to indulge patients who cannot be bothered to turn up for appointments” – Name and address supplied

“Fining won’t work. I will not be seen as morally right or ethical. In any event, isn’t it a bit like London’s Congestion Charge. The logical conclusion of which is that as charges continue to rise the only drivers who will ultimately be able to enter London will be the wealthy ones who generally drive the highest polluters. So if one wants a surgery of the better off who misbehave then this is the way to go. Being struck off works to a point, if they have DNAd many times (whatever “many” means). However, recently a patient was de-listed from a nearby surgery because she had DNAd 12 times in less than a year. The PCT insisted that we took the patient on as she was in our catchment area. This same patient was de-listed by us only 9 months earlier because she had DNAd over 90 times in three years. This history made no difference to the PCT who insisted we took her back. What about a third option? Patients who DNA more than X% of the time are only allowed GP appointments at the end of each surgery. Doctors and nurses can then feel optimistic about getting away earlier than they might have expected”  – Name and  address supplied

“I have felt for a long time that there needs to be some incentive for patients not to abuse the appointments system. At present if someone wakes up feeling better on the day of their appointment or something better comes up, eg shopping, visit from a friend, etc, they are quite happy to DNA without notice. If GPs had the same rule as dentists where if you DNA an appointment you cannot have another one until you have paid £20, you would see a significant reduction in DNAs. Obviously a system would have to be worked out to cover geniune emergencies but I think a penalty for DNAs could work and it would go a long way in educating people that DNAs without valid reason are not acceptable. It is OK to talk about providing a good service to people but they need to share some of the responsibility of ensuring a good service can be provided. It is not a one way street” – Dean Thompson

“A fine system should be developed, but it has to be national, consistent, without loopholes and guidelines made public via the general media etc. Patients should not be able to book further appointments (emergencies excluded – which need to be tightly controlled with guidelines made public – ie health professional assessment of emergency) – David Allen, Practice Manager