Deprivation is biggest driver of missed GP appointments, research finds

GPs have warned against fining patients for missed appointments, after researchers found that socioeconomic deprivation is the biggest indicator that patients are likely to miss multiple GP visits.

There is ‘clear evidence’ that patients who serially miss appointments are more likely to be socially disadvantaged, according to research published in the Lancet Public Health.

GP leaders said the results showed that tactics such as charging patients for missed appointments would only penalise the most vulnerable in society.

UK researchers looked at data on more than 550,000 Scottish patients gathered by GP practices over three years between 2013 and 2016.

The results suggest that nearly a fifth of patients (19%) missed more than two appointments over this timeframe, while close to half (46%) missed at least one.

Practices with delays of two to three days following appointment booking requests, those that offered a higher number of appointments per patient and those in urban locations were more likely to have higher numbers of non-attendance.

Patients aged 16-30 as well as those over 90 were the most likely to miss multiple appointments.

Missed GP appointments

The researchers warned that because both elderly and socioeconomically deprived patients are likely to be affected, there was a strong potential for this to amplify health inequalities – especially if they miss preventative activities such as screening and chronic disease monitoring.

They suggested that practices could ‘selectively offer on-the-day appointments for patients at high risk of serial non-attendance’ to help mitigate this risk.

GPC chair Dr Richard Vautrey said: ‘Missed appointments result in valuable time and resources being wasted, but we do need to understand the reasons why this occurs.

‘As the Lancet Public Health report demonstrates, those from lower socioeconomic backgrounds are more likely to miss appointments and many of these patients are often under pressure financially or in other parts of their lives, factors that often contribute to their non-attendance.

Deprived patients

‘It is important that the government and NHS works with GPs to find positive ways to encourage appropriate use of GP services and through education campaigns re-enforces the importance of attending booked appointments, as well as the negative impact missing appointments have on other patients. This must be targeted on those groups who are more likely to miss a consultation with their GP.’

RCGP chair Professor Helen Stokes-Lampard said: ‘One of the college’s main objections to charging patients when they miss appointments has always been that this could disproportionally impact on the most vulnerable in society, and this new research backs this up.

‘We understand why GPs and our teams get frustrated when patients don’t turn up to their appointments. It’s wasteful for everyone, but in some cases this can be a warning sign that something significant is wrong with the patient and follow-up action is needed – and it may not always be a physical problem but sometimes a psychological or social issue.

‘It is interesting, but perhaps not surprising, that the research found that frequently missing appointments correlates with a delay in them getting an appointment.

‘Whilst practices will always try to offer appointments that are timely and convenient for patients, the current resource and workforce pressures we are facing, with GPs conducting more consultations than ever before to meet increasing demand, is making this more and more difficult.’

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