Late-comers and non-attenders

Time-keeping is crucial to guaranteed 48-hour access. Dr Tillmann Jacobi explains

GPs and surgeries are judged on providing guaranteed access in 48 hours, which means there is greater awareness about keeping time and appointments.

However, patients’ behaviour can be a major influence on your daily time-keeping. A patient arriving late can cause several different reactions in the doctor. 

Some surgeries have a clear policy on late-comers: receptionists often bounce patients automatically if they arrive more than 10 or 15 minutes late for their scheduled appointment.

Of course, a common-sense approach should be applied, for example when an elderly patient with mobility difficulties comes late, or if there are some exceptional circumstances causing unexpected delays (such as road works and bad weather).

General practice is also about running a business. Therefore, arriving late is not necessarily a trivial act, because it can disrupt a complex system of multiple tasks with a number of people involved.
So, it is part of a professional relationship to have some expectation of the patient to make a reasonable effort to comply with the system and to avoid time-wasting. If you as a doctor can apologise when you are running late, so too should the patient.

Some GPs record in their notes that a patient arrived late, in order to give some hints for future appointments and for other colleagues. The appointment system, such as Synergy, may automatically log how often the patient failed to attend.

Depending on how well you know the patient, you could address repeated late-coming at some stage. If you decide to ignore it, you must share the responsibility for the dysfunctional behaviour.

Reasons for non-attendance are many. Research so far suggests that in the majority of cases the patient has simply forgotten about the appointment.

There are also notorious non-attenders, and this might simply be another expression of a somewhat disorganised lifestyle.

Different surgeries have very different average rates of non-attenders, depending on the local community and its socio-economic factors. Seeing the GP might be simpler and cheaper than seeing a hospital specialist; however, it is not free and should not be taken for granted.

The surgery may have a policy, for example, that a patient receives a letter if more than three appointments are missed within a certain period (six or 12 months) to indicate that this habit does not go unnoticed. It would be somewhat exceptional, but not impossible, to consider removal from the practice list in severe and persistent cases.

When a patient fails to attend, you may feel prompted to react in one way or another. Much depends on the loss of resources and time. Some doctors regard virtually every non-attendance as a significant event and routinely do some follow-up. It is likely that you would do something similar if you were called to a home-visit and arrived at a closed, unanswered door.

You could simply ignore the non-attender’s records until the end of the day, and then as a minimum add a note saying ‘Did not attend — no reason’.

However, flicking briefly through the notes could flag-up crisis potentials of a social or protection nature, in particular vulnerable patients such as the elderly or children. So, although it might be tempting to fill some unexpectedly gained time with other tasks, it could be worthwhile checking this patient’s notes and estimating how unusual this non-appearance is.

The outcomes could be to do nothing about it or to try one of the following options: call the patient on the phone, immediately or later in the day; write a note to mention it in the next consultation; or write a letter, in case of frequent non-attendance.

If patients with mental impairment have difficulties attending appointments, you could consider a reminder call in the morning or even the involvement of a family-member or carer. 

If the surgery has an established policy drawn up concerning late-comers or non-attenders, this could be displayed in the
waiting area.

The different temperaments and tolerance of doctors will influence the outcomes if patients arrive late. It is interesting to reflect on this and realise how this may have changed during training or during the job.  

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