Welsh GPs face missed appointments crackdown

Patients fail to attend more than one in 10 GP appointments in Wales, prompting calls for 'urgent action from NHS leaders.

Dr Charlotte Jones: patient focus

GPs in Wales also face a crackdown on opening hours, after NHS officials pledged to investigate practices that failed to offer appointments throughout their contracted hours.

Giving evidence to the public accounts committee of the Welsh Assembly, NHS Wales chief executive David Sissling said DNA rates were as high as 11% in parts of Wales.

‘It is a matter of concern and it is clearly the responsibility of the health boards and the practices to address that. It is an area that we are drawing to their attention as a matter for urgent action,' he said.

‘There is something of a paradox that where there is appropriate access to appointments, we are seeing a significant number of people who, having made an appointment, do not turn up, which is clearly frustrating for us and for general practitioners, health boards and, indeed, I am sure, members of the public.

'We accept that this is an area to which we need to pay much more attention, because there is clearly scope within this to release capacity that could be used beneficially for other patients.’

But Mr Stirling rejected calls to sanction patients who miss appointments, calling for a sympathetic approach to often vulnerable patients. ‘Adopting an approach that says there is a blame in this would simply be inappropriate.’

There was, he said, evidence of best practice across Wales including use of online booking systems and text message reminders.

Assembly members, taking evidence on unscheduled care, asked Mr Sissling why patients found it difficult to book appointments after 5pm and what could be done to improve access.

Mr Sissling said 68% of practices operated within an hour of their contracted hours, but the situation was improving. The number of practices with appointments available between 5pm and 6.30pm on at least two days a week had reached 94%, he added.

NHS bosses were unable to say what the spread of evening appoinments was across the 5pm to 6.30pm period, but agreed to break the data down into half-hour slots and look at how many appointments were available.

Mr Sissling said health boards should apply the GP contract with ‘rigour and great precision' to deal with practice opening hours.

But committee chairman Darren Millar criticised practices, health boards and the NHS.

‘This would never be allowed to happen between two contractual parties outside of the public sector, would it?’ he said.

‘It seems pretty extraordinary that this issue has not been dealt with, given that GP access is clearly putting significant pressure on our unscheduled care systems.’

In a previous committee hearing in November, GPC Wales chairwoman Dr Charlotte Jones said health boards should deal with practices that breach their contracted opening hours. She told assembly members that the GPC would launch a consultation on access before the end of the year.

‘The aim is to start challenging some of the practices and saying that we need to be more of a patient-focused service provider, rather than thinking about the business and the running of the practice,' she said.

Deputy chairman, Dr David Bailey, rejected as ‘messy’ and ‘impossible to police’ a suggestion that patients who missed appointments could be charged.

‘I do not think that it would be terribly helpful in terms of providing an equitable service for the patients who need it most.’

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