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Half of GPs want to fine patients who don't attend appointments

Exclusive Just over half of GPs think patients should be fined if they don’t turn up to appointments, a Pulse survey has revealed.

The survey of 821 respondents, open only to GPs, found that 51% backed the fines.

A further 12% said they were not sure, and just over a third (37%) said they disagreed fines should be levied for did not attends (DNAs).

The response comes as GP appointments have become harder to come by, with the average waiting time now around two weeks.

Health secretary Jeremy Hunt said two years ago that he did not have a problem ‘in principle’ in charging patients for missing appointments.

A north London GP who backed fines told Pulse that the DNAs at his practice were enough to give one GP a week off every month.

Another London GP thought a £10 charge would be reasonable for patients who fail to attend.

A GP in north-west Surrey said: ‘When some services appear “free” some patients do not always appreciate the true costs to provide that service.’

Others suggest removing repeat DNA patients from their list or charging patients a refundable deposit.

A GP partner in west Kent told Pulse patients had to take responsibility and stressed: ‘We cannot continue to pretend that this is not a problem.’

One doctor suggested that it should be up to the NHS to collect the money. Another said patients with dementia should be exempt.

One GP in Glasgow, who opposed fines, said there were other ways of cutting DNAs, without hitting people’s pockets.

His practice sends text reminders to patients and also offers a large percentage of on-day appointments.

‘By doing so we have cut DNAs by over 900 appointments a year,’ they said.

Some GPs thought it would not be worth the time spent on administration and appeals and time is better spent all triaging patients.

Some GPs also said they had plenty of work to do to fill the time they would have spent seeing the no-shows.

A locum in Devon said: ‘Most who DNA are in a terrible life situation and it would make their lives worse and they would not have the money to pay anyway.

‘The admin charges of collecting the money would far outweigh any income generated from it.’

Another locum from west Lincolnshire said: ‘A DNA is a GPs’ saviour.’

The BMA said it ‘has consistently opposed charges for patients as such a system who require an expensive, cumbersome bureaucracy to collect and issue fines’.

A spokesperson said: ’Those who may be most likely to miss appointments, particularly vulnerable patients, may also be the people who would be exempt from fines and fining them is not the way to address some none attendance issues.’

Mr Hunt also told the told the RCGP conference last month that GPs felt they were on a ‘hamster wheel’ of 10 minute appointments. 

Meanwhile, a survey of 40 practices by Wiltshire CCG found patients missed 37.5 days of care at every practice through did not attends.

They amounted to 281 missed appointments between July and September last year.

Should patients be fined for not attending GP appointments?

Yes - 51%

No - 37%

Don’t know - 12%

The survey was launched on 10 October 2017, collating responses using the SurveyMonkey tool. The 25 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a Ninja Coffee Bar as an incentive to complete the survey. A total of 821 GPs answered this question.

Readers' comments (11)

  • Non-starter. Totally unenforceable.

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  • Why stop there?

    Charge for all appointments at the time of booking and watch the number of DNA's plummet (indeed, watch the number of appointments plummet). As a sop to the hand wringing Cardies, you could scrap all prescription charges in England, thus unifying UK prescription charges and meaning that the burden of cost moves away from the medicine and on to the clinicians time, which is the most valuable asset in an overburdened system. £144 per year for each of my GMS patients vs £108 for an ECG at my local DGH. The economics no longer work.

    A political decision has been made (or the absence of a decision to the contrary, which is the same thing) to defund the NHS to the point of collapse. We've been pointing this out for years and the electorate have been deaf, re-electing austerity governments. in the end, it is not our job to defend the NHS - its our job to provide services to patients without sacrificing our sanity or clinical standards. The NHS no longer allows us to do this safely, no change is coming, so it is time we left.

    I am aware that this "is exactly what THEY want", but they've won, and it's not my problem any more. The public get the healthcare they deserve or are prepared to fight for.

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  • I actually like DNAs. gives me a breather!!
    I only wish they would organize themselves better and club themselves. Then I could actually take a few weeks off while the clinics are still "running"!!

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  • Cobblers

    A DNA is time for coffee and jammy dodger. Little enough time as it is for self care.

    Charging would need to be part of an overall change of the FATPOA (Free At The Point Of Abuse) system we have currently.

    Babylon has inserted a wedge and the free access system is starting to unravel.

    Cassandra moi, nope, more a Hopeful Priam.

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  • Do you remember when the DOH set up an institution to recoup prescription charges that patients should have paid? It cost more to run than what was recouped! And how exactly are we meant to collect the money for those that DNA’d when many of those will be on benefits and will just refuse to pay the fine. Seems best to allow us our coffee break for those that DNA unless the DOH intends to setup another bureaucratic machine to collect fines which,of course, would create more useless jobs and reduce the unemployment rate!

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  • I agree. Why chase them for money. Not in our interests. Nicer to have the free time to catch up. It's is the NHS's problem and if they think it is a problem, then up to them to find their own solution and not involve us.

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  • Record all DNAs with the same code, with additional freetext if appropriate (e.g urgent appointment or valid excuse) and you soon start to see clearly who the regulars are, which does include infrequent attenders.
    Warning letter first then off the list if ongoing abuse of the system. Helps a bit.
    What particularly annoys me is when running behind the regular non-attenders always turn up!

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  • David Banner

    Fining DNAs will never happen, pointless debate.
    Personally I too love DNAs, they are my favourite patients and help keep our sanity, but there is a special place in Hell for the pseudoDNAs who tease us by not showing on time then rock up late.

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  • AlanAlmond

    Just charge people a small fee to book an appointment..i simply dont accept the idea that it is beyond our capability to find a way to collect the charge that doesn’t cost more than it does to implement. Costa coffee runs an entire business up and down the country selling £2.50 cups of coffee and yet some people seriously suggest it would impossible to collect a £5 fee for a GP appointment and NOT make a loss. Give me a break ...we build nuclear submarines in this country, but it’s too difficult to charge for a GP appointment? Self evidently nuts. The moral/medical pros and cons of charging are a different issue but logistics are a lame excuse to avoid the idea. Charge people , they’ll realise the service actually costs , they’ll value it more and DNA less.

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  • Knowledge is Porridge

    Even a 5p carrier bag charge makes a big difference:
    £1 per appointment, £1 per prescription item, and never cheaper than OTC purchase.
    Are we not able to pilot this somewhere and see what happens? Surely Wales or northern Ireland could be brave enough to try it?

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