We must face up to the cause of so much waste – our patients

I work in one surgery but, clearly, I am a patient in another. I really can't see why a doctor/nurse/ cannot gently remind me when I turn up, having missed an appt., of that fact - or even to say to me "That cost £30" or whatever. My GP has only once commented on a missed appt. and that was to apologise for not ringing me to see what was happening! That was service. But she sits there with my case open on the screen -= and I can clearly see the "cancer" and "heart risk" flags. Why not a larger than usual "stand out font" box showing the cost (with a pound sign) of that patient's missed appointment. That allows he GP to comment or respond to a patient noticing it. It can be explained as a "monitoring" entry for practice management purposes (which it is) and allows the doctor to say something to the effect of "Yes, Mr Smith, £3000 is a lot of money, perhaps an operation for somebody with [insert disease of choice]"

I completely agree with the principles set out in this post. I work in a high deprivation area and regularly have high DNA rates, late attendees and 'forgotten' appointments in out patients or referrals. We have taken a slightly firmer stance on this. When patients are late, I remind them. When they DNA we point that out normally as they book in, or at end of consultation. With referrals however we are now informing patients that missing appointments etc is unacceptable and patients will only be allowed one re-referral unless exceptional circumstances. Some may comment well everyone can state their case is exceptional, but I now take a clear stance, informing patients that such agreements will be documented in the notes and their agreement to comply with the 'verbal contract'.

Interestingly we have now seen a reduction in our DNA rates so hopefully might keep working.

Given the increasing demands on the NHS we must look at co-payment for NHS services such as GP consults, prescriptions and A+E visits. There could be a reduced rate for pensioners, children and the unemployed. It might make patients think about the cost of services, and encourage self-treatment of URTIs and other minor illnesses, leaving the NHS more resources to deal with more serious and chronic conditions. It might also lead to less wastage of prescription medications.