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A faulty production line

Why practices should offer more same-day appointments

One in five patients misses at least one GP appointment a year, reports Carolyn Wickware

Practices with patients at higher risk of serial DNAs should consider selectively offering on-the-day appointments, a new study has concluded.

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The study published in The Lancet Public Health looked at the appointment history of 550,083 patients in Scotland over three years and found that only 9% of DNAs were one-off missed appointments, with the majority being missed by serial offenders. 

It also found that there were ‘clear differences’ in the characteristics of patients who serially miss appointments, with patients over the age of 75 and those who lived in more deprived areas most likely to miss appointments regularly.

But it also found practices offering on-the-day appointments were less likely to have a high proportion of DNAs.

As a result, they concluded: ‘There might be a case for some practices selectively offering on-the-day appointments for patients at high risk of serial non-attendance.’

The researchers, from the universities of Glasgow, Lancaster and Aberdeen, analysed more than 13 million appointments over three years, and found that 12% were not attended – of which 91% were missed by serial offenders.

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dnas 2 580px

They found that, in line with clinicians’ experience, patients in deprived areas are more likely to miss appointments. But they said it was ‘unexpected’ that older people missed more appointments, saying transport issues might be a factor. Women miss more appointments due to the higher number they book, although when researchers adjusted for this, men were more likely to miss appointments.

The study concluded that practices in affluent areas could do more to prepare for serial DNAs. It said: ‘Practices in more affluent areas seem to be more poorly equipped to accommodate patients who repeatedly miss multiple appointments than practices in more deprived areas and could benefit most from similar adaptations to their appointment systems.’

In November 2017, a Pulse survey revealed that just over half of GPs would now be willing to fine patients who miss appointments. In 2015, health secretary Jeremy Hunt said he did not have a problem ‘in principle’ with charging patients for DNAs.

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

He called for a targeted campaign to enforce ‘the importance of attending booked appointments, as well as the negative impact missing appointments has on other patients’.

The study comes as GP appointments become harder to secure, with the average waiting time in the UK now around two weeks.

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Readers' comments (4)

  • David Banner

    For decades GPs had a “turn up and be seen” policy, but as demand rocketed we moved to appointments. When Blair introduced the 48 hr access target, most practices moved to “book on the day” only, leading to an obscene scramble for appointments at 8am every morning, and working patients angry they could not book in advance. The target was quietly scrapped. Now the GP shortage is biting, and pressure on A&E rising, it’s Back To The Future with “book on the day”. But you can fit a quart into a pint pot, so any appointment system is doomed to fail without more GPs.

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  • David Banner

    Sorry, “can’t” not “can”, slight difference!!

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  • DNA rates have always been higher when appointments are booked a week or two in the future. The reason for this is that by the time the patient is seen the patient’s problem/concern has either settled or no longer bothers the patient.

    There is also a big difference between patients requesting appointments and appointments that are made by clinicians for follow up. In the latter case DNA’s are higher.

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  • So to be clear, all appts on the day, also all appts book in advance, with whoever you WANT when you WANT. No waiting times to see the Doctor but appts for as long as you want at all times.
    Of course we must prioritise, the old, the young, the working, the disabled, carers, the unemployed, the mentally ill, the chronic diseased, the worried well and the daily mail readers and all holiday makers from any country in the world. Easy peasy. Work shy fops the lot of us!

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