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Should GPs charge for DNAs? Yes

I have a love/hate relationship with patients who do not attend their appointments. 

I love the fact I can catch up when running behind, grab a quick cup of coffee, or make a start on my ever-growing in-tray. But I hate the fact that patients then complain that they can’t get an appointment quickly enough, and we are always only just coping with the demand. 

About one in 20 GP appointments is missed by the patient, costing the NHS approximately £162 million per year. That’s a lot of money wasted at a time when NHS purse strings are getting tighter and tighter. 

Like most practices we’ve tried various things to stop patients from failing to turn up. One practice I worked in had a ‘three strikes and you’re out’ policy – miss three booked appointments in six months and it was time for you to find a new GP. While this might seem a little harsh, it did have the desired effect to some extent – probably by moving the worst offenders on to other practices who then had to deal with them.

When I make an appointment to see my dentist or solicitor, I am often informed that I will be charged a cancellation fee if I fail to turn up without adequate prior notification. Surely it is time to consider a similar scheme in the NHS to stem the tide of wasted appointments?

By not arriving for their appointment, the patient has prevented another patient from being seen, as well as leaving me twiddling my thumbs wondering if they’ll turn up.
The cost of a GP appointment is £10–£20, I estimate, and a monetary fine to the patient of this value would remind them that there is actually a cost to a service that is provided free at the point of use, as well as acting as a disincentive to them doing the same in future. 

Taking responsibility

If the NHS is seen as having no monetary value, it appears worthless and is treated as such. 

A trial a few years ago presented patients on discharge from hospital with a faux bill detailing their treatment and the costs of it. In a society where few can remember there being no free medical care, all the patients studied were amazed at the cost of their care.

With the ongoing negative press regarding doctors’ salaries and pensions, few patients have much sympathy for wasted GP time, and not many seem bothered about the inconvenience and potential harm their fellow patients are put to either. By reminding them in a way that hits them in the wallet, they are likely to be more considerate next time – just as my car parking behaviour certainly changed after a fine. 

If the fine were pitched so as to cover the cost of the appointment, no GP could be accused of seeking to profit from sick patients, and an appeal scheme could be used when there was a genuine reason for failing to attend (though I’m fairly sure of my dentist’s response if I were to appeal to their cuddly side after having wasted their time).

To make a small charge in the event of a patient failing to attend their booked GP appointment will not bring about the privatisation of the NHS. It will not herald the onslaught of co-payments and a myriad of other charges for services. It will not be the end of the NHS as free at the point of use. 

It will, however, encourage patients to think about the value the NHS has and realise that wasting their appointment comes at a cost. And it may even help prevent further privatisation, as patients wake up to the real worth and value of the NHS.

Dr Richard van Mellaerts is a GP in Kingston in Surrey

Click here to read Dr Jonny Tomlinson arguing that GPs shouldn’t charge for DNAs