Debating the cost of missed appointments
Recent research as quoted in the Lancet, indicated that 1 in 5 people regularly missed their GP appointment. That’s 20% of all appointments. The research also found that ‘poorer people in more affluent areas’; young people between 16 and 30, and those over the age of 90 tended to be what they referred to as ‘no shows’ or ‘Did Not Attends”.
There are similar issues in hospitals. The Department of Health suggests 1 in 10 people 'Do Not Attend' outpatient appointments. That’s 10% of all appointments. Given the number of people who attend outpatients (OPD), this equates to hundreds of thousands of people.
Last year, Healthwatch interviewed patients attending the Royal Sussex County Hospital OPD, and 21% of the patients said that they had been unable to keep appointments for a variety of reasons, such as a clash with another hospital appointment, or personal reasons.
So, what are the reasons for people not turning up for appointments?
Of course, some people simply forget. However, patients have also told Healthwatch that they have been unable get through to the booking office at the hospital, or the GP surgery, to cancel or change an appointment. Certainly, in the work Healthwatch has done to look at OPD, this was a major cause. People also complained to Healthwatch about receiving duplicate letters with different dates for appointments; being notified of ‘last minute’ appointments, and even appointments which had taken so long to come through that they were unsure what they were for. When they tried to phone up to clarify, they often got no reply and gave up. Last year, there were serious problems with the appointment systems at the hospital and though considerable improvements have been made and the ‘Did Not Attend’ rate is now down to 6% - lower than the national average - this still equates to a significant number of missed appointments.
Healthwatch has just completed an extensive survey of peoples’ experiences of GP practices. Our research shows that in many surgeries in Brighton and Hove booking an appointment is challenging. A third of patients reported that booking an appointment on the phone had been ‘difficult’. The average wait time between booking and the appointment date was five days.
This pattern tallies with national statistics which show that one in five people wait at least a week to see their GP and more than 1 in 10 fail to get an appointment at all. These difficulties make it more likely that patients will just not turn up for an appointment, as they have been unable to contact the reception to make a change and re-arrange. If people wait a long time for an appointment their circumstances may have changed and the appointment may no longer be necessary.
It would be interesting to know how many people who cannot get a GP appointment chose to seek help from the hospital Accident and Emergency Department (A&E). It is estimated that 39% of the over 400 people a day that attend A&E have conditions that could be dealt with in general practice - that’s about 150 people per day.
Does it matter?
Yes. Delays in getting a consultation at GP surgeries and OPD are growing. The appointment slots missed could be used by other patients with pressing problems and reduce waiting times overall. The NHS is under great financial strain and every penny counts. A missed appointment has financial consequences. An OPD appointment is estimated to cost about £120, despite the fact that staff complete other work if people do not turn up. This often results in clinics becoming more likely to overbook in efforts to compensate, and this can cause delays to those who do attend their appointments.
What can be done?
For those people who forget their appointments, a study showed that text reminders improved take up and particularly if people were told what the cost was of a missed appointment. In light of this, it could be a method to be made common practice across the NHS. Though booking systems at the hospital have improved and some GP practices have excellent telephone and appointment systems, others do not. These need updated telephony as well as easy access to appointments both online and in person.
Appointments at hospitals should be routinely negotiated so that a mutually appropriate appointment can be given. A waiting list of people wanting appointments could be kept so that last minute cancellations can be used by other patients.
Patients need to be given information about how a missed appointment can affect other patients and the cost of those missed appointments.
The numbers of people who do not attend clinics and surgeries could be displayed, along with the cost of appointment slots in surgeries and clinics. This is an issue where hospitals, general practice and patients can all play their part and get better care from the NHS and better value for money.
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