Local systems are needed to address local problems

“Non-attendance at NHS outpatient clinics and at general practices is more common in deprived populations. It results from the organisation of these services, which currently puts the needs of staff before those of patients. Discuss.” Proposing this debate at your next management away day should enliven proceedings. What evidence exists for the various parts of the statement?

The national figure of 12% for non-attendance at outpatient clinics in the United Kingdom hides large variations between specialties and between regions. Studies report figures that range from 5% to 34%. 1 2 Much less research has been done on non-attendance in general practices, though figures of 3% and 6.5% have been reported. The first figure comes from an unpublished doctor-patient partnership survey in 1998 and an unpublished survey (by WH) of 500 non-attenders in Exeter. The higher figure is from a study of 221 000 appointments in practices in Sheffield.3

Different methods have been used to assess deprivation, such as extrapolation from postcode data, information from interviews or postal questionnaires, and validated indices of deprivation.4^{– …}