Intended for healthcare professionals

Letters Missed GP appointments

Dominant factor explaining missed GP appointments is largely ignored

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1334 (Published 26 March 2019) Cite this as: BMJ 2019;364:l1334
  1. Stephen Black, data scientist
  1. Black Box Data Science, Biggleswade SG18 0QA, UK
  1. steve.i.black{at}gmail.com

Oliver is right to challenge the dominant narrative surrounding the newly released data on GP appointments and the number of missed appointments.1

He (rightly) opposes the knee jerk reaction of many commentators that sought to put the blame on feckless patients. He argues that many patients may have good reasons to miss appointments. But, in looking at the justifiable reasons why patients might miss appointments, he and many researchers miss the single biggest cause of missed appointments: GP behaviour.

In the six months of data where DNA (did not attend) rates are available,23 one factor dominates any explanation of the missed appointments: how long the patient had to wait for the appointment. Under 2% of patients offered appointments on the same day fail to turn up, but when the appointment is delayed until the next day the DNA rate is 5%. When the appointment is in the next week or later the DNA rate is 8-9%. So, the number of missed appointments more than doubles if the GP can see patients only on the next day and nearly doubles again if the appointment is in the next week.

The wait for an appointment is such a big factor that it is not worth looking at the other factors if you want to tackle the problem. The problem is GP processes that are not designed to handle most urgent requests on the same day. GP processes, not feckless patients, explain nearly all of the problem. We will not fix it by fining or punishing patients: we will fix it only by encouraging GPs to design their processes so that most appointments can be handled on the same day.

I am surprised that such a large and obvious factor in explaining the problem has been largely ignored.

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