Intended for healthcare professionals

Rapid response to:

Letters Missed GP appointments

Dominant factor explaining missed GP appointments is largely ignored

BMJ 2019; 364 doi: (Published 26 March 2019) Cite this as: BMJ 2019;364:l1334

Rapid Response:

Re: Dominant factor explaining missed GP appointments is largely ignored

Missed appointments remain a complex issue and cannot be fully explained by a single patient or practice factor. Stephen Black argues that the ‘single biggest cause’ of missed appointments is the result of appointment delay. He also suggests that such a large and obvious factor is ‘often ignored’. These statements do not reflect outcomes from current research.

First, appointment delay has previously been considered [1,2]. Second, while significant, appointment delay is neither the only nor largest factor when attempting to predict non-attendance alongside multiple patient and practice factors. For example, we previously observed that practices with appointment delays of 2–3 days were at highest risk of having more missed appointments when compared with on-the-day appointments. This risk is reduced with appointment delays extending beyond 3 days [1].

While we agree with some of Stephen Black’s sentiments including the idea that patients should not be punished for non-attendance, interventions that simply shift ‘urgent’ appointments to the same day may not be sufficient for patients who are already unlikely to attend. Alternatively, practice-based strategies that consider multiple patient factors are more likely to succeed [2].

1. Ellis, D. A., McQueenie, R., McConnachie, A., Wilson, P and Williamson, A. E. (2017). Demographic and practice factors predicting repeated non-attendance in primary care: A national retrospective cohort analysis. The Lancet Public Health. 2(12), e551-e559

2. McQueenie, R., Ellis, D. A., McConnachie, A., Wilson, P and Williamson, A. E. (2019). Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study. BMC Medicine. 17:2

Competing interests: No competing interests

01 April 2019
David A Ellis
Lecture in Computational Social Science
Philip Wilson, Ross McQueenie, Andrea Williamson
Lancaster University
Department of Psychology