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Sixty seconds on . . . missed GP appointments

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l69 (Published 04 January 2019) Cite this as: BMJ 2019;364:l69

Re: Sixty seconds on . . . missed GP appointments

Gareth Iacobucci points out that missed GP appointments have been the subject of intense political interest, much of it misleading and designed to blame 'feckless' patients. In an article published today in BMC Medicine (https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1234-0), we describe an extremely strong association between repeatedly missing appointments and a greatly increased risk of mortality independent of the presence of known long-term conditions. These findings hold even after correcting for the number of appointments made. Around 5% of patients who missed more than two appointments per year over a three-year period had died within a year of follow up.

The increased risk of all-cause mortality illustrates a dose-based response with increasing number of missed appointments. Patients with long-term mental health conditions who missed more than two appointments per year had a greater than 8-fold increase in risk of all-cause mortality compared with those who missed no appointments. These patients died prematurely, commonly from non-natural external factors such as suicide.

Missed appointments therefore represent a significant risk marker for all-cause mortality, particularly in patients with mental health conditions. For these patients, existing primary healthcare appointment systems may be ineffective. Clinicians (and politicians) should carefully consider the causes of repeated missed appointments rather than ascribing blame

Competing interests: No competing interests

11 January 2019
Philip Wilson
Professor of Primary Care and Rural Health
Ross McQueenie, David Ellis, Andrea Williamson
University of Aberdeen
Centre for Rural Health, University of Aberdeen, Inverness IV2 3JH