Should patients be charged for missed GP appointments?

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With millions across the UK calling for a pay rise for our health heroes, maybe it’s also time we start charging serial offenders abusing one of the fundamental parts of our NHS, the GP appointments system. Our NHS knows no bounds and rightly so; the vast majority of people are proud of our National Health Service, yet despite its well-regard it is not being treated as well as it should.

To my surprise, last night while scrolling through Twitter and being led, as usual, down the rabbit hole of the online world, I came across a statistic. Not only was it shocking, but I was further flurried by the fact that not one of my fellow politically enthused friends were aware of it. According to NHS England, 15 million GP appointments are wasted every year. These vital slots of our beloved Health Service are costing millions, due to tactless laziness and lack of consideration for our supposed national treasure. Equating to 1 in 20 GP appointments being missed, it begs the question, did we really appreciate our NHS before this crisis?

Of course, from time to time, other more important things come into fruition and so previously booked appointments can’t be attended. This, however, can be resolved by a simple cancellation over the phone and the rebooking of a new appointment. But, the serious and costly problem prevails when patients fail to follow through with a cancellation, not making the surgery aware of their non-attendance, and thus taking up an appointment that could have otherwise been booked by a different patient. And the costs are not small either. With each appointment costing an average of £30, over £216 million pounds are wasted every year. Not to mention, this £216 million pounds lost could pay for the annual salary of 2,325 full time GPs or provide 58,320 hip replacement operations.

It seems now the only method left to address this continual abuse of the system is the introduction of a penalty for habitual offenders who time and time again take our NHS for granted. So while we all clap outside our houses every Thursday at 8pm, do we actually value our Health Service and its workers in times of business as usual?

* Alice Lilley is a 16 year old A Level student, living in London and currently studying English Literature, French and Politics

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21 Comments

  • David Warren 21st May '20 - 6:46pm

    YES, YES, YES

  • Michael Sammon 21st May '20 - 7:08pm

    Yes, this sounds very sensible to me.

  • Ryan Wardeh 21st May '20 - 7:12pm

    I really enjoyed reading the article. However, I actually disagree with penalising people for repeated missed appointments. There is clear evidence that patients who repeatedly miss appointments are more likely to be socially disadvantaged and people “from lower socioeconomic backgrounds are more likely to miss appointments and many of these patients are often under pressure financially or in other parts of their lives, factors that often contribute to their non-attendance” (according to GPC chair Dr Richard Vautrey). There might be something more serious going on with someone’s life if they miss an appointment, so I think that instead of basically adding another tax on the poor with a penalty for missed appointments, we should tackle those socioeconomic factors that lead to the appointment being missed in the first place for many people.

  • Richard Underhill 21st May '20 - 7:53pm

    No.
    This has been checked locally.
    The GP chairing the meeting said that he is not worried about patients missing GP appointments because they know that they need them. Missed appointments are mainly for nurses.

  • Olive George 21st May '20 - 8:36pm

    Alice is my grand-daughter and in lockdown she is applying herself to developing reasoned arguments. I am proud of her clear and concise thrust. Well done Alice. You will go far, I know.

  • John Marriott 21st May '20 - 8:45pm

    Unless they have a valid reason, YES.

  • marcstevens 21st May '20 - 9:18pm

    I would say no at the moment but patients who miss appointments should be warned of the cost to NHS resources and reminded of their responsibilities.

  • No. You have no idea why someone may have missed an appointment but financially punishing someone who is in some sort of crisis is not a price worth paying. Not to mention the obvious problem of fines being issued in error and the bureaucracy associated with enforcement and appeals processes which would likely cost more than any fines collected.

    What has changed that makes this suddenly necessary? Do the public as a collective disrespect healthcare professionals? It doesn’t sound or look like it (literally!).

    With modern technology and management techniques I’d have thought it was never easier to make productive use of professionals’ time accounting for an expected amount of missed appointments.

    Good luck with your A-Levels!

    (If you wanted to go down the route of “make people respect appointments” I think you would introduce an up front fee, but I oppose this because even a small monetary charge has a disproportionate affect on usage and many conditions become more costly and difficult to treat if patients delay seeking diagnosis.)

  • This is a great idea! People should respect our NHS, especially as it is not difficult to phone and cancel an appointment if necessary.

  • John Barrett 21st May '20 - 10:11pm

    Some time ago, I noticed a sign in the waiting room of my local medical centre with the number of missed appointments that month, which was in the hundreds.

    After seeing my own GP, I asked to speak to the practice manager to share my thoughts on a few ways of reducing this number. For instance; my dentist’s practice emails a reminder one week before an appointment and again the day before. My barber sends me a text the day before and said that this has cut the number of missed appointments down to near zero. There were other things we discussed, but he said they would not be introducing any of them, as missed appointments cost the practice very little and the people who would not like them cut down to zero are the doctors.

    If someone does not turn up, this often gives the doctor some more time to spend with other patients, as the time they have allocated is often not enough, or it reduces the waiting time for others, as the doctors often run late as the day goes on. Missed appointments also lets them catch up on the paperwork or have a coffee.

    All things considered, it was not something that the doctors actually wanted to reduce.

    When I mentioned the cost of missed appointments, he said that he did not know how the NHS calculated a figure, but in practical terms there were few, if any, costs related to missed appointments.

    One concern I would have about charging people, is that for those on the breadline, it might discourage them from making an appointment in the first place and for others with mental health issues, it might be the responsibility of someone else to get them there on time, so the charge could fall on the wrong person.

    If we are looking for ways to reduce costs or abuse of the health service, I would suggest that the demand on the NHS could be dramatically reduced if the public started to look after themselves.

    Each year over 80,000 people die from smoking related diseases and that appears to be what the NHS has to deal with regularly every year. The corona virus pandemic is a long way short of reaching this total, yet it has put the NHS under serious strain and the country in lockdown. Other problems like alcohol related health issues could be dramatically reduced, if we all took more care of ourselves. After lockdown it will be time to stop clapping and for many others who ignore their own health risks to stop abusing the NHS.

  • Tony Greaves 21st May '20 - 10:51pm

    No, completely the wrong way to tackle the problem (and the costs of administering such a system, dealing with appeals, enforcing charges etc might well mean there is no saving at all). Trying to do this might well just knock some people off GPs’ lists which can be dangerous for various reasons. I also suggest that the figures for the costs of appointments don’t add up. Is £30 the cost of each missed appointment or the average cost of appointments? Also, I suggest that a typical GP practice knows its normal level of missed appointments and over-books to compensate. Basically I gently suggest that it’s not the Liberal way to tackle the problem.

  • Great article, very informative. It’s not that hard to pick up the phone and cancel an appointment.

  • David Evershed 22nd May '20 - 2:46am

    Having fines for non attendance for doctor appointments was discussed at our GP surgery but it was pointed out that the main offenders were drug adicts or other patients who were disfunctional. So the fines would not be an incentive and would remain unpaid.

    Anyhow, physical attendance in the last few months has now largely been replaced by remote consultations over the internet or by telephone. After being scheduled, such consultations are initiated by the doctor so if no one answers the call the doctor moves on to the next patient with little delay.

    Doctor productivity has thus been improved and patients have a huge saving in travel time and waiting time as well as mostly same day consultations instead of many days delay. A few people are subsequently required to attend the surgery in person.

    So the coronavirus has accelerated the change in GP appointment practice which was happening anyway but much more slowly.

    Just a reminder that GP practices are largely private partnership businesses.

  • Excellent article Alice

    1 in 20 missed appointments just goes to show the system is being abused on an industrial scale, and those that play by the rules are penalised yet again.

    This change is long overdue combined with missed hospital appointments which are much more expensive.

  • NO
    Alice Lilley should learn to research her subject before rushing into print with error, but then she is only sixteen and learning her trade as a Politician. J. Barrett, T. Greaves and D. Evershed have been wiser and spoken to local GP. The GP know how to run their business, usually they just take the next patient in the queue or catch up on something needing done. I know because I have done surgeries.
    What is more worrying is the number of comments in agreement, quickly posted, that were uninformed and ignorant of the facts.
    Covid19 has revealed weaknesses in politics and the NHS which require sorting, hopefully this will be done by a less Class Driven, Money Grubbing Govt. than we have got just now.
    Donald C. FRCP.

  • Alice deserves great credit for marshalling her case….. and, as a Granddad, I can identify with the heart warming pride of Grandma Olive George.

    Unfortunately, both John Barrett and Tony Greaves have spelled out the difficulties and I think they make the more powerful case. Maybe Alice can reflect on this as part of a political learning curve.

    My own dentist and doctor use the text phone reminder system successfully, ensuring that those of us of advanced years do what we should.

  • I have read the comments above this and I do agree that we could try other methods but in the end people are not going to stop abusing the system unless there is a consequence for missing appointments. My friend is a retired GP doctor and she said this was a frequent problem and thinks that if there was a charge less people would do it.

  • Julian Tisi 22nd May '20 - 4:03pm

    “Alice Lilley should learn to research her subject before rushing into print with error, but then she is only sixteen and learning her trade as a Politician”

    Rather patronising IMO. Given that many doctors and others here and elsewhere actually agree with her suggests perhaps she has done her research! Actually I think this is an excellent article. As with others I’m worried about the impact that fines might have on the most vulnerable, but on the other hand we have to reduce the cost of missed appointments some way or other.

  • It may seem attractive but just a few minutes thought about how it would be implemented shows it is a non-starter. We have no mechanism for billing people so you would need a whole department to manage that, you would have to chase people who didn’t pay – that would look great when the debt collectors turn up at the house of an elderly or disabled person, and presumably you would need some kind of appeals process. Also healthcare professionals would probably not co-operate, just as many don’t now when asked to check entitlement to NHS services.

  • Yes! If people can be bothered to book an appointment then they should be bothered to cancel it if they can’t make it. I think the system could definitely be implemented for those that repeatedly miss appointments.

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