Missed appointments at the GP

[Tamega]

Our gp practice started to warn patients who have missed more than 3 appointments in a year. If they miss another they will be removed and a note added into their medical records.
What do you think about this?

Fantastic idea. There is absolutely NO reason that missing 3 appointments without cancelling is justified. Unless someone is unconscious for the 3 times or taken to hospital, which is highly unlikely to happen THREE times

I will caveat this by saying - If someone has severe learning disabilities/complex needs/dementia, for example then obviously it would be their care worker/family, as the person wouldn’t be making the appointment for themselves in the first place. Still, the next of kin should still be informed that they need to cancel any appointment.

I agree. I live in one of those countries, and there is a message on a computer screen in the surgery pointing out that missed appointments will be charged for.

Typical MN however, people fall over themselves to make excuses for the select few!

Because there is a difference between charging for a missed appointment (presumably there is also a charge for attended appointments?) and delisting a patient from their local GP, making it harder for them to access healthcare at all

Having worked in a country where people were charged for GP appointments , guess what, people would rock up at the A&E department instead or simply not seek help for conditions that would be easily treated until it was much later. I saw conditions there linked to poor access to healthcare that you simply wouldn’t have seen in Britain since pre-antibiotic times.

I used to work as a GP receptionist (never, ever again, brutal!!) and the missed appointments with absolutely no notification from the patients used to drive me mad. It’s crap enough having to tell poorly patients they have to wait x amount of time before there’s a free appointment, then you get these selfish buggers (and it was often the same culprits time and again… who then kicked off if they couldn’t get another appointment just like that a day or two later!) just missing their appointments without so much as an excuse or an apology!
With all that being said, I do think it needs to be as easy as is possible to cancel the appointments for this system to be even remotely fair and there should be a degree of flexibility so GPs can use their discretion if they feel there’s a valid reason or excuse but something should be done, definitely.

Good on the GP. I think it's awful to treat a GP service like that when there is such a shortage.

Are we talking about other countries, where these people may well be unable to access healthcare as it's paid for and they may not have insurance that covers them?
As I said our GP and the ones I have experience of know who has legitimate issues the rest of the population can get on with it and pay whatever.
Unfortunately you seem to think these issues are a very small minority

Yes unfortunately it's very hard to stop someone doing things or to force things on people he does live with his sibling but it's hard he rang me in pain forgetting he could have called to his sibling upstairs for example. Brain injury can be very difficult.

Not everyone with learning difficulties etc lives with someone, they don't necessarily have an advocate. Mental health hits anyone you don't always have someone caring for you . It's possible now to never leave your home getting everything delivered this is why it's important gps know their patients.

Seems fair to me

I would support it as long as:

• cacellibg appointments is easy and doesn't require waiting in massive phone queues
• allowances are made for those who struggle with organisation due to disabilities or health conditions (for example my mum's cancer treatment causes brain fog and although usually very organised, without my dad to help keep the calendar I can see that she could miss an appointment)
• where telephone appointments are made, there are allowances for when the window is several hours so someone could miss the appointment by nipping to the loo or whatever, or the dr calling well outside the appointment time
• the NHS's own crap admin. Appointment letter arriving after the appointment they notify us not unusual.

Seems fair enough. Obviously there are occasions when you genuinely can't make it and can't phone in time, but you're going to be pretty unlucky if that happens and I'm sure if you contact surgery to explain it was due to an unexpected emergency most will understand if you contacted them later in the day.

That’s completely fair! I accidentally missed an appointment recently (for the very first time) and I felt so guilty about it

I have also worked in multiple countries where GP appointments are charged for and I’m not suggesting it should be the case here for exactly the same reason.

I was responding to the few who believe that the whole population should be able to keep missing appointments because a select few have disabilities or conditions that may prevent them from attending. In countries where healthcare is paid for, almost everyone attends medical appointments or cancels. They don’t just fail to turn up

No I’m referring to countries where GP appointments are mostly subsidised but a small fee is payable for the appointment. If a patient does not attend without a valid reason, they pay the full fee (without subsidy). Exemptions are made for those who have genuine difficulties.

The level of non-attendance is sky high here because there is no respect for the medical profession or their time

GP practices in UK are actually not allowed to do this (they’re probably just hoping the threat will work). It is your right to be registered at a GP practice and they would have to provide evidence of violent, abusive or criminal behaviour towards the practice before they can remove you from their list. You must be provided with an alternative service eg another local practice or a special primary care service for people who have been removed from their practice because of violent or other unacceptable behaviour. Just missing appointments doesn’t qualify as unacceptable behaviour.

Similarly, GP practices are rarely allowed to be “full” - if you live in the catchment area for the practice, they must accept you onto their list. If there are exceptional circumstances (eg all the GPs bar one retire and there are no locums available) the list can be closed to new patients but normally only temporarily. This is one reason why practices are struggling to meet demand - they have no control over it. A new housing development can overwhelm a small practice if it’s not been properly planned.

The level of non-attendance is sky high here because there is no respect for the medical profession or their time

The above comment sums up the whole issue really!

The level of non-attendance is sky high here because there is no respect for the medical profession or their time.

The above comment sums up the entire issue really!

As long as it's not due to them being unable to attend as unwell/un hospital etc I think it's fair.

Well firstly, I didn’t say “Learning Difficulties”, a term used to describe specific difficulties, such as Dyslexia, Dyscalculia etc…and doesn’t affect IQ.

That’s why I specifically used the term “Learning disabilities”, whereby IQ is affected so they aren’t able to make informed decisions if it’s severe or even moderate/mild in some situations.

The above is nothing to do with Mental Health.

I understand what you mean when you’ve made the comparison, but this is something close to my heart and whenever I hear or see someone using the terms interchangeably and in the wrong context, I use the opportunity to explain the difference.

To answer your point, if someone can’t leave the house that day, that’s fine just cancel the appointment. Don’t do nothing. And certainly not on 3 separate occasions

Long slots would be stopped in general if I ran the country. In fact doctors would be well down the list of who would be first to end them. It is saying that your time is less or not important.

And what does he do when he hasn't been able to speak on a phone for several years as he clams up ....assuming he's remembered to check if he has anything he needs to do today? He's ND with mental health issues as is common. He's also grieving
What does the other one I care for remotely do when he can't tell you the day, time or if he can take more pain meds because he can't remember to set a reminder of when he can take them...if he's remembered to charge his phone. What should my sister have done if it were a day where she couldn't have even rolled over in bed and was waiting for her ND son to remember to check on her?
Your life seems simple some of us have multiple worries.

This very specific case in your family does not apply to over 95% of people who are cancelling appointments. You are distracting from the actual problem and it is just not sustainable for people to keep failing to attend appointments. Those who are really in need miss out because of the selfish ones who book and dont show

Are there stats about the percentage of appointments that are DNAs for selfish twat reasons?

As long as there’s a realistic way to cancel, absolutely.

I’d be raging if our practise implemented this. They’ve currently got a system where they send out appointments via post for somethings, and then it’s serious luck of the draw and persistence to get through on phone to rearrange or cancel. (Like an hour of hitting redial to get into the queue for speaking to someone). With that system, consequences for not attending would be unreasonable.

If it’s straightforward to rearrange / cancel then absolutely.