One of the perennial scapegoats of the NHS is the patient who doesn’t turn up for their GP appointment. The headlines write themselves: millions of pounds wasted and other patients can’t get seen. But while missed GP visits have become a symbol of inefficiency, a far bigger – and often overlooked – problem lies within our hospitals.
Every day, there are more than 300,000 outpatient appointments at hospitals, from MRI and breast scans to plaster casts and blood tests. And every day, 20,000 patients don’t turn up.
On the surface the data looks like a success story for the NHS, with the percentage of appointments that patients miss gently falling over the last decade.
Unfortunately, like most of our health service, the figures are running to stand still and not even achieving that. Although the percentage missed has fallen, the number of appointments overall has ballooned by 20 per cent. What was fewer than 7 million missed appointments in 2010 has grown to more than 8 million in the last year.
The cost is ballooning too. Hospital appointments are far more expensive than GP visits: the NHS says the cost is £160 per missed slot. That number has been used since 2016 so it’s likely to be even higher now. Even using the £160 figure puts the total annual cost of missed appointments at a staggering £1.25 billion.
Within these national figures is a wide divergence between trusts. In the most recent data, both the Bedfordshire and Doncaster trusts had missed appointment rates of around 10 per cent. By contrast, the Cambridge and York trusts had rates under 4 per cent. Every trust faces unique challenges, but the differences are stark and suggest that some have found better ways to manage the problem than others.
There’s also considerable variation in attendance by age. Around 10 per cent of working-age adults fail to turn up, as do children, likely because their parents – also working-age adults – are responsible for taking them. Attendance improves significantly over the age of 50, which may be down to more settled lives and fewer commitments – or them just taking their health more seriously. Younger people may be more affected by transient addresses or a lack of engagement with the traditional NHS letter.
To be fair to the NHS, it’s a problem they’re well aware of. One major cause of patients failing to attend appointments is simple forgetfulness. Over the years, various text reminders and prompts have been used – you’ve probably seen a few, and these have shown real success in improving attendance rates. Gently guilting people with reminders about the cost of missed appointments has also proven effective.
But there’s a bigger issue: NHS bureaucracy. Surveys show that up to half of people who have missed their appointments blame problems with appointment letters – either they never turned up or arrived after the appointed day. Others needed to change their appointment – it clashed with a holiday, wedding, or even a haircut – but struggled to get through to someone to change it.
Although the NHS is famously slow at adopting technology – it is still phasing out fax machines, after all – this seems like it could be an easy win. Banks have been sending letters via a secure portal for a couple of decades, tracking whether we’ve opened them, and saving a fortune in postage. Why can’t hospitals? Similarly, we’re all used to booking restaurant tables or concert tickets online. Why should scheduling an MRI be any different?
The variation between trusts shows that some are already embracing these solutions, but the NHS needs to go further. Tackling missed appointments is about more than just reminders – it’s about transforming the patient experience. A more modern system, where communication is seamless and rescheduling is easy, would do more than save money. It would mean patients got the tests and treatment they need on time, as well as freeing up time for many more, and – just maybe – allow the NHS to start to make a dent in those waiting lists.
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