NHS: Should No-Show Patients Be Punished?

Most family doctors would like to see fines imposed on patients who fail to show up to appointments, a poll has found, although many GPs feared the penalty would probably hit the most vulnerable patients. Health Secretary Jeremy Hunt expressed “in principle” support for such fines two years ago but the idea received a mixed reaction from most doctors and was swiftly slapped down.

The poll by Pulse, the magazine for GPs, found that 51% of family doctors now agree that “patients should be fined for not attending GP appointments.”

Many responded that while they could “see the attraction” of fines they would be a minefield for practices to enforce and would likely punish patients who most need to be seen.

Estimates suggest that missed GP appointments cost the NHS £162m a year while missed hospital appointments cost as much as £750m a year.

With millions of patients having trouble seeing their GPs one GP in North London told the survey team that removing missed appointments would free up an extra week of GP time every month in that GP’s practice.

Just 37% of the 821 GPs who responded to the poll said they would be totally against fines, while 12% were undecided.

The senior GP at a practice in Hertfordshire told Felix Magazine that he was very much in favour of introducing fines but he admitted it was a divisive issue. ” Two other partners are against it because they feel this is not the way to ensure people keep their appointments,” he said.

“They feel we should place the onus on the practice and send out text messages to remind people of when their allotted time is and to ask them to reply by text if they can make it or not. I tell them it is not our job to chase people, it is up to the individual to be there unless there is extenuating circumstances. Fines will help cut down on the numbers of ‘no shows’.”

One suggested to Pulse that a £10 charge might work while a partner in a West Kent practice told the magazine that something had to be done. “We cannot continue to pretend that this is not a problem,” he said.

A GP in north-west Surrey said the challenge was to change the attitudes of patients. “When some services appear ‘free’ some patients do not always appreciate the true costs to provide that service,” he said.

But Dr Russell Brown, a GP partner in East Sussex, insisted that the scheme wouldn’t solve the problems of demand. “I can see the attraction of it. But how would it work?” he asked.

“Do the practices do it? That’s a huge job, and what are we going to do about people who refuse to pay? It’s a minefield and I’m not convinced it would do anything to solve any of the problems general practice is facing.”

He added that the people GPs see missing appointments were often their more vulnerable patients. “It’s certainly more frequent in people who tend to have chaotic lives,“ Brown said. ”Most people turn up but young people miss more appointments, people in poverty, even old folk with dementia.

“It’s exactly the people you’d expect and generally speaking it’s the people who need to access general practice more than other groups.“ Brown said the impact varied drastically from practice to practice depending on how they book appointments and some practices might not even record them.

GP representatives for the British Medical Association (BMA), who negotiate the national contract GPs operate on, said they also opposed the fines. A BMA spokesperson told Pulse fines would not work. “Those who may be most likely to miss appointments, particularly vulnerable patients, may also be the people who would be exempt from fines and fining them is not the way to address some non-attendance issues,” the spokesperson said.

 

by Bob Graham

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