Non-attendance in primary care: the views of patients and practices on its causes, impact and solutions

More than 12 million appointments in primary care are not attended each year: this is about 6.5% of the appointments made. Missing appointments is widely perceived as a waste of resources and a potential barrier to the achievement of the 48-hour access target.

To explore and compare the views of primary care team members and patients in relation to the causes, impacts and potential solutions to the issue of non-attendance.

A qualitative study using semi-structured interviews with a purposive sample of 24 patients over the age of 18 years, 7 GPs, a GP Registrar, a Nurse Practitioner and 5 receptionists carried out in one health centre in urban South Essex with additional interviews in a practice in rural Essex and a practice in inner city London.

The major themes were: competing priorities for patients; the efficiency of appointment booking systems; the significance of relationships on non-attendance; differing attitudes towards non-attendance between different groups; and interventions. Poor patient-staff relationships was given as a reason for non-attendance, while missing appointments was seen as making relationships worse. Inefficiencies in the appointment booking systems were perceived as key in this 'relationship' context.

Some non-attendance is inevitable with pre-booked appointments, as GP appointments must compete with patients' other priorities and the complexities of their day. Utilising modern communication technologies, such as SMS text messaging, may make cancellation simpler. A structured approach to matching supply and demand of appointments might reduce problems arising from non-attendance.