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National Health Service: Missed Appointments

Volume 795: debated on Wednesday 30 January 2019


Asked by

To ask Her Majesty’s Government what is their latest estimate of the annual cost to the National Health Service of patients missing appointments with their general practitioners.

My Lords, as data on the number of missed appointments in general practice is available for only six months of the period 2017 to November 2018, we are unable to provide a precise estimate of the cost. However, NHS England produced an approximation using the limited data available, which suggested that the cost to the NHS of missed GP appointments was over £216 million a year.

I am grateful to my noble friend. If you add in the number of missed appointments at hospitals as well, the figure from NHS England—not from the Government because they do not have figures—rises to over £1 billion. It is a huge amount of money, yet recently the Government in a Written Answer discussing missed appointments said it did not really matter because,

“staff are able to use time resulting from missed appointments productively … This may include”,


“support to other patients, or spending time on personal development”.

I hope noble Lords will accept that perhaps that is not sufficient. Does she accept that while of course all patients have a right to the National Health Service, they have a responsibility to it too? I ask her to go back to the department and shake a few sticks there, so that it accepts that the department itself and not just NHS England has a responsibility for this problem, institutes some research as to why so many patients miss their appointments, and comes up with policies that will tackle this massive drain on the resources of the National Health Service.

I am always happy to go back and shake the tree to find out the answers. I am a little bit like the Chief Medical Officer and believe that what you can measure you can manage. To that degree, I agree with the noble Lord that we need greater understanding of where patients are missed and exactly how that is managed. I also agree that there are rights but also responsibilities. However, some patients miss appointments for very good reasons, and we have to understand those reasons so that we do not just think it is irresponsible behaviour; I know it is not. I agree with the noble Lord that if somebody misses an appointment the GP could use the time to cover another issue. It is important if patients miss appointments because 70% or more of them will come back.

My Lords, some 15 years ago when I retired from the health service, we accurately costed how much the lost appointments in my out-patient clinic cost. The figure then was over £200 per patient in a clinic that was grossly oversubscribed, so we lost a lot of patients as a result. It is not good enough to say that we have looked at general practitioners. Can the noble Baroness answer the important question put by the noble Lord, Lord Dobbs? It is an effective drain on the health service and results in salaries being paid unnecessarily.

My Lords, I agree that it is a very important issue, and the NHS is looking at it. If you miss an appointment with a consultant or GP, the costs of that service are stated very clearly. We take this issue seriously and are tackling it.

My Lords, this morning I had an appointment at a hospital in Wales, for which I had two reminders on my mobile phone, yet because I live in Wales I do not have access to the NHS app to make appointments with my GP. First, as the app develops, would it not make sense to add reminder functionality to it to remind people of their GP appointments? Secondly, what discussions have taken place with the Government of Wales to allow patients in Wales the same advantage from digital health management as patients in England?

My Lords, of course the NHS is a devolved service, so that is a matter for Wales. It is important to have technology, and in fact some GPs send reminders by text to let people know that they have a forthcoming appointment.

My Lords, building on the last question, can the Minister please update us on the ambitious targets in the 10-year plan for doctors’ appointments by Skype? I believe that these will greatly reduce the number of missed appointments, but investment in infrastructure and skills for GPs and patients alike is vital.

The noble Baroness is absolutely right that we need to ensure that the workforce is skilled enough to utilise this technology. I do not have the exact numbers for Skype consultations, but the Secretary of State is very keen that we use technology for patients who are able and have the competence to use it. However, there are other methods of contacting GPs, so it is not just a case of using that new technology.

My Lords, the Minister says that she is not able to disclose the numbers because they are not monitored, but NHS Digital very helpfully gives the number of mental health service appointments that are unfulfilled, as it calls them, with children and young adults not turning up. In the year to October 2018, there were 600,000 unfulfilled appointments. Given that the Government know the nature of the problem, can they not take steps to resolve it?

The Government are taking steps to try to resolve this situation but, as I said, it is not straightforward. It is not sufficient to look just at the number of missed appointments, because patients miss appointments for a range of reasons, particularly in mental health services, and we need to better understand that information. NHS England is collating that data. It is not at the level at which we would like it to be but we will of course take appropriate actions as we better understand it.

My Lords, does the Minister agree that there are two sides to this Question? Particularly with hospitals, there is also the problem of cancelling operations at short notice. I required surgery for a very inconvenient complaint, my operation was cancelled the day before, and I had to go for private medical treatment—where I was treated by the same surgeon who would have treated me had my operation not been cancelled.

My Lords, it is always regrettable when any patient has an operation cancelled. No hospital or clinical team will do that lightly; they take the whole situation into consideration. I am sorry about the noble Lord’s experience.