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  • Scotland sets out policy on improving workforce planning for primary care

    Scotland sets out policy on improving workforce planning for primary care

    Wednesday, 09 May 2018 16:12
  • DHSC to address concerns of prescription direction to distance selling pharmacies

    DHSC to address concerns of prescription direction to distance selling pharmacies

    Thursday, 19 April 2018 16:51
  • Study gives pointers on why patients are reluctant to disclose sexual orientation

    Study gives pointers on why patients are reluctant to disclose sexual orientation

    Thursday, 01 February 2018 11:35

a empty waiting room image frustrated patientDecember 7 2017

People of low socioeconomic status, and those aged 16-30 or over 90 are significantly more likely to miss multiple GP appointments, new research has found. In addition, “urban practices in more affluent areas that predominantly offer appointments with a delay of 2–3 days are most likely to have registered patients who miss multiple appointments.” 

The findings come in analysis of 13 million appointments over three years at more than from more than 100 general practices across Scotland. Nearly a fifth of patients failed to attend two or more appointments during the study period.

The study published online by The Lancet Public Health also noted that men missed fewer appointments overall than women. However, when taking into consideration the number of appointments each made, men were more likely to miss an appointment.

The researchers, based at the Universities of Lancaster, Glasgow and Aberdeen, said there were clear differences between patients who miss no appointments, those who miss a few, and those who miss multiple appointments.

Data indicated that “the most important patient-level factor to predict likelihood of serially missing general practice appointments remains high levels of socioeconomic deprivation. “At a practice level, appointment delays of 2–3 days, practices offering a high number of appointments per patient, urban practices, and higher average practice SIMD [Scottish Index of Multiple Deprivation] were all factors driving increased risk of non-attendance.”

The researchers propose that, “for health service-focused activity on tackling health inequalities, future interventions in universal health-care systems need to take patients’ engagement patterns into account. Subsequent interventions are likely to become more successful if they are targeted, instead of adopting a one-size-fits-all approach.

“The practice at which a patient is registered has an important role in generating patterns of missed appointments, and practice policies regarding appointment scheduling might be a useful future intervention target.”

Responding to the findings, Professor Helen Stokes-Lampard, RCGP Chair, said: “One of the College’s main objections to charging patients when they miss appointments has always been that this could disproportionally impact on the most vulnerable in society, and this new research backs this up.

“We understand why GPs and our teams get frustrated when patients don’t turn up to their appointments. It’s wasteful for everyone, but in some cases this can be a warning sign that something significant is wrong with the patient and follow-up action is needed – and it may not always be a physical problem but sometimes a psychological or social issue.

“It is interesting, but perhaps not surprising, that the research found that frequently missing appointments correlates with a delay in them getting an appointment. Whilst practices will always try to offer appointments that are timely and convenient for patients, the current resource and workforce pressures we are facing, with GPs conducting more consultations than ever before to meet increasing demand, is making this more and more difficult.”

Professor Stokes-Lampard said that GP practices are implementing successful schemes to reduce missed appointments, including sending text-message reminders, improving patient education, and displaying awareness posters detailing the unintended consequences of not attending.

Dr Richard Vautrey, BMA GP committee chair, said: “Missed appointments do result in valuable time and resources being wasted, but we do need to understand the reasons why this occurs. As the Lancet Public Health report demonstrates, those from lower socio-economic backgrounds are more likely to miss appointments and many of these patients are often under pressure financially or in other parts of their lives, factors that often contribute to their non-attendance.

“It is important that the government and NHS works with GPs to find positive ways to encourage appropriate use of GP services and through education campaigns re-enforces the importance of attending booked appointments, as well as the negative impact missing appointments have on other patients. This must be targeted on those groups who are more likely to miss a consultation with their GP.”

Links:
DA Ellis et al. ‘Demographic and practice factors predicting repeated non-attendance in primary care: a national retrospective cohort analysis’. The Lancet. December 2017. 2; 12: e551–e559           
RCGP comment                  
BMA comment 

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