Who should invest in reducing missed appointments?

This is a guest post on our Blog from Elizabeth, a Sheffield based public health director turned Entrepreneur (@startupliz)

“GPs don’t have any money to invest in technology”, my contact at the Local Medical Council stated firmly. This gave me a familiar pang of frustration that I remembered from my days of commissioning services from primary care providers. I was having a conversation about ways to reduce the burden of missed appointments. The reason missed appointments are called one of the “wicked issues” was becoming more apparent as we talked.

GP practices get paid per head of registered population. They also get paid for various specific health promoting activities such as asking patients if they smoke or supporting them to manage their diabetes. These payments are part of the Quality Outcomes Framework (QOF).

They do not get paid per appointment- that is, for actually seeing a patient. If a patient who has made an appointment doesn’t turn up, it’s no financial loss in that sense for the practice. The practice does, however, miss out on QOF points (points mean payments) that they could have made during that visit.

That missed appointment also means that regardless of what the patient may have been coming in for - ingrown toenail, sore throat - they will have missed out on the chance to have a beneficial health intervention with the GP. They could have been asked about their smoking habit or their weight, for instance. This is part of the purpose behind QOF points and payments.

Of course, GPs work very long and over-scheduled days. Missed appointments create space in those days. The practice is paid to have that patient registered, not to see them in the surgery. When you are facing a non-stop marathon of a day, missing out on a few QOF opportunities may not seem such a bad tradeoff, especially if you have already hit your threshold to qualify for the points.

This creates a very complex task of balancing resources and benefits in an overburdened system. The problem of reducing missed appointments in primary care is not nearly as straightforward as it first appears.

Perhaps this means that the “wicked issue” of reducing missed appointments in primary care requires a different approach than asking GPs themselves to invest in technology that makes it easier for patients to get and manage their appointments. Maybe there needs to be a call to action by the NHS, or by patient groups and advocates, that insist on the investment in simple technology such as DrDoctor provides so that NHS resources are maximised and patients get a good, modern service for their taxpayer pound. DrDoctor showed an immediate reduction in missed appointments by 30% in one hospital trust following the introduction of their appointment management system. This was estimated to save that hospital £800,000 in one year. How can primary care NOT afford to invest in this technology? It’s good for the NHS, and it’s good for patients.