I’m a GP – I’ve missed appointments and we shouldn’t be charging patients for that

NHS figures show 8 million hospital appointments and 1 million GP appointments each year. Announcing Labour’s 10-year health plan this week, Wes Streeting refused to rule out fining patients who miss appointments. Rishi Sunak’s Conservatives previously proposed a patient fine of £10, but the policy was dropped. This year France introduced fines for missed appointments: patients will pay 5 euros for not showing up. Here’s what GP and former president of the Royal College of General Practitioners, Dr Clare Gerada, explains i why it would be a logistical nightmare, and it’s morally questionable.

Confession: I’ve missed NHS appointments in the past, and I’m a doctor myself. I remember one time in particular when I was younger and I was afraid to go there.

He had had a cervical hemorrhage and they had to do further investigation. I walked up to the front door of the GP practice and then I couldn’t get in, I was too scared.

Fortunately, my surgery reached people when I wasn’t there. I thought about it afterwards and reflected on why I had done it; I was afraid

Missed appointments are of course a problem for the NHS, but when we talk about them, we forget the complex and emotionally charged reasons why people miss them. This is not like booking a movie ticket or booking a holiday. We underestimate how scary it can be to go to the doctor to talk about a health problem.

The policy of penalizing people who miss appointments, which kept cropping up under the last government, is nonsense.

Beyond the emotional considerations, there are practical issues. First, how are we going to get people to pay? Would we ask all patients to pay in advance, like they do when they reserve a table at a restaurant, and keep their card? Few patients would be interested in this. What about those without internet banking? What happens if they don’t make this payment? Logistically, it doesn’t work.

Second, it places the burden and blame for the missed appointment on patients, when many of the problems are really in the system. I know patients who have not received their appointment letter until after the date it happened. Thousands of patients are having appointments and even surgeries canceled by the NHS due to strikes, cyber attacks and shortages. There are patients who come to the hospital and there is no one to see them.

Then there are those who wait 18 months for an appointment, and when they do, their circumstances have changed: maybe they’re dead, maybe they’re better, maybe they’ve gone abroad for surgery. A lot can happen in that time. We couldn’t afford to charge patients who miss appointments without first solving our own systems.

It is now almost impossible to contact hospital services to cancel or reschedule, I know from personal experience. If you look at the letters you receive confirming a consultation or treatment, there is usually no phone number, just an email address. And emails go unanswered. If you manage to call and speak to a secretary, you may not know which consultant you are trying to contact.

Text messages to remind patients of an appointment, which also allow cancellation, are a good idea and have reduced no-shows by 35 percent in pilot studies. Wes Streeting knows this: he has previously said a nationwide rollout could save the NHS £300m a year.

Finally, despite what is said about it, I actually see a less pressing need to charge for missed appointments these days, because most people attend, at least when it comes to the GP.

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When I started as a GP in 1991, there was an ADN (no-attend) rate of 25%, so one in four patients didn’t come to their appointments. This was when patients were most likely to book in advance, six to eight weeks. They would come in for a routine blood pressure check and on the way out they would book a repeat visit and not show up.

Things aren’t done that way today. Most patients book on the day of the appointment or the day before, so the likelihood of no-shows is much lower. And if they end up not coming, it’s because something catastrophic has happened, a practical obstacle like a canceled train, or they’re too sick to come.

I think we should be able to have a mix of appointments – on the day and those that need to be booked in advance, if you’re trying to get time off, it has to be scheduled, but generally people do. much closer to the need, so it’s more likely to come anyway.

If Wes Streeting really wants to know why people don’t keep their appointments, he can come and ask GPs, we’ll tell him. We know the problems because we are the ones who have to carry the can when appointments are missed. I think he is a fabulous Secretary of State for Health, he has some really good ideas, but I think this fine should be scrapped as a concept once and for all.