Doctors warned to check no-shows

VIEWPOINT By Dr Jacqui Phillips
Legal adviser, Medical Defence Union

Image caption,
Missed appointments cost millions

Missed appointments cost the NHS more than £600m a year - the cost of running two medium sized hospitals. But as well as the cost and inconvenience, some patients are risking their lives by not attending.

In this week's Scrubbing Up, legal adviser Dr Jacqui Phillips of the MDU - which gives legal advice to medics - says doctors should try to chase patients who do not attend, or face complaints.

Ever sat down after a hard day's work to watch EastEnders, only to be struck by a sinking feeling that you've forgotten something important?

You check your diary only to realise that you've completely forgotten a doctor's appointment earlier in the day. Take comfort though from the fact that you're not alone.

Ethical dilemma

Figures show that patients miss around 10m GP and 5m practice nurse appointments each year.

But aside from the financial cost to the NHS and the disruption to surgeries and hospital clinics, missed appointments can also raise an ethical dilemma for doctors.

Who is responsible for your health? Should doctors rely on you to make another appointment? Or do they have a duty to chase you up?

It may seem like a minor issue but there have been cases where missed appointments have led to serious consequences for doctors and patients alike.

In one example a man with bipolar disorder made an emergency appointment with his GP, saying he felt very depressed.

When he failed to attend though, the practice took no action. Sadly, the man was admitted to hospital the next day having taken an overdose.

The family's complaint was upheld by the health service ombudsman on the basis that the practice did not have a policy for dealing with missed appointments.

The ombudsman was also critical that the practice had not made any effort to investigate why the patient had failed to attend, particularly in view of his medical history.

A duty of care

As patients, we are of course responsible for ensuring our own attendance at an appointment, but doctors also have responsibility in certain cases of non-attendance.

In some cases patients' health and social problems can contribute to their failure to attend and sometimes, a patient doesn't fully understand the importance of attending an appointment or how the appointment system works. These patients may need more help.

Image caption,
Patients should keep appointments

In another example a lady developed cervical cancer after failing to attend appointments for smear tests over a nine-year period, despite regular reminders from the practice.

She then sued her GPs alleging that she had not been properly informed about the importance of attending for a repeat smear.

But the practice had kept records of the missed appointments and the advice they had given her over the years and the claim was successfully defended on the basis that doctors did all that was reasonable to persuade her to attend.

Keep in touch

But to try to avoid incidents like these, doctors are advised to ensure patients understand the appointments system, the importance of attending and the consequences of missing an appointment.

They should also have a system for identifying patients who fail to attend appointments and a means of dealing with those that cause concern.

Sometimes anxious patients can be reassured by the opportunity to talk to their doctor about their worries.

With many doctors now using text messages to remind patients of appointments and patients being able to text back if they can't attend, it's tempting to think that missed appointments will become a thing of the past. But with human nature being what it is, doctors may still find themselves chasing up their wayward patients for some time to come.

In the meantime, if you do forget a doctor's appointment, as most of us have done at one time or other, please spare a thought for the practice or hospital, and give them a call.

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