Non-attenders are less likely to own a car or a telephone and are more likely to be unemployed. Patients with lower paid jobs may have difficulty in getting time off work or arranging childcare. These reasons also partly explain the peak age range of 20-30 in non-attenders, as this is the usual age for raising a family, explain the authors.
The strategy of overbooking appointments to allow for anticipated non-attendance may be counterproductive, say the authors. Not only does 100% attendance put pressure on both patients and staff, but overbooking means that the appointment time is rarely met, so patients have to clear their commitments for the whole morning or afternoon. For some people this is impossible, and for others the difficulty may be enough to tip the balance towards not attending.
Several hospitals have instituted systems offering patients a choice of time and date, which have resulted in reductions in non-attendance of up to 60%, say the authors. However, increasing flexibility and therefore the complexity of appointment systems carries a risk. For instance, patients who cannot read English, because of learning difficulties or cultural background, may be disadvantaged with newer systems.
No single solution will work across the NHS, say the authors. Local trusts in primary and secondary care should be able to devise local systems to allow convenient access for their patients. “If some of these measures are adopted non-attendance should fall, though it will never disappear – we are all human,” they conclude.
Editorial: Non-attendance at general practices and outpatient clinics BMJ Volume 323, pp 1081-2