Practice management

Reducing missed appointments

• A systematic review explored the rate of missed primary care appointments, reported reasons for appointments being missed and the patients more likely to not attend appointments.

  
  

• Patients were more likely to miss an appointment on a Monday. Some forgot, others couldn’t get time off work or find childcare. Those with a mental health diagnosis, multiple health conditions, in ethnic minority groups and those attending practices in areas of high deprivation were more likely to miss appointments.

o WiseGP actions:

• Is your system for cancelling appointments straightforward and accessible online?

  
  

• Could a member of your team audit appointment non-attendance, so interventions could be targeted to those most likely to miss appointments within your practice population? For instance, a reminder phone call to those without a mobile phone, or provision of appointments at certain times for those who need a carer or relative to accompany them or would benefit from avoiding a busy waiting room.

  
  

• As people are more likely to miss appointments on a Monday, could pre-bookable non-urgent appointments be scheduled on other days?

  
  

• Do you make use of appointment reminder texts and offer a switch to a remote consultation to patients who have transport difficulties?

Read more about the research informing these recommendations here:

bjgp.org

Background Missed GP appointments have considerable time and cost implications for healthcare services. Aim This systematic review aims to explore the rate of missed primary care appointments, what the reported reasons are for appointments being missed, and which patients are more likely to miss appointments. Design and setting This study reports the findings of a systematic review. The included studies report the rate or reasons of missed appointments in a primary care setting. Method Databases were searched using a pre-defined search strategy. Eligible studies were selected for inclusion based on detailed inclusion criteria through title, abstract, and full text screening. Quality was assessed on all included studies, and findings were synthesised to answer the research questions. Results A total of 26 studies met the inclusion criteria for the review. Of these, 19 reported a rate of missed appointments. The mean rate of missed appointments was 15.2%, with a median of 12.9%. Twelve studies reported a reason that appointments were missed, with work or family/childcare commitments, forgetting the appointment, and transportation difficulties most commonly reported. In all, 20 studies reported characteristics of people likely to miss appointments. Patients who were likely to miss appointments were those from minority ethnicity, low sociodemographic status, and younger patients ( < 21 years). Conclusion Findings from this review have potential implications for targeted interventions to address missed appointments in primary care. This is the first step for clinicians to be able to target interventions to reduce the rate of missed appointments.

Implementing group consultations

• Group consultations offer an alternative to one-to-one consultations for long-term conditions, providing clinical management advice, patient education and peer support. Clinicians enjoy facilitating these consultations, though significant work is required to initiate and sustain the approach and some patients may not be comfortable discussing concerns within a group.

WiseGP actions:

1. Explore at a practice meeting whether any team members have ideas for consultations that could be delivered at a group level. Would a PCN physiotherapist/occupational therapist group consultation be valuable to deliver falls prevention advice to elderly people scoring high for frailty within your practice?

Read more about the research informing these recommendations here: https://bjgp.org/content/72/720/e483

https://bjgp.org/content/71/707/e413

Identifying vulnerable patients who miss DNA appointments

• Patients who miss more than 2 GP appointments a year are more likely to be vulnerable and have poorer health outcomes. Patients with more long-term conditions are at greater risk of missing multiple appointments, which is a strong risk factor for increased mortality. Repeated DNA’s should consequently be considered as part of the patient safety agenda.

WiseGP actions:

1. Consider having a proactive practice police for repeated DNAs. Ensure DNAs are coded and consider auditing DNAs and practice follow-up of patients with high DNA rates.

Read more about the research informing these recommendations here:

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1234-0

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30217-7/fulltext