How much do no-show patients impact you?

A newsGP poll has revealed up to a third of general practices experience more than 5% of patients not showing up to pre-booked appointments.
 
Of the 1122 respondents to the survey, which ran this month and asked how many patients on average fail to attend consultations, 21% said the number of no-shows ranged between one in every 20 to one in every 10 appointments.
 
Around 9% of participants said they experienced up to one in five missed appointments or even higher, while the majority, around two thirds, said it happens for less than 5% of appointments.
 
Dr Mukesh Haikerwal, a practice owner in south-west Melbourne, describes no-shows as ‘not huge … but problematic’.
 
‘If one or two appointments for doctors are missed [each day], that adds up to quite a lot by the end of the week,’ he told newsGP
 
‘That’s why we’re very wary of this as an issue.’
 
Dr Haikerwal does not report any difference in non-attendance rates between bulk billed and private appointments – and believes having a good understanding of those making the bookings is key.
 
‘In many ways, it’s about knowing your patient,’ he said.
 
‘If people haven’t turned up, either the doctors or the practice manager will ring to check in on them to make sure they are okay.
 
‘With a lot of established practices that have been in the area for a while, overall, the numbers [for non-attendance] are low.’
 
‘It’s often people who are new to the practice, and the people [who] are regulars tend to do it less often.’
 
He also believes the online booking technology is acting as a deterrent, with credit card registrations making people more wary about not turning up.
 
While his practice introduced a fee for non-attendance, Dr Haikerwal acknowledges this can be hard to enforce – but says serial offenders will eventually be blocked from booking online and only be able to arrange appointments in person.
 
Dr David Adam, a member of the RACGP Expert Committee – Practice Technology and Management, echoes Dr Haikerwal’s view on established practices.
 
He says that as a GP with a ‘fairly consistent’ patient base, no-shows are rare for him personally, but he is aware of the serious impact non-attendance can have.
 
‘Practice viability at the moment is very difficult,’ he told newsGP.
 
‘When there’s under-utilisation of the service, that really affects the viability of practice, so it’s a real concern for practice owners.’
 
Dr Adam said the SMS reminder systems in place in many clinics have been very effective at reducing no-shows, a tool sometimes used alongside direct contact with patients known to be at high risk of not showing up.
 
As for non-attendance fees, Dr Adam is unconvinced.
 
‘It’s not clear to me that particularly reduces non-attendance rates, but I think every practice would have to make that assessment for themselves,’ he said.
 
For Dr Tim Senior, RACGP Specific Interests Poverty and Health Chair, a key concern is that patients who do not show up are more likely to have serious health issues.
 
‘There is this new concept in some research coming through now, particularly in the UK, around “missingness”, where patients who are missing appointments more frequently are those at higher risk of worse health outcomes,’ he told newsGP.
 
‘They often have more complex health outcomes and higher mortality. It can be a marker of patients who may be at higher risk.
 
‘If they are missing multiple appointments, they need better medical care, and often need more help in getting to appointments. But that’s difficult for practices because there’s very little resourcing available to help do that.’

A long-term GP in Sydney, Dr Senior says no-shows were having a significant effect on wait times and the availability of appointments at his clinic a few years ago, prompting complaints from patients – and mitigating measures to be introduced.
 
‘We send SMS text reminders, and we call the patients several times if necessary before the day to make sure they come, and that’s certainly got our no-show rate down,’ he said.
 
‘It’s particularly important for the specialists who come and visit and have clinics, because those appointments are much, much rarer.
 
‘We’ve got our no-shows down now through that active reminder and management for patients.’
 
Dr Senior also references the importance of patient knowledge.
 
‘I think the better we understand the circumstances of our patients, the more able we are to help them avoid doing this,’ he said.
 
‘There’s usually going to be a reason that patients have for missing appointments, and so if we can understand those and help patients with those, then we’re likely to have fewer.’
 
Dr Haikerwal, meanwhile, says mitigating non-attendance risks is likely to remain a feature of running a general practice.
 
‘This is all part of that practice management and maintaining good relationships and respect,’ he said.
 
‘And I think that with those bona fides established, you still have some people that don’t turn up, but not very often.’
 
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