GPs have long been counting the cost of missed appointments. No-shows cost Scottish surgeries tens of millions of pounds a year, adding even more pressure to a service that is already suffering an ongoing retention and recruitment crisis amid increasing demands from patients and health boards alike.

The problem, then, is clear: with NHS finances stretched ever more thinly, resources expected to go further and more of us living longer with complex health needs, it simply cannot afford to subsidise missed appointments.

Sadly, workable solutions are more difficult to devise and implement, though new approaches - such as text reminders - are already being used by many surgeries. New research by the University of Glasgow, however, sheds light on the factors associated with the problem and will likely give new impetus to the debate on how best to ensure patients turn up.

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In the largest ever UK survey of missed appointments, researchers anonymously tracked half a million patients in Scotland for three years, discovering a fifth missed more than two appointments, and almost half didn’t turn up for at least one per year. The most common factor in the no-shows – some of whom missed dozens of appointments – was deprivation. The data also revealed that those most likely to miss multiple appointments were young people aged 16 to 30 and those over 90.

But it is surely revealing – though not particularly surprising – that deprivation appears to be the key indicator. Indeed, the research also reveals deprived patients in more affluent areas are also less likely to attend.

As the scientists who carried out the research point out, constantly missing GP slots is associated with the sort of poor health outcomes that still afflicts the West of Scotland particularly badly. And they urge health managers to focus on “positive strategies” to support patient attendance.

Some suggest that automatic same-day appointments for serial non-attendees could help alleviate the problem, though more responsible patients who always make the effort to attend or at least let the surgery know if they cannot, may quite rightly feel aggrieved at such a move.

With this in mind, perhaps it is time for more stick and fewer carrots. Only last year, GPs called for patients who missed appointments to be automatically fined, with charging rates starting at around £5. Critics say such a strategy would only hurt the most vulnerable, and could be difficult and costly to manage.

But surely making clear the real cost of broken appointments, hitting no-shows in the pocket, may at least force them to think about the damage they are causing. It’s not difficult or expensive, after all, to lift the phone. Missed appointment fines are already common, after all, in many other spheres of life. And since we all purport to value the NHS, surely all of us have a responsibility to ensure waste is kept to a minimum, regardless of socio-economic status?