Patients who miss multiple GP appointments are being wrongly portrayed as "irresponsible" and fining them for no-shows would only make the situation worse, a researcher has warned.

Dr Calum Lindsay, one of the researchers involved in a major study at Glasgow University investigating the causes and possible remedies for missed appointments, said the shift towards more telephone triage and phone and video consultations was also likely to be aggravating the problem.

Missed GP appointments cost surgeries in Scotland tens of millions of pounds a year, with some practices implementing initiatives such as sending text reminders to patients' phones.


The idea that patients should be fined for no-shows in the NHS has been repeatedly raised, including by Prime Minister Rishi Sunak who previously suggested £10 penalties.

However, the Glasgow University study - published in the journal, BMC Medicine - found that a wide range of obstacles are preventing people from engaging with healthcare, and urges a shift away from the view that it is primarily caused by forgetfulness or irresponsible patient behaviour.

They found that the patients most likely to miss appointments tended to experience anxiety, worry, shame or embarrassment about their health, and may not feel their problems could be solved.

Negative prior experiences of seeking care, including poor communication, were also a factor along with higher levels of mistrust in healthcare providers - sometimes linked to wider experiences of trauma, stigma, or discrimination.

They also highlighted issues some patients had navigating healthcare systems, including feeling deterred by "gatekeeping" reception staff, long delays, administrative errors, and a lack of flexibility in appointment scheduling, which was particularly difficult for people with lots of other appointments or caring responsibilities.

Travel costs, inadequate public transport, poor mental health, and poor mobility also impacted on patients' attendance.

The findings build on previous work which tracked half a million patients in Scotland over three years, discovering that one in five missed more than two appointments.

In-person appointments were seen as important for building good trust and communication between patients and doctorsIn-person appointments were seen as important for building good trust and communication between patients and doctors (Image: PA)

The most common factor behind the no-shows – some of whom missed dozens of appointments – was deprivation.

Non-attendance was most frequent for the 16-30 and over 90 age groups.

Dr Lindsay, a research associate for general practice and primary care, said: "The folk who tend to miss the greatest number of appointments are the folk who are in the greatest deprivation, who have the largest number of long-term mental and physical health conditions, and are often living in particularly difficult circumstances.

"That combination often means that the people with the greatest need are the folk who are finding it hardest to navigate the system and engage with the system as it's currently operating.

"Fining gets talked about a lot, but that wouldn't engage with any of the causes.

"A fine is a punishment, and a punishment is for misbehaviour or being kind of irresponsible or deviant.

"What our research shows is that there is an awful lot more to it than that.

"If you fine people, you may just alienate them further from the health system.

"It's also likely to be targeting people who don't have the money and the means to pay a fine, and you might just make the situation worse and exclude these people further who need access the most."

The research is ongoing to develop a range of recommendations for practices and policymakers on how missed appointments can best be tackled.

Dr Lindsay said the team expects to have "something pretty concrete" before the end of the year.

Telephone triage by GP receptionists has become more detailedTelephone triage by GP receptionists has become more detailed (Image: Getty)

He added that there is also evidence that non-attendance is becoming a bigger issue. 

He said: "There is definitely evidence that things like the cost of living crisis are having an impact, for example on the affordability of travel.

"So people are prioritising limited financial means for other things like food and energy.

"But there's also the re-organisation of some aspects of primary care.

"Certainly what some of the evidence tells us is that technological access - tech literacy, phone credit, and things like that - can be difficult for people in phoning for appointments, but also engaging with telephone triage and remote care.

"And we've found that relationships, communication, and mistrust is such a big part of the picture, that if the health service does move away from elements of that kind of in-person approach that can make the problem worse.

"On top of that, there are a lot of things to do with continuity of care that are harder to sustain when there is a workforce crisis going on and difficulties for GPs offering any appointments at all let alone same-day appointments with the same GP all the time.

"When you combine all those things, you have an environment that contributes to multiple missed appointments being more likely."