People who miss practice appointments regularly are often highly vulnerable, according to a major analysis published today.

The findings reopened the debate on how to deal with people who fail to turn up for appointments. It has been suggested that fines might deter this.

In the largest survey yet to be undertaken on missed appointments, researchers said they found that patients who struggle to attend appointments have high levels of social and health vulnerability.

The conclusions come after researchers from the universities of Glasgow, Lancaster and Aberdeen tracked the appointment histories of more than 500,000 patients in Scotland between 2013 and 2016, using anonymised NHS data.

They examined the characteristics of patients who regularly do not turn up for appointments with their doctors and found that those most likely to miss multiple appointments are aged 16 to 30 years old or are over 90 years old.

Writing in today’s edition of The Lancet Public Health, the researchers said that nearly 20% of patients missed more than two appointments over three years, while 46% missed one or more appointments per year.

Patients were more likely to miss multiple appointments if they were registered in GP practices which either offered appointments two to three days after booking or were located in affluent urban areas.

Lead author Dr Andrea Williamson, of the University of Glasgow, said: “These first results about the profiles of patients who struggle to attend GP appointments support clinical intelligence that patients who serially miss, have high levels of social and health vulnerability.

“Our work in this study is based on the theory that serial missed appointments are ‘health harming behaviours’ – complex behaviours that have their roots in experienced adversity. From our findings it would suggest that future ways to increase attendance should focus on positive strategies to support patient’s attendance.”

Co-author of the study Dr David Ellis of Lancaster University added: “Although we found that age was a factor, the most important patient-level factor to predict the likelihood of serially missing GP appointments remains high levels of socio-economic deprivation.”

Dr Ross McQueenie, from the University of Glasgow, added: “Our results suggest that socioeconomically deprived patients living in more affluent areas might have particularly high levels of unmet health need in primary care settings.”

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said the findings supported their misgivings about charging patients for missed appointments.

“One of the College’s main objections to charging patients when they miss appointments has always been that this could disproportionally impact on the most vulnerable in society, and this new research backs this up,” she said.

“We understand why GPs and our teams get frustrated when patients don’t turn up to their appointments. It’s wasteful for everyone, but in some cases this can be a warning sign that something significant is wrong with the patient and follow-up action is needed – and it may not always be a physical problem but sometimes a psychological or social issue.”

She said while practices were already using methods to reduce missed appointments, such as text message reminders, the health service needs NHS England’s GP Forward View, which promises £2.4bn extra a year for general practice and 5,000 more GPs, to be delivered in full and as a matter of urgency.

Dr Richard Vautrey, chair of the British Medical Association’s GP committee, said: “It is important that the government and NHS works with GPs to find positive ways to encourage appropriate use of GP services and through education campaigns re-enforces the importance of attending booked appointments, as well as the negative impact missing appointments have on other patients.

“This must be targeted on those groups who are more likely to miss a consultation with their GP.”

Demographic and practice factors predicting repeated non-attendance in primary care: a national retrospective cohort analysis. The Lancet Public Health 5 December 2017.