Earlier this week the results of a survey were published suggesting that 70% of patients would be willing to pay a charge of £10 for missing a GP appointment.
The relatively small poll of 507 UK patients by Astellas Pharma highlights the fact that no-shows are clearly an issue for GP practices – the health service says 12 million slots are missed every year, costing £160 million. So is charging really the answer? And if so, is £10 the correct fee?
Hard to administer
RCGP chair Dr Maureen Baker responded to the survey results by arguing that charging for missed appointments would “be hard to administer for very little return and would add an extra layer of bureaucracy for GPs and their teams, who are already struggling with heavy workloads in order to meet rising patient demand”.
She added: “Charging for appointments – missed or otherwise – would fundamentally change one of the founding principles of the NHS, that access is free at the point of need. When patients don’t turn up for appointments, it can be frustrating – for both GPs and for patients who could have had the appointment otherwise – but charging a penalty for this is not the answer.”
Mixed views
Practice managers that we’ve spoken to seem to be divided over the potential success of charging for DNAs.
One told Practice Index: “My concerns surround the reputational damage to my practice. In the day and age of ratings and open feedback I hate to think what would happen if we started to charge for DNAs. I don’t want to risk that so any charging has to be nationwide and apply across all practices. Communication has to be incredibly efficient too, which I doubt we can expect from the current administration.”
Other negative views revolved around the cost of administration, a potential increase in no-shows as people see paying a fee as making them entitled to miss out and the fact that it could penalise people with genuine issues. In fact, when this issue came up last year during BBC’s Question Time, the Conservative chairwoman of the Health Select Committee, Dr Sarah Wollaston, attacked the proposal on Twitter by saying charging for missed appointments “would risk penalising those too unwell to attend, such as those with severe depression”.
In favour
One PM who is in favour told us that they, together with a group of fellow PMs, had discussed the issue and decided they were in favour. They had also come up with the suggestion of automatic billing for no-shows by registering credit cards or direct debit instructions for all patients so that if they didn’t show up they would automatically be billed.
“We could even set up automatic emailing of letters or printing of postal letters, which is simple enough technology these days,” one PM added. How this would go down with patients, who knows?
The fee
Another hotly debated topic is how much to charge for DNAs. Some argue that £10 is an insufficient deterrent while others say it would be too much for the more vulnerable members of society such as the unemployed or disabled, who happen to be harder to engage with in the first place.
Some PMs argue that a figure closer to £30 would be better as it would cover admin costs more accurately and encourage people to turn up or, in some cases at least, not book an appointment in the first place (which could, of course, lead to other problems and deter the truly needy).
The bigger picture
While the debate about charging for DNAs will rumble on, it only scratches the surface of what is a much bigger issue – excessive workload. How we fix that is a discussion for another day.
Other findings
Interestingly, the Astellas poll mentioned above also found that only one in four patients thinks that UK governments are spending enough on health and that 39% would be willing to pay an additional charge for quicker access to healthcare in general. Meanwhile, half of patients polled said they would be willing to accept an appointment by webcam if it made it easier to get an appointment.
We would love to hear your views on this topic. Would you like to charge for no-shows or do you think it’s a bad idea? How much should the penalty be? How would you administer it? Let us know by commenting below or or in the Practice Index Forum here.
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February 12, 2016 at 9:01 am
I work in one of most socio economically deprived practices in the country, our patients just do not have debit or credit cards. Having said all of which if you can pick up a phone to make an appt you could (usually) pick up a phone to cancel. Our PRG support the idea of charges for those who waste appts I get abuse when I write to patients warning them re their DNA rate, I always offer them the opportunity to explain to the PRG why they think they have a right to stop others seeing a Dr/nurse. No one ever turns up. Interestingly they always have enough credit to on their phones to ring and be aggressive to me though they do not have enough credit to cancel an appt. DNAs are stopping others from getting appts. So many have this over riding sense of entitlement its free so I will abuse it. I am involved in trying to get an education project off the ground to go into schools and try to educate kids about the NHS- fire and police services go in already. A work in progress.
February 12, 2016 at 11:44 am
This debate has long been discussed in the NHS. I do not believe it is the answer to charge ‘no shows’. The people that do no show often do not have regard for systems and procedure so are unlikely to change behaviour in case of a £10 charge.
I have always said it is often the system that needs addressing and looking at why people no show. It is usually because they booked their appointment just in case, and since have got better or simply forgot to cancel. There is a direct correlation in the farther people book ahead the higher percentage there is that a person is likely to no show. But this shouldn’t be an excuse for practices to embargo patients booking ahead especially if they cannot access a GP on the day they need to. Booking ahead in this case becomes a necessity for patients to access the system.
We need to address in house GP appointment systems and patient education. We have seen working with GP practices DNA rates of 10-20% per week reduce to less than 1% per week with a change of system and behaviour.
I would say that any scheme to charge patients would probably cost more than £10 per pt to administer, so that cost would probably be a non starter in any serious discussion.
February 12, 2016 at 1:13 pm
I’m not sure that it should happen, as it couldn’t be administered fairly and would only serve to create barriers to Primary Care. The fact that Primary Care is a “catch-all” and “see-all” service should be revelled in, whilst also being respected in equal measure.
However, if it were to happen, it would need to be done as part of a whole-system change. To charge for DNAs in Primary Care is simply to further incentivise inappropriate service use.
What is more pivotal to changing public treatment of a system is to understand the behaviour and thought processes behind that treatment, and work to rectify those attitudes. After all, aren’t we in the business of treating both the symptoms and the cause?
February 12, 2016 at 10:59 pm
I often have wondered why the NHS Regulations provided for dentists to charge patients for failed appointments yet GPs cannot charge. Perhaps the mere threat of a charge might tempt patients to attend their appointments. Anyway I have quite understood the time wasted argument. Most GPs are happy for a breather or to catch up on paperwork if a patient does not turn up. The only real grumble is if DNAs are at the end of the day and home beckons.
February 16, 2016 at 5:51 pm
I don’t think we should purely on the pragmatic basis that this could become like Capital Gains Tax and cost more to administer than it raises. The majority of people attending the majority of GP surgeries are entitled to free prescriptions. I am assuming that there would be similar exemptions for these charges. The pressure of work at my surgery is such that DNAs allow time to catch up.
February 16, 2016 at 8:18 pm
What is a DNA? Is it the patient who turns up 15 minutes late because they got stuck in traffic and the GP refuses to see? Is it the patient who turns up at the wrong time or date as a result of the practice’s mistake. As well as those too unwell there are many more similar reasons that have all been experienced.
Why would a patient pay? What penalty if they don’t? Where is the goodwill in fining patients? Personally, I’m more interested in growing my list and offering a great patient experience. I’ve never known this to be an effective strategy and would rather concentrate on positive messages rather than negative ones.
Now, charging patients for attending, that’s an altogether far more interesting proposition!