Why don’t we just… charge people for missed doctor’s appointments?

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The NHS was seventy years old this month, and despite many knocks, trips and tribulations it’s still standing – that’s some feat. It’s a time for celebration but also a time to see what steps we can take to make it run better.

As a doctor, one of the problems I’m frequently faced with is the irreducibly long waiting list and the rightful ire that this can attract from patients who need to be seen in a timely fashion.

Don’t get me wrong, if you’re suspected of having a serious illness then you will be seen in short order, but it’s all too easy to find yourself waiting months and months to be seen for a problem which, while not life-threatening, can make significant inroads into the quality of your life.

Some have suggested solutions for this. There is the proposal of privatisation – that cure-all paraded by politicos and pundits across the pond (and with a fair few proponents here also) – but let’s not go there, shall we? Some have tried waiting list initiatives and hiring locum staff, but all of this addresses the problem from one direction: what can the hospital do to help the patient?

Let me play devil’s advocate for a moment and progress by paraphrasing my favourite US president: ask not what the NHS can do for you, ask what you can do for the NHS.

We all get sick, and sometimes this means we are too ill to even turn up to clinic. Sometimes a family member gets sick. Stuff happens. On such occasions, one’s memory can suddenly become sieve-like, and the most anally retentive sort can become a flustered mess. And then there are the homeless, the phoneless, those who may not know they had an appointment. This definitely accounts for a number of people who fail to turn up for clinic – but not everyone. The result is that in some places almost a quarter of appointments aren’t attended (with a national average of about 10 per cent missed). That’s a heck of a lot of missed appointments. But if more people informed clinics about being unable to attend (and the NHS is doing things to help make this easier for us all: there are automated text messages and a new appointment app available to all in the near future) this would make a significant dent in waiting lists. It wouldn’t cure the problem, but it would be more than chicken soup for the common cold.

Most people already know that this is a good idea, but perhaps we need to pay more than lip service to it. Perhaps we also need to pay in pounds. Maybe we should take a leaf out of the handbooks of healthcare providers like many dentists and private physiotherapy practices and agree that charging for a failed attendance is an idea worth exploring.

I don’t mean an astronomical fee, but something that will act as a prompt for the future – something that will mean that the next time we receive an appointment we’ll ink it in red, flag it up on Outlook, or stick a post-it note on the fridge. Because if I miss an appointment without good cause, and fail to cancel it, I might have cost you your opportunity to be seen by a doctor in a timely fashion. By cancelling my appointment I’d be helping the NHS, yes, but I’ll also be helping out someone else in need. Someone like you.

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