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Sunday 25 August 2019
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Ask an expert: What can I do about patients who are always late for appointments?

Deputy editor Angela Sharda asks our panel of experts how practices can prevent patients who are frequently late from disrupting the appointments system.
 
Tracy Dell, practice manager, Plane Trees Group Practice
 
Practices usually allow up to ten minutes after the allotted appointment time for a patient to be seen but this depends on the circumstances and needs to be individually assessed.
 
Has the patient called ahead to explain that there are exceptional circumstances? Is it a poorly child or vulnerable patient? Is there a gap in the appointment schedule that the patient can be moved to?
 
Appointment systems usually convert slots to a DNA (did not attend) status after 10 minutes have elapsed. Practices should have a protocol or policy for dealing with DNAs, including patients who arrive late.
 
If a patient is persistently late for appointments this should be picked up by the practice as soon as possible. Steps can then be taken to work with the patient and establish a reason behind it.
 
Practices should try talking to the patient to highlight the issue and explain the impact it has on the practice and other patients.
 
It is important to find out if there are any personal circumstances that should be taken into consideration, such as memory loss, transport difficulties and carer or dependent responsibilities.
 
It may be as simple as making sure future appointment bookings are made for a certain time of the day or that a text reminder is sent to the patient.
 
Daniel Vincent, managing partner, Ryalls Park Medical Centre, Yeovil
 
In these circumstances I would always try to talk to the patient first, explain that we have noticed that they are frequently late and that the team is worried. 
 
Their response would very much dictate the next step. Often patients have very good reasons for their lateness.
 
I would then take the opportunity to discuss why we run a timed appointment system and the disruption that is caused by lateness.
 
If the lateness continues, the team would consider issuing a warning to the patient with the opportunity to request an eight-day removal from the practice list if the situation does not improve.
 
 
Steve Williams, co-chair of the Practice Management Network
 
Generally patients are seen on the basis of need, so wherever possible, they will be seen even if they are late for an appointment. This will normally be assessed on urgency which will determine whether the patient is seen sooner, or at the end of the surgery. 
 
In the case of a repeat offender, it would be useful to have a discussion with them and explain how the above procedure works (or how you operate in your practice).
 
Use of technology can help, such as sending text messages to remind patients of their appointment or in future, the use of the NHS App.
 
If all else fails, you could also get your PPG involved as part of the education process.
 
Kay Keane, practice business manager, Stockport
 
My first option would always be to talk to the patient and help them understand the impact of their lateness on other patients.
 
Our policy is that if a patient is up to ten minutes late then the doctor will see them and after that it’s at the GP’s discretion.
 
Of course if it was someone who was very poorly or a child who needed to be seen, then we would slot them into the clinic.
 
As with everything in general practice, it's important to understand the whole story. If it’s a regular occurrence then they might be more suited to a practice that has walk-in appointments rather than an appointment system.