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Sunday 18 August 2019
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Sponsored feature: Managing medico-legal risks with missed appointments

Dr Kathryn Leask, medico-legal adviser at the Medical Defence Union, explains what practices should when patients fail to turn up for appointments

Dr Kathryn Leask, medico-legal adviser at the Medical Defence Union, explains what practices should when patients fail to turn up for appointments 
 
According to NHS England more than 15 million general practice appointments are wasted each year due to patients failing to attend, or not letting the practice know soon enough that they won’t be attending – preventing the appointment from being offered to someone else. This equates to one in twenty appointments and is costing the NHS millions of pounds.
 
Practices can take steps to try to minimise this by, for example, sending text reminders to patients – with their permission – when their appointment is made and also a further reminder as the date approaches.
 
Reminders encouraging patients to cancel appointments well in advance can also be placed in the waiting room or on the practice website.
 
As well as the disruption and inconvenience of missed appointments for staff and other patients, there are also medico-legal consequences to consider for the patients who fail to attend.
 
It is important to consider why a particular patient may not have attended their appointment and whether there are any health or social problems that could have contributed to this.
 
Has the patient not fully understood the need to attend their appointment or failed to navigate the appointment system correctly, for example.
 
While a competent adult patient is clearly responsible for ensuring their own attendance, there may be vulnerable patients for whom the situation is different – and a practice will need to show what steps they have taken to investigate why a patient has not attended.
 
Missed emergency appointments
 
Where a patient who is known to be acutely unwell fails to attend an emergency appointment, the practice should be able to demonstrate that reasonable steps were taken to investigate why the patient did not attend and that necessary care was provided.
 
Practice policy should be followed and action taken should be carefully documented.
 
Screening appointments
 
Practices need a clear protocol on what action to take where a patient fails to attend for a routine screening, for example, as part of the NHS cervical screening programme.
 
Clearly, patients can choose whether to take up the offer of screening, assuming they are competent to make decisions for themselves. However, doctors need to ensure that patients have been given adequate information to enable them to make an informed decision.
 
Again, the practice needs to document all steps that have been taken to inform the patient of the importance of attending screening appointments. This may be especially important if a patient is at a particularly high risk of being affected by the condition being screened for.
 
Chronic disease reviews
 
Chronic disease reviews can cause particular problems for doctors where the patient does not attend for monitoring but still requests repeat prescriptions. Consider why that patient may not be attending.
 
Do they have mobility problems or difficulty in getting to the practice? Are they vulnerable in another way?
 
While it’s important to respect a competent patient’s decision to refuse an investigation or treatment, it is also vital that patients fully understand the risks they may be exposing themselves to by not engaging with the necessary monitoring of their condition. This discussion should be carefully documented.
 
If a patient refuses to attend for monitoring of their chronic disease, the GP will have to consider whether to issue a prescription given the potential risks associated with a failure to monitor the patient’s condition against the patient’s need to receive medication.
 
Hospital appointments
 
Where a patient misses a hospital appointment following a GP referral, the hospital may discharge them and no new appointments will be made without further contact from the GP.
 
It may fall to a patient’s GP to follow up with a patient who misses an appointment, and their individual circumstances will need to be taken into account. Practices should have a system in place for dealing with failed hospital attendances to ensure patient safety and care is not compromised.
 
If a patient comes to harm or might have been harmed as a result of missing an appointment, this should be investigated so that any mistakes or near misses can be analysed and lessons learned from them.