PT  - JOURNAL ARTICLE
AU  - Tom Margham
AU  - Crystal Williams
AU  - Jack Steadman
AU  - Sally Hull
TI  - Reducing missed appointments in general practice: evaluation of a quality improvement programme in East London
AID  - 10.3399/bjgp20X713909
DP  - 2021 Jan 01
TA  - British Journal of General Practice
PG  - e31--e38
VI  - 71
IP  - 702
4099  - http://bjgp.org/content/71/702/e31.short
4100  - http://bjgp.org/content/71/702/e31.full
SO  - Br J Gen Pract2021 Jan 01; 71
AB  - Background Missed appointments are common in primary care, contributing to reduced clinical capacity. NHS England has estimated that there are 7.2 million missed general practice appointments annually, at a cost of £216 million. Reducing these numbers is important for an efficient primary care sector.Aim To evaluate the impact of a system-wide quality improvement (QI) programme on the rates of missed GP appointments, and to identify effective practice interventions.Design and setting Practices within a clinical commissioning group (CCG) in East London, with an ethnically diverse and socially deprived population.Method Study practices engaged in a generic QI programme, which included sharing data on appointment systems and Did Not Attend (DNA) rates. Fourteen out of 25 practices implemented DNA reduction projects, supported by practice-based coaching. Appointment data were collected from practice electronic health records. Evaluation included comparisons of DNA rates pre- and post-intervention using interrupted times series analysis.Results In total, 25 out of 32 practices engaged with the programme. The mean DNA rate at baseline was 7% (range 2–12%); 2 years later the generic intervention DNA rates were 5.2%. This equates to a reduction of 4030 missed appointments. The most effective practice intervention was to reduce the forward booking time to 1 day. The practice that made this change reduced its mean DNA rate from 7.8% to 3.9%.Conclusion Forward booking time in days is the best predictor of practice DNA rates. Sharing appointment data produced a significant reduction in missed appointments, and behaviour change interventions with patients had a modest additional impact; in contrast, introducing structural change to the appointment system effectively reduced DNA rates. To reduce non-attendance, it appears that the appointment system needs to change, not the patient.