Fining so-called “no-show” patients is a bad idea

It has been suggested this morning (Telegraph) that NHS “no-show” patients should be charged a fee – basically a fine by another name.

Norman Lamb, a key adviser to Deputy Prime Minister Nick Clegg, told the Sunday Express: “We should consider introducing a charge for missed appointments.

“People have to understand when there is only a limited amount of money available it means cuts on care that could go on other patients.”

I’m surprised this has been suggested and I am most definitely against it, for two reasons.

Firstly is having heard stories about the historical (thankfully!) practice of Charing Cross Gender Identity Clinic to discharge patients who failed to show up for two appointments. However – and this is the reason I’ve said “so-called” no-show patients – stories of appointment letters turning up after the appointment and people being discharged as a result were common. In some cases, letters simply did not turn up at all.

Some bits of the NHS have very good administration but in any organisation of this size, there will be areas where the paperwork is not of the same standard. It is dangerous to make a universal assumption that the NHS is functioning correctly and fine patients, probably already suffering from appointment confusion, if it is not.

Secondly, what should the fine be? £100? That’s an awful lot of money to someone on benefits who really needs the NHS and does not have the mental energy to spare appealing fines if the administration is messed up. It’s not a great deal of money to someone who is earning a decent wage and thus is not so dependent on the NHS. £20? That’s still a big blow to someone on the poverty line but just a meal out for the middle-classes.

What has also been suggested are SMS reminders for those patients who supply a mobile phone number, something that both my hairdresser and my dentist (And I suspect many other similar organisations) use. I would prefer rolling out this more positive, cooperative approach across the NHS first before we even consider the authoritarian penalty approach.


  1. Some parts of the NHS do have a reminder system in place. Leighton Hospital, Crewe, for example has a phone system in place that automaticall calls you and requires you to confirm using your DoB that you are you and will attend. This just requires a touch tone phone so works with both mobiles and landlines. My GP has an SMS system for appointment reminders.

    I do wish it was rolled out throughout the NHS as I think it would reduce the number of wasted appointments. I’m not sure that at CHX GIC it would be anything other than a disaster as the method they use for booking appointments seems to require about 3 separate systems.

    As for a fine, it wouldn’t work for the very reason that those on benefit wouldn’t be able to pay the fine. What would happen then? Would they be excluded from further NHS care until they paid it, or would it be like court fines where it’s docked from benefit at some low rate each week? Unworkable systems are worse than no system at all. Reminders are a much better way of going about things.

  2. My dentist will phone you repeatedly and remind you, but he does cost all the money in the world.

    I thought most bits of the NHS discharged you if you failed to show up – I certainly seem to see that sort of warning a lot.

  3. My doctor in Germany also uses the SMS appointment confirmation and reminder, which is a godsend. It’s completely integrated into their reservations system so once an appointment is made, the SMS notifications are completely automatic.

    These SMSes solve the biggest problem with appointments, namely people simply forgetting, and the notification two days before the appointment gives plenty of time to cancel without causing problems for the practice. It’s simple and it solves the issue of how people different people react to incentives and fines.

    Freakonomics, the book by Steven Levitt and Stephen Dubner, covers the issue of incentives and fines, using the example of an Israeli kindergarten which brought fines in for late pickups. Instead of finding the rate of late pickups drop, they found that people just felt that they were now paying for the right to pick up their child late, so late pickups increased.

    Fines can be a tricky problem and I think that the NHS would find them adding more problems to their list than it removes. Maybe they should read Freakonomics? 🙂

  4. I think fines are only suitable if the clinic has received “positive confirmation” from the patient in the last 7 days. Either a phone call/visit from the patient confirming/making the appointment (asking someone to remember an appointment within a week isn’t too bad), or an automated phone call/SMS which the patient has got to say “Yes” to.

  5. My Canadian doctor has a sign in her office saying there is a $25 charge for missed appointments. I missed one once (my fault: misread the date) but was never asked to pay. I think it’s mostly there to scare people and invoked with discretion.

    My specialists and dentist always give a reminder phone call the day before.

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