[dev_north_east]

First off, apologies. I mean more of a rigid, defensiveness in general among British people? Do you know what I mean? No offense meant and I withdraw that.

> Are missed appointments such a issue for GPs?

"Patients who miss GP appointments are costing NHS England £216m a year, officials have said." - https://www.bbc.co.uk/news/health-46732626

And the incident I described what started due to one of the girls, a receptionist in a GP, bemoaning how many missed appointments they have and what a backlog it begets. People agreed. Just now I checked my doctor's online portal and I can't get an appointment for over two weeks (they advise to ring up at 8 on the morning if it#s an emergency and they'll try to fit you in). Unfortunately recently I had cause to have 6 appointments over a two week period, I saw a lot of names being called and no-one attending.

> If someone doesn't show they move onto the next person.

This presumes that people without an appointment, just hang around the waiting area... As said the backlog grows.

[pjc50]

Yeah, there's a real .. bimodality? to NHS service users. A small fraction of people, usually elderly and/or disabled, with essentially infinite health problems, take up most of the time. Everyone else has to fit in around them.

Often their inability to keep appointments is inextricably linked to the medical condition, too - either physical or mental. Often it's linked to poverty or insecure living too.

We could start trying to price them out, which will at the margin result in someone dying of a preventable condition. This seems to be becoming more politically acceptable (see benefits system, food banks, refugees etc), but it's also something people are right to be squeamish about.

[IneffablePigeon]

I can see your argument, although while £216m is a lot of money it's still a drop in the bucket compared to the NHS's total budget (about 0.2%).

Personally, I think the situation can be improved by more education. I think a fine would unfairly affect the less well off, not only because it would be a much more significant amount to them but because those are the same people who are more likely to have unforseen circumstances that mean they can't make an appointment, such as a job where they might just change your shift with little/no notice.

I think the actual booking system could fix a lot of these issues at most surgeries, too. My last surgery held back 75% of appointments such that you couldn't book them until the day of the appointment. This meant that you could almost always get a same day appointment as long as you called at 8:30am, and also meant you probably had a much better idea of whether you were going to be able to make that appointment or not. People who needed to get an advance appointment could still do so, and would have to wait a couple of weeks usually but that's no worse than most other places. It really did seem to fix a lot of the problems I've seen - I don't know why more places don't do it.