[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.