A missed appointment is a reason to ask

What we found in the news

NHS England's guidance on missed outpatient appointments (opens in a new tab), published in February 2023 and updated that August, describes several reasons people may not attend. It makes this point:

“Many of these are outside of their control.”

— NHS England, Reducing did not attends in outpatient services, introduction

The guidance draws on service experience and examples. We are revisiting its invitation to understand the local reasons for missed appointments, without transferring a particular provider's reported improvement to another service or to genus.

Why this matters to us

An appointment record can tell a team that someone did not arrive. It cannot, on its own, explain why.

In an illustrative situation, a person receives a reminder for a clinic visit but cannot use the cancellation link on their older telephone. They try a number that closes before they finish work. By the day of the appointment, the service sees an empty slot.

At genus, we think the next useful question is about the journey to the appointment. Was the information received? Could the person act on it? Did the arrangement still fit their circumstances?

Make the next contact curious and practical

Use the service's appropriate follow-up process. When contact is made, give the person room to explain what happened without requiring them to defend their interest in care.

They may have misunderstood the location, been unable to leave work or decided the appointment no longer seemed necessary. Each answer needs an appropriate response. Clinical decisions about ongoing care belong with the responsible professional.

Ask what would make the next step workable. Repeating the same appointment arrangement may repeat the same barrier.

For our telephone example, the useful response could include an accessible way to rearrange and a check that the correct contact route is visible. It should not depend on the person purchasing a newer device.

Some missed contacts raise safeguarding or clinical concerns. Follow the established procedures for those situations; a routine access conversation is not a substitute for professional assessment.

Test the route your service offers

Staff and managers can walk through a fictional booking from the recipient's position. Try finding the location, changing the time and contacting the service without using the preferred digital channel.

Notice where the process assumes something that may not be available: a private email address, mobile data, transport at a particular hour or help from another person.

An appointment reminder can be clear while the appointment itself remains inaccessible. Ask whether the available options address the obstacle or merely describe it more efficiently.

Where a supporter is involved, confirm the person's wishes and the supporter's actual role. A copied message does not establish that someone has accepted responsibility for bringing the person.

Read the measure alongside the experience

Attendance rates matter to service planning, but they need context. A lower missed-appointment count does not necessarily mean access has improved if people facing the greatest barriers have stopped being offered appointments.

Review what changed in the process and who benefited. Use appropriate aggregated information and feedback, with care around small groups and personal data.

The question may lead to a modest adjustment: clearer arrival information, a telephone option that is answered at useful times or a way to flag a transport issue before the appointment day.

Invite staff who handle calls and reception to contribute. They often see the practical point where a process stops working, although their observations should be checked rather than treated as a complete account of every person's experience.

The genus connection

Today, configured genus community calendars and communication tools can help organizations keep agreed dates and relevant information available. Reviewed resources can explain how a particular program's arrangements work.

These capabilities do not establish that a reminder was understood, that transport is available or that a booking can be changed automatically. Integration and workflow details need to be agreed for the organization.

For us, the useful role of technology is to support an accessible route back into the conversation. A missed interaction should leave the team curious about the conditions around it, with an appropriate next step for the person.

One question to take away

What would your team want to understand before interpreting a missed appointment as a lack of interest?