Research
Serial missed appointments in the NHS
This Scottish big data project investigated the epidemiology of patterns of missed appointments in the NHS.
Explore our findings about patient and GP practice demographic factors, morbidity and mortality outcomes.
Our paper about patterns of missed appointments and associations with morbidity and mortality outcomes won the prestigious Royal College of GPs health service research paper of the year 2019. Andrea Williamson the principal investigator talks about why this paper is so important for an influence for change.
A new project (short title "Missingness interventions") funded by NIHR started in early December 2022 and will run until the end of February 2025. Our aim is to develop a theoretically informed understanding of "missingness" from patient, professional and policy perspectives with the intent of co-producing a complex intervention with multiple components for primary care to test in a future study. Find out more about this work.
Recent activity and additions
A paper entitled "Attention-deficit/hyperactivity disorder and serial missed appointments in general practice." by McQueenie R, Ellis DA, Williamson A, Wilson P (2024) in PLOS Mental Health 1(2): e0000045.
The paper was discussed in the following publications. (PLOS journal has a good system for showing publication impact.)
Pulse - Patients with ADHD more likely to miss GP appointments. (Emma Wilkinson, 18/07/24)
Medical Xpress - New study reveals high rates of missed GP appointments among patients with ADHD (University of Aberdeen, 9/07/24)
myScience - High rates of missed GP appointments among patients with ADHD (Health, 9/07/24)
ScienMag - New study reveals high rates of missed GP appointments among patients with ADHD (9/7/24)
MirageNews - Research Finds High ADHD Patient No-Show Rates (10/7/24)
University of Aberdeen - New study reveals high rates of missed GP appointments among patients with ADHD (9/7/24)
Research team
- Andrea E Williamson (lead investigator) @aewilliamsonl University of Glasgow
- David A Ellis (co-investigator) @davidaellis University of Lancaster
- Ross McQueenie (research assistant) University of Glasgow
- Phil Wilson (co-investigator) University of Aberdeen
- Alex McConnachie (co-investigator) University of Glasgow
Publications
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McQueenie R, Ellis DA, Williamson A, Wilson P (2024) Attention-deficit/hyperactivity disorder and serial missed appointments in general practice. PLOS Mental Health 1(2) e0000045.
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McConnachie, A., Ellis, D.A., Wilson, P., McQueenie, R., Williamson, A.E. Quantifying unmet need in General Practice: a retrospective cohort study of administrative data
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Ross McQueenie, David A. Ellis, Michael Fleming, Philip Wilson & Andrea E. Williamson Educational associations with missed GP appointments for patients under 35 years old: administrative data linkage study BMC Medicine volume 19, Article number: 219 (2021)
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Williamson AE, McQueenie R, Ellis DA, McConnachie A, Wilson P (2021) ‘Missingness’ in health care: Associations between hospital utilization and missed appointments in general practice. A retrospective cohort study. PLoS ONE 16(6): e0253163.
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Andrea Williamson Missingness in health care - a "new normal" is not a level playing field Opinion piece (RCGP Learning, 2020)
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Andrea E Williamson, Ross McQueenie, David A Ellis, Alex McConnachie and Philip Wilson General practice recording of adverse childhood experiences: a retrospective cohort study of GP records BJGP Open 18 February 2020
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Williamson, A. E. (2019) Missed GP appointments are no scandal [Rapid Response]. BMJ, 364:I545
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Wilson, P., Ellis, D., Williamson, A. E. (2019) Missed GP appointments linked to higher risk of death. BMJ, 364:I485. (doi:10.1136/bmj.l485)
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McQueenie, R., Ellis, D. A., McConnachie, A. , Wilson, P. and Williamson, A. E. (2019) Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study. BMC Medicine, 17, 2. (doi:10.1186/s12916-018-1234-0)
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Ellis, D. A., McQueenie, R., McConnachie, A. , Wilson, P. and Williamson, A. (2017) Demographic and practice factors predicting repeated non-attendance in primary care: a national retrospective cohort analysis. Lancet Public Health, 2(12), e551-e559. (doi:10.1016/S2468-2667(17)30217-7) (PMID:29253440) (PMCID:PMC5725414)
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Ellis, D. A., McQueenie, R., McConnachie, A. , Wilson, P. and Williamson, A. (2018) Non-attending patients in general practice. Lancet Public Health, 3(3), e113. (doi:10.1016/S2468-2667(18)30020-3) (PMID:29519700)
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Williamson, Andrea and Ellis, David Alexander and Wilson, Philip and McQueenie, Ross and McConnachie, Alex (2017) Understanding repeated non-attendance in health services: a pilot analysis of administrative data and full study protocol for a national retrospective cohort BMJ Open 7(2)
Presentations
- Why do we need action on "missingness" in healthcare?
Ross McQueenie, Andrea Williamson
(November 2022 Public Health Information Network Scotland Annual Symposium) - Missingness in healthcare: morbidity and mortality outcomes
Andrea Williamson, Ross McQueenie, David Ellis, Alex McConnachie, Phil Wilson
(February 2021, RCGP Conference) - Serial Missed Appointments in the NHS
Andrea Williamson
(November 2019, Scottish Faculty of Public Health Annual Conference) - What role do health care systems have in engagement in care?
Andrea Williamson, Ross McQueenie
(November 2019, NAPCRG Annual Meeting) - Serial missed appointments in the NHS - update
Andrea Williamson, Ross McQueenie, David Ellis
(February 2019, Scottish Government Health Directorate) - Repeated missed appointments in primary care - what do they signify?
Phil Wilson
(January 2019, ADEGS (Scottish University Departments of General Practice/Primary Care) Conference) - Serial missed appointments in primary care - data linkage study
Phil Wilson
(November 2018, NHS Highland R&D Conference) - serial missed attendance in primary care - data linkage
Phil Wilson
(November 2017, NHS Highland R&D Conference) - Use of "big data" in primary and secondary healthcare
Ross McQueenie
(October 2017, University of West of Scotland, School of Science and Sport Seminar Series) - Serial missed appointments in the NHS
Andrea Williamson
(July 2017, Society for Academic Primary Care Annual Conference) - Patient demographics and practice factors in patterns of repeated non-attendance
Ross McQueenie
(June 2017, Scottish School of Primary Care Conference) - Patient demographics in patterns of repeated non-attendance in primary care
Ross McQueenie
(January 2017, NADEGS (Scottish University Departments of General Practice/Primary Care) Conference) - Individual differences and missed appointments in the NHS
David Ellis
(November 2016, Invited talk presented at University of Lincoln Psychology Research Seminar) - Serial missed appointments: background, methods, and analysis plan
Andrea Williamson
(June 2016, Revolving Doors Multiple Disadvantage Research Seminar Series London) - Serial missed appointments: evidence from practice, research and theory
Andrea Williamson, David Ellis
(June 2014, Scottish Government Health Division CPD Seminar, St Andrews House Edinburgh)
Impact
- Communication from GPs across the UK about how following on from this research they have changed practice policy on managing "DNAs"
- Guidance to GP practice managers from the Medical and Dental Defence Union of Scotland about management of DNAs, 2019
- Cited by the World Health Organisation in "Addressing social determinants of noncommunicable diseases in primary care: a systematic review 2020" World Health Organisation Bulletin
- Cited and the importance of addressing missed appointments discussed in the NICE Guideline "Integrated health and social care for people experiencing homelessness 2022"
- Overview | Integrated health and social care for people experiencing homelessness | Guidance | NICE
This guideline covers providing integrated health and social care services for people experiencing homelessness. It aims to improve access to and engagement with health and social care, and ensure care is coordinated across different services - Cited and new policy focus in the recommendations on addressing "missingness" in health care in Primary Care Health Inequalities Short Life Working Group Report 2022
- the Scottish Government report published 24/7/24 into Inclusion Health in General Practice cited the Williamson et al 2021 paper "Missingness' in health care: Associations between hospital utilization and missed appointments in general practice. A retrospective cohort study".
- A story in the Glasgow Times reports that £1 million funding will be awarded to the Keppoch Medical Practice in Possil park as part of the IHAGP programme to tackle health inequalities (by Kirsty Feerick)
Related work
- Reflections on an international workshop on "missingness" in healthcare
Dr Andrea Williamson, Dr Ross McQueenie (NAPCRG 2019)
This report is from a workshop at an international primary care conference which explored the factors that contribute to "missingness" in health care in a range of high income country health care systems. It will inform future work on the topic. - Ross Innes, BSc Global Health in a Primary Care Context undergraduate student, 2016-2017 (supervisors Dr Andrea Williamson, Dr Ross McQueenie and Dr Ula Chetty) conducted a small qualitative research study called Managing to attend appointments- what works and what stymies engagement in health care?
This explored the lived experience of experts by experience - people who have had significant adversity and have struggled to attend health care appointments, and the professionals who have cared for them. Participants were recruited from voluntary sector organisations in homelessness and substance use. This small project demonstrated it is possible to recruit participants with lived experience of serially missing health appointments. It will inform the future development of strategies and health service design to reduce serial missed appointments in the NHS.
Contact us
- Andrea Williamson andrea.williamson@glasgow.ac.uk
- Ross McQueenie ross.mcqueenie@glasgow.ac.uk