GPs face duty to chase e-booking ‘no shows’

GP practices are facing extra workload to chase up patients who fail to book a hospital appointment once they have been given a Choose and Book reference number.

It is thought that almost 5% of patients currently fail to convert their unique booking reference number (UBRN) into a hospital appointment. The Medical Defence Union says GPs have a ‘duty of care’ to chase up such patients but a senior GP representative says practices will need to make their own decisions on how to act, probably on an individual patient basis.

Deciding how to deal with patients who fail to book an appointment is a new problem for GP practices created by the Choose and Book system. Practices can book appointments for patients in the surgery but some may choose to book the appointment later and will leave the practice with a UBRN.

Dr Richard Vautrey deputy chairman of the British Medical Association’s General Practitioner Committee and its lead on IT issues, said it was a potential workload problem for practices.

He told EHI Primary Care: “It gives GPs a difficult dilemma of how much they should nanny their patients and how much responsibility lies with the patient. When we are now putting more responsibility on the patient I think there is a strong argument for saying that it is the patient’s responsibility.”

Dr Vautrey said that historically practices already make decisions on a daily basis on how to handle patients who miss their hospital appointments and he thought it likely most practices will decide what to do according to the patient’s individual circumstances.

The Choose and Book system will show practices which patients have failed to book an appointment and Dr Nicholas Norwell, medico-legal adviser at the MDU, said GPs would then have a legal duty of care to act if they knew an appointment had not been made.

He said: “Once a patient has been referred the GP has a duty to put a full stop to the process one way or another which might mean calling the patient back in and deciding the referral is no longer necessary .

“In the past this situation has arisen with abnormal test results when patients do not come back in and you then have a duty to pursue it and do what a reasonable doctor would do in those circumstances. Failing to make an appointment is analogous to an abnormal haemoglobin.”

A spokesperson for the Department of Health said some unbooked appointments would be for patients who had not yet decided when it would be convenient for them to attend an appointment and others would relate to patients who had decided they no longer wanted to be referred to a specialist.

She added: "In all cases, if a patient chooses not to book an appointment within seven days of seeing their GP, then the Choose and Book Appointments Line will write to the patient reminding them that they should make their appointment. If after a further seven days the patient has still not made their appointment, the Appointments Line will send another reminder letter.

"The Choose and Book service can trace all patients by their UBRN and can therefore identify those who have not yet booked an appointment. This information is available to those people who have the appropriate levels of access to the system. This is something that has never been possible before. In addition, the list of patients who have not converted their UBRNs is highlighted to the referring GP and their practice staff, who are now able to track where in the referral process their patients are."