The last time I went to see my GP – a 220km round trip from my rural home town – I noticed a sign at reception telling clients that the reason it was so difficult to get a timely appointment was because 154 of us hadn’t shown up for booked consults during the month of July.
It stuck in my craw because it’s now standard to experience a weeks-long wait for a GP appointment at every clinic across this region, if you can even get into one. With so many slots tied up by clients who don’t cancel, management of chronic conditions has become even more difficult, particularly in rural communities.
Many locals – me included – manage the situation by booking several appointments way ahead of time, then cancelling those we don’t need. It feels a bit like “bracketing”, the habit of ordering multiple sizes when buying clothing online and sending back what doesn’t fit.
Years ago, I asked clinic staff if they minded clients treating the service like an online fashion retailer. They accept the practice as a means of ensuring access to a doctor, as long as clients call to cancel so someone else can use the slot; they charge the full consult fee for all un-cancelled appointments that someone just doesn’t turn up for.
People miss medical appointments for many reasons: escalating costs, the tyranny of distance, worsening illness or feeling better by the time the date rolls around.
Many other clinics charge for no-shows: fees that cannot be reimbursed by Medicare, the Department of Veterans’ Affairs, or private health funds and insurers. So if my medical centre isn’t out of pocket, is there a wider cost for such a terrible track record; and if so, how much?
The dearth of big-picture data makes the whole issue feel slightly taboo, but the financial implications are writ large at hospital emergency departments.
When my husband couldn’t get an appointment for an acute condition at any GP clinic across our region in 2022, he spent seven hours waiting to see a doctor at our local hospital, the same amount of time it would have taken to drive to a walk-in GP clinic in Sydney. When I was unable to get into a GP clinic after a chest injury in 2023, I waited at the same hospital until I was seen by a senior nurse.
Before checking any of my symptoms, she pressured me to reveal how hard I’d tried to get into my GP at short notice, apologised when she realised my pain levels were real, wrote up a management plan and advised me to get to my doctor when I could.
It’s a fair call, considering each non-admitted emergency department presentation costs the taxpayer $600, compared with an average of $40 for each GP consult, according to Nicole Higgins, president of the Royal Australian College of General Practitioners (RACGP).
Higgins’s organisation is calling for funding for people to see their GP after an unplanned hospital visit so they don’t wind up back in the emergency department. She said a 12% reduction in hospital admissions would save at least $69m annually.
The Hunter New England health district, where I live, estimates one in 10 people don’t show up for booked outpatient appointments at Newcastle’s John Hunter hospital. That’s pretty standard – and it isn’t new.
A decade ago, Queensland’s then acting health minister Scott Emerson estimated the state’s monthly financial burden had been $2.6m a month in 2012-13 due to specialist outpatient appointment no-shows, lifting to $3.8m by 2015.
“That money … could have paid for 171 knee replacements, 172 hip replacements, or 89 cochlear implants, and clearly make a huge difference to many people’s lives,” he said in a statement at the time.
The problem was so prevalent that by 2019, medical centres were being encouraged by financial advisers to charge $30 to $85 for each no-show and just alert clients to the fee. After all, GP clinics are small businesses and their sustainability is as fragile as anything else on the high streets of country towns.
When I call to book an appointment at my clinic, I’m always met with a recorded message first, reminding me to cancel any bookings I don’t require, giving fair warning that no-shows will be charged to me. Unlike my optometrist, this clinic doesn’t send out an SMS reminder the day before.
But should a GP’s duty of care extend to acting as their clients’ personal assistant?
From January to March this year, the Tasmanian government implemented the “Did Not Attend” campaign to raise awareness of the no-show issue through confirmation calls to clients who had scheduled outpatient appointments. It also informed the community on the impact of not letting a medical provider know about a cancellation.
After an extension of the initiative, the rate of no-shows in that state had, by May 2024, dropped from 10% to 6%, which was a record monthly low of missed appointments.
The Tasmanian health minister, Guy Barnett, urged people to collaborate with the state’s health system.
“An effective healthcare system is everyone’s responsibility, and we all have a role to play to ensure Tasmanians can get the health care they need, when and where they need it,” he said in May.
“We understand life is busy, and plans can change, but the message for Tasmanians is clear – if you can’t make it, let somebody else take it.”
The simple slogan is clearly getting through, but I’m shocked that a no-show rate of 6% counts as a “record low”.
It’s very human to hedge our bets when it comes to health and wellbeing, and the high rate of no-shows does put some onus on care providers. But it also suggests a level of preventable inefficiency that’s well within our power to change.
