A patient-focused healthcare system is key to tackling missingness
Published: 23 July 2026
Embedding a patient-focused approach across all healthcare settings could help to better tackle the problem of missingness in healthcare, according to researchers
Embedding a patient-focused approach across all healthcare settings could help to better tackle the problem of missingness in healthcare, according to researchers.
Evidence from a new study led by the University of Glasgow, together with real-world examples from GP practices, highlight the need to focus on the many complex and overlapping reasons why patients miss appointments in order to be able to effectively tackle this important healthcare issue.
Missingness is defined as “the repeated tendency not to take up offers of care such that it has a negative impact on the person and their life chances”.
Being missing either from GP or hospital out-patient appointments, can have a lasting and damaging impact on a person’s health, and is associated with a much higher risk of early death. People who are the most vulnerable in society, and those already experiencing a range of physical and mental health concerns are at most risk, yet current methods to tackle missingness often focus blame on poor patient behaviour and ultimately penalise those most at-risk.
The new study, published in BMC Medicine and funded by the National Institute for Health Research (NIHR), draws on a range of sources including existing literature, interviews and working groups with stakeholders in order create a set of core guiding principles and suite of adaptable interventions on how to best tackle missingness in healthcare.
Key to those principles is the need to embed a ‘missingness lens’ in healthcare settings, focused on understanding the many complex causes of multiple missed appointments; including the interaction between patients’ lives, their circumstances, and the way healthcare is delivered.
The suite of interventions highlights the importance of: embedding a change of perspective around missed appointments; identification of those patients most at risk; a focus on building relationships and better communication; creating a missingness coordinator role to liaise with patients; thinking about transport and logistics; improving appointment flexibility; and improved contact around appointments by healthcare staff to ensure patients are brought back into healthcare.
Currently in most settings, when patients miss appointments, they are either sent letters by their GP practice or, often in hospital out-patient settings, are discharged from the clinic and instructed to seek a new referral if they want to be given another appointment. This current administrative practice puts the blame for missed appointments solely with patients, ignoring possible causes and other factors which may need intervention. This and other negative experiences can lead to distrust and a feeling among missing patients – often those most in need – that healthcare settings are ‘not for them’.
Dr Calum Lindsay, first author of the paper from the University of Glasgow, said: “We know that patients at risk of missingness are already more likely to have multiple physical and mental health conditions. In addition, they are also more likely to live in adverse or precarious circumstances and experience a range of negative health outcomes.
“However, existing approaches designed to address missed appointments rarely focus on these patients, and when they do it is often through a punitive lens rather than one that engages meaningfully with the causes of missingness. As a result, existing interventions are often ineffective for these patients and may instead worsen access inequalities.”
Addressing missingness in healthcare is a tangible way to address health inequalities, and addressing missingness in healthcare is a focus of the recently published Population Health Framework for Scotland. Scottish Government have funded Glasgow Deep End practices through the Inclusion Health Action in General Practice funding to address missingness which has led to GP practices changing what they do. The concept of missingness is gathering traction across the UK and was included in the recent Royal College of GPs ‘Fairer Practice Toolkit’.
In Govanhill, Glasgow, the Victoria Practice at the Govanhill Health Centre, has taken significant steps to tackle the issue of missingness over the past three years.
By working with the Govanhill COPC (Community-oriented Primary Care) group and learning that other services in the area were also having issues with patients missing appointments, the practice made changes, including increasing appointments from 10 to 15 minutes (no longer double appointments for interpreter); working with the community and local groups to better understand barriers to attending appointments; taking a more proactive and flexible approach to speak with patients following a missed appointment; and participated in sessions on health inequality.
The practice also changed the way they offered bookable and on-the-day appointments and introduced a Missingness Coordinator to reach out to patients to offer support or guidance, particularly those who frequently fail to attend screening services.
Between January 2024 to January 2025, they saw a 30.7% improvement comparing month on month and, anecdotally, there are now days when they have no missed appointments.
Robert Shaw, Practice Manager, said: “When I joined the practice as Practice Manager in June 2023, I could see we had a severe problem with missed appointments, which was causing problems, including patients not receiving the care they needed, wasting interpreters’ time and a lack of continuity of care. It wasn’t uncommon for us to have patients register with us having already been registered and removed from one (or more) of the three other practices in our local vicinity.
“By making a series of changes and small steps over the past three years, including identifying our practice value -- who we want to be and what kind of service do we want to offer – we’ve significantly reduced the number of missed appointments at the practice. I’d also add the positive impact this work has had on our team. They’re not exhausting themselves trying to get patients to fit into a system that doesn’t work for them. A more flexible approach has seemed to ease the pressure on them significantly, allowing them to respond with compassion rather than frustration.”
Professor Andrea Williamson, GP and Professor of General Practice and Inclusion Health at the University of Glasgow who led the research, said: “Our research shows that we need to move away from a system of patient blame for service problems, towards an approach where services are incentivised and committed to identifying and addressing barriers to care.
“The study highlights the importance of both building and repairing relationships to help patients feel safe, alongside directing responses to those who need them most, ensuring they are tailored to fit their priorities and circumstances.”
The study, ‘Addressing the causes of ‘missingness’ in healthcare: a co-designed suite of interventions’ is published in BMC Medicine. The project is funded by the National Institute for Health Research (NIHR).
Enquiries: ali.howard@glasgow.ac.uk or elizabeth.mcmeekin@glasgow.ac.uk
First published: 23 July 2026