General Practice and Primary Care

2024 Understanding the causes of missingness in primary care: a realist review

Following publication of this paper in the BMC Medical journal: Lindsay, C., Baruffati, D., Mackenzie, M. et al. Understanding the causes of missingness in primary care: a realist review. BMC Med 22, 235 (2024). https://doi.org/10.1186/s12916-024-03456-2

a number of articles discussed the project

• An article in the Herald (behind a paywall) by Helen McArdle, published 29/06/24

"Why do people miss GP appointments - and how can we fix it?

Patients who miss multiple GP appointments are being wrongly portrayed as "irresponsible" and fining them for no-shows would only make the situation worse, a researcher has warned.

Dr Calum Lindsay, one of the researchers involved in a major study at Glasgow University investigating the causes and possible remedies for missed appointments, said the shift towards more telephone triage and phone and video consultations was also likely to be aggravating the problem."

• An online article in healthandcare.scot (by Frankie Macpherson, published 7/7/24) discussing our research - 

"Researchers: policy needed for patient ‘missingness'

The causes of missed healthcare appointments in primary care are complex and varied, and must be addressed through policy rather than placing blame with individuals, Glasgow researchers say in a first-of-its-kind study."

2023 Inclusion health and missingness in health care: dig where you stand

The British Journal of General Practice invited Andrea Williamson, the project co PI, to write a lead editorial for the October 2023 issue, following on from a lecture given at SAPC earlier in the year. 

The image on the journal cover, shown here, used the word "Missingness" as defined in our project.

Cover credit: UNTITLED. Artist: UNKNOWN. Image from DrugFAM Art Competition.

DrugFAM is a UK registered charity that supports people affected and bereaved by a loved one’s harmful use of drugs, alcohol, and gambling. Its trained volunteers and professional Family Support Workers help those in need through a 365-day-a-year telephone helpline, evidenced-based outcome evaluated one-to-one sessions and weekly support group meetings. DrugFAM understands the profound impact a loved one’s harmful use of drugs, alcohol, and gambling can have, and delivers its support with compassion, care, and understanding. For more information or support call 0300 888 3853. 

This research aims to address the problem of multiple missed appointments and low uptake of care offers in health care, described as "missingness".

This is an under-researched area, disproportionately affects the most marginalised groups in society and is associated with high levels of premature mortality. Our research seeks to more fully understand the drivers of missingness, its consequences, the populations who are most at risk, and to develop targeted interventions to address it.

The study will be undertaken in three overlapping stages.

1. The first is a review of the existing literature and knowledge pertaining to missingness. This will be used to create a "programme theory" about the known causes of missingness in different contexts across identified at-risk groups, and about the kinds of interventions which may target these causes to address missingness.
2. The second will involve refining this programme theory by gathering knowledge, through in-depth interviews, with two groups who have a deep understanding of missingness; "experts-by-experience" who have missed multiple appointments in the past, and professionals and practitioners who work with people who have experienced missingness across health and social care settings. This research will be undertaken with a sample of thirty people from each of these populations across Scotland and England.
3. The third stage will draw on the knowledge accrued across the previous two stages to develop targeted interventions tailored towards different causes of missingness across these at-risk populations.

The research is funded by the National Institute for Health and Care Research, with members of the research team based at the University of Glasgow, University of Oxford, University of Bath and Homeless Network Scotland. Ethical approval for the study has been obtained from University of Glasgow's College of Medical, Veterinary and Life Sciences Ethics Committee (project number 200220187).

The full study protocol can be found on the NIHR website.

To contact a member of the research team directly, follow the link to their profile or organisation page. For contact about the project in general, you can use our email address missingness@glasgow.ac.uk 

Principal Investigator

Prof Andrea Williamson 
Professor of General Practice and Inclusion Health (General Practice and Primary Care, University of Glasgow) 

Co-Principal Investigator

Prof Kate O’Donnell
Professor of Primary Care Research and Development (General Practice and Primary Care, University of Glasgow) 

Other team members

• Dr David Baruffati
  Research Associate (College of Medical, Veterinary and Life Sciences, University of Glasgow) 
• Dr Calum Lindsay
  Research Associate (College of Medical, Veterinary and Life Sciences, University of Glasgow) 
• Ms Elspeth Rae 
  Research Administrator (College of Medical, Veterinary and Life Sciences, University of Glasgow) 
• Dr Geoff Wong 
  Associate Professor of Primary Care (University of Oxford) 
• Ms Claire Duddy 
  Realist Reviewer and NIHR Pre-Doctoral Fellow (University of Oxford) 
  (01 December 2022 to 05 June 2023)
• Prof Mhairi Mackenzie
  Professor of Public Policy (Urban Studies, University of Glasgow) 
• Ms Michelle Major 
  Improvement Lead (Homeless Network Scotland) 
• Prof Sharon Simpson
  Professor of Behavioural Sciences and Health (MRC/CSO Social & Public Health Sciences Unit, University of Glasgow) 
• Prof David Ellis 
  Professor of Behavioural Science (University of Bath) 

• Andrea E Williamson. Inclusion health and missingness in health care: dig where you stand. Editorial, British Journal of General Practice 2023; 73 (735): 436-437. DOI: https://doi.org/10.3399/bjgp23X734985
• Lindsay C, Baruffati D, Mackenzie M et al. A realist review of the causes of, and current interventions to address ‘missingness’ in health care. NIHR Open Res 2023, 3:33
• Lindsay, C., Baruffati, D., Mackenzie, M. et al. Understanding the causes of missingness in primary care: a realist review. BMC Med 22, 235 (2024). https://doi.org/10.1186/s12916-024-03456-2

We asked an illustrator, Jack Brougham, to create some images showing some themes from our work. The images werre used to spark discussion with research participats and in presentations of our research at conferences and meetings.

These presentations were recently given by Andrea Williamson.

AEW missingness assertive outreach October 2023

AEW grand round presentation missingness interventions November 2023 

Articles linked to/discussing our research

• An article in the Herald (behind a paywall) by Helen McArdle, published 29/06/24

"Why do people miss GP appointments - and how can we fix it?

Patients who miss multiple GP appointments are being wrongly portrayed as "irresponsible" and fining them for no-shows would only make the situation worse, a researcher has warned.

Dr Calum Lindsay, one of the researchers involved in a major study at Glasgow University investigating the causes and possible remedies for missed appointments, said the shift towards more telephone triage and phone and video consultations was also likely to be aggravating the problem."

• An online article in healthandcare.scot (by Frankie Macpherson, published 7/7/24) discussing our research - 

"The causes of missed healthcare appointments in primary care are complex and varied, and must be addressed through policy rather than placing blame with individuals, Glasgow researchers say in a first-of-its-kind study."

• Missingness research project included in online article in healthandcare.scot (by Frankie Macpherson, published 11/7/24) discussing stigma - 

"In the first of a series of shorts hosted by national charity Scottish Families Affected by Alcohol and Drugs (SFAD), attendees heard that stigma around with alcohol and drug use worsens people’s mental and physical health."

Policy documents etc referring to our research

‌Serial missed appointments in the NHS

missingness@glasgow.ac.uk