General Practice and Primary Care

2024 CMO Scotland annual report for 2023-2024 published "Realistic medicine - Taking care"

This report discusses how to deliver the overarching aim of Realistic Medicine, to deliver better value care for patients, and for our health and care system. The report includes the idea of "missingness" which is discussed in Chapter 1 and mentioned in Chapter 4.

2024 Scottish Government report published "Inclusion health action in general practice: early evaluation report"

This report into the Inclusion Health Action in General Practice programme (IHAGP) draws on previously published research from the Serial Missed Appointments research and ideas from the Missingness Interventions project, along with work done by other organisations in the field of Inclusion Health, to encourage general practices to look at ways to address this theme.

"Missingness" is mentioned in the Introduction (with a link to the Serial Missed Appointments 2021 paper) and in particular in Case Study 4.

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 aimed 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 sought 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 was undertaken in three overlapping stages.

1. The first was a review of the existing literature and knowledge pertaining to missingness. This was 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 involved refining this programme theory by gathering knowledge, through in-depth interviews, with two groups with 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 was undertaken with a sample of thirty people from each of these populations across Scotland and England.
3. The third stage drew 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 was 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 was 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 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 David Baruffati
  Research Associate (06 December 2022 to 28 November 2024) now Affiliate Researcher (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 
  Impact 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) 

• Baruffati, D. and Williamson, A.E.W. (on behalf of the Missingness in Healthcare Team) MISSINGNESS: Understanding Missingness in Healthcare. Part of a downloadable Report published by the South Asian Health Foundation, editors Ali, S. et al.
• 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
• 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
• 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

These presentations are the short and longer versions of presentations given by members of the project team.

This is currently to test the accessibility of the pdf document only. Any questions about the "Missingness Interventions" project should be addressed to the Missingness Interventions email address directly.

Missingness in healthcare presentation short version 

Videos

• This video shows excerpts from the April 2024 Deep End conference held in Glasgow, and includes Prof Andrea Williamson talking about aspects of the Missingness research projects (on youtube, produced by Edward Sharp-Paul). It gives a good overview of the conference themes (joy, inclusivity, advocacy, kindness and hope) including contributions from other key-note speakers.

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."

• 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)

• An article in the Doctor online magazine (British Medical Association) talking about Prof Andrea Williamson's work in Missingness research, Inclusion Health and the Deep End program amongst other things (by Peter Blackburn).

Policy documents etc referring to our research

•  The Scottish Government just published (24/07/24) a report looking at early outcomes of its Inclusion Health in General Practice (IHAGP) programme.

Inclusion health action in general practice: early evaluation report (ISBN: 9781836015468) 

"IHAGP provided funding to 66 individual general practices within NHS Greater Glasgow and Clyde. The funding was intended to support work to prevent health outcomes worsening for people with greatest need, and proactively engage those who are ‘lost’ to the system but need support to manage their health and social circumstances. Three themes for IHAGP activity were established:

• Developing connections with the local community - implementing inclusive patient engagement/community participation approaches to create or enhance existing patient/community participation capacity.
• Enhancing workforce knowledge and skills - practice staff to access education, knowledge resources or training on health inequality and health equity.
• Proactive outreach and extended consultations - enabling proactive outreach and extended consultations with patients who are at high risk of physical or mental ill health due to poverty and inequality."

The introduction to the report mentions earlier research from the Serial Missed appointments project

"The development of IHAGP was informed by the existing evidence generated from previous local initiatives, which included the evaluation of Govan Social and Health Integration Project, the Deep End Pioneer Scheme, the Chance 2 Change project, the CarePlus study and research on “missingness”."

In particular, this finding from the research resonated with staff

"That statistic that people who miss appointments are eight times more likely to die is really powerful. And it's really changing how people see missed appointments. So people are now really much more proactive at coding them and are following people up and phoning them."

‌Serial missed appointments in the NHS

missingness@glasgow.ac.uk