General Practice and Primary Care

CMO Scotland annual report for 2023-2024 published "Realistic medicine - Taking care" 24/08/24

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.

Scottish Government report published "Inclusion health action in general practice: early evaluation report" 24/07/24

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."

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 Social Policy and Inequalities (Urban Studies and Social Policy, University of Glasgow)
  Associate Professor of Public Policy (School of Health and Wellbeing, 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.

These links are 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.

updated Missingness in healthcare presentation short version (18 slides)

Missingness LONG presentation (39 slides)

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 column in the Scotsman by Karyn McClusky (chief executive of Community Justice Scotalnd), published 13/01/25, discussing the importance and relevance of the concept of "missingness" to the field of criminal justice
• Mention of "missingness" work in Deep End International Bulletin No 12, November 2024 
• An article in the Herald (behind a paywall) by Helen McArdle, published 29/06/24 

Andrea Williamson (with Carey Lunan and Claire McIntosh) invited to present missingness work at the Chief Medical Officer for Scotlands quarterly Directors of Public Health meeting, 04/02/2025

Andrea Williamson follow up meeting with Director of Public Health Fife, 20/01/2025

Andrea Williamson, Calum Lindsay meeting with Dr Cindy Chew (Radiologist), 14/01/25

Andrea Williamson discussion with list analysts Scot Gov/PHS, 13/01/25

Andrea Williamson, Calum Lindsay launch of Public Health Fife Inclusion Health group, 13/01/25

Andrea Williamson, Calum Lindsay presentation to Patients' Association about missingness work and discussion about how it relates to their work, 06/01/25

Andrea Williamson, Calum Lindsay (with Carey Lunan and Joanna MacDonald) invited to present at GIRFE learning network, 09/12/2024

Andrea Williamson, Calum Lindsay discussion with Christopher Mackie - role of missingness in dentistry, 04/12/24

Andrea Williamson (with Carey Lunan and Claire McIntosh) invited to present missingness work at the Chief Medical Officer for Scotlands quarterly Directors of Public Health meeting, 03/12/24

Andrea Williamson discussion meeting Diabetes UK, 12/11/24

Andrea Williamson participated in an online workshop entitled "Unmet needs in Primary care" presenting missingness work, discussion and exchange of ideas, 11/12/24

Andrea Williamson, Calum Lindsay meeting with Laura Jones, RNIB/NHS Engagement Manager, 10/12/24

Andrea Williamson, Calum Lindsay meeting with Italian healthworkers (Rimini Romagna HI) to plan future knowledge exchange to influence service design in Italy, 9/12/24

Calum Lindsay presented missingness work at Annual Royal College of Physicians and Surgeons Glasgow annual Dental Conference, 21/11/2024

Andrea Williamson presented Missingness work at RCPsych in Scotland Medical Psychotherapy Faculty Conference, 15/11/2024

Andrea Williamson met with Dr Stefan Serban Cons public health Childsmile NHS Scotland initiative to discuss data in relation to missingness work, 04/11/2024

Andrea Williamson presentation to I-SPHERE and Centre for Homelessness Impact, 21/10/24 

Andrea Williamson missingness learning for cervical screening uptake planning in NHS Ayrshire and Arran, 27/08/24

Andrea Williamson NHS Health Improvement Scotland + Public Health Scotland, evaluating missingness in new CTAC primary care provision national evaluation, 22/08/24

Andrea Williamson conversation with Clair McIntosh about patient directed discharge, 05/12/23

Andrea Williamson conversation with Craig Bell and colleagues from Scottish Government  Realistic Medicine Policy Team,  13/12/23

Andrea Williamson presentation to Scottish Health Action on Alcohol Problems steering group, 04/12/23

Andrea Williamson meeting with Tom Margham CEG, discussion about missingness in healthcare and how it relates to GP practice coding in England.  14/5/24

Andrea Williamson meeting with research group investigating changes to outpatients scheduling in Northern England and relationship to missingness, Manchester, 15/5/24

‌Serial missed appointments in the NHS

missingness@glasgow.ac.uk