School of Health & Wellbeing

Our research on missingness in healthcare, led by Professor Andrea Williamson, is reshaping health services to be more inclusive, accessible and responsive to those who need it most.

Professor Williamson is a GP and internationally recognised expert in Inclusion Health. The research she leads about missingness in healthcare has inspired a new field of research and changed health policy and practice.

Defining missingness

"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.

Our research found that a high rate of missed GP appointments in Scotland (an average of more than two per year) predicted very high premature death rates. These patients were more likely to have multimorbidity (two or more co-existing long-term health issues, especially mental health conditions), and to experience poverty and social adversity.

Understanding the causes of missingness

There are numerous challenges that contribute to missingness. These include logistical barriers such as transportation, rigid scheduling, and a lack of flexibility in appointment systems. But the problem runs deeper - many people avoid healthcare due to past trauma, mistrust of the NHS, or the stigma they feel when seeking care.

Addressing missingness requires a suite of interventions to change the healthcare structures and systems that sometimes fail to accommodate the needs of the most vulnerable. These interventions include understanding and responding to the specific reasons behind missed appointments, identifying and contacting high-risk individuals, and implementing missingness coordinators.

Changing health policy and practice

• Addressing missingness in healthcare is a focus of the Population Health Framework for Scotland which sets out the Scottish Government’s approach to improving Scotland’s health and reducing health inequalities for the next decade.
  
  “To provide a healthcare system that is truly equitable for all we must address the causes of low engagement in healthcare, including missingness”.

• A CPD resource has been developed to help GP practices identify and address the causes of missingness in their own practices. It covers what they are already doing to support vulnerable patients and address the wider social determinants of health e.g. Community Links Workers and financial advisers, and what could be improved.
• A Royal College of GPs Fairer Practice Toolkit equips healthcare professionals with practical knowledge and tools to reduce health inequalities in their practice. 
• 70 Deep End GP practices in Glasgow introduced a new approach to appointment letters aimed at better supporting patients and improving engagement with services. Previous missed appointment letters with language like "Did Not Attend" were torn up and rewritten.
• Being registered with a general practice is the ‘gateway’ to accessing the rest of the healthcare system, if and when it is required. A template letter was created for practices to share with patients who require additional support to register with a new General Practice.
• Glasgow Alcohol and Drug Recovery Services published Missingness Guidance for all staff which has practical guidance for the context of community health services.
• Missingness Coordinators are now in some GP practices. 

 

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First published: 3 July 2026