Defaulters in general practice: who are they and what can be done about them?

Background. The study of patients in primary care settings who default on their appointment has been based largely on short-term surveys in individual health centres. Objective. As part of a wider research project into the potential of practice computer appointment systems as a data source, we wanted to explore the aggregate pattern of default. Method. Comprehensive computer appointment data from nine general practices for 1 or 2 years were analysed to explore the pattern of defaulted appointments for doctors and practice nurses. Results, Around 6.5% of all appointments ended in a default. Default rates were found to be highest amongst young adults and, at a practice level, to be highly correlated with deprivation level. About two-thirds of those who defaulted only did it once during the year, A small core of patients defaulted frequently, but only a quarter of these repeated their behaviour in the following year. Conclusions, The discussion suggests that strategies based on educating or punishing defaulters in order to change their behaviour may be of limited effectiveness.