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.