An exploration of factors (among BME communities) associated with non-attendance at outpatients appointments in Sheffield

BME non attendance at outpatients

Project Plan

The National Health Service (NHS) in England needs to achieve up to £20 billion of efficiency savings by 2015 through a focus on quality, innovation, productivity and prevention. Missed health care appointments are a major source of potentially avoidable cost and resource inefficiency which impact upon the health of the patient and treatment outcomes. Since 1999 the cost of missed appointments to the NHS has tripled and in 2009 was estimated to be more than £600 million for that year (Kennard, 2009; Beecham, 1999). A recent report by the Department of Health, England reported that of the 15 million appointments offered at consultant led clinics between October and December 2012, around 1.5 million patients did not attend (DH, 2012).  The estimated cost is around £100 per appointment (Kennard, 2009).  A 1% reduction of missed appointments could result in savings of £6 million per year on consultant clinics in England and in excess of £16 million per year in savings to GP practices. Cost savings to allied health professional (AHP) and nursing clinics are potentially considerable. Reducing the number of missed appointments may be a relatively inexpensive way to support the intentions of the NHS to treat patients within 18 weeks of GP referral (DH 2009).

This proposal was developed through consultation with the Equality Directorate at Sheffield Teaching Hospitals NHS Foundation Trust hospitals.  They initially approached Sheffield Hallam University as they were concerned about the local black and minority ethnic (BME) groups non- attendance rates. In Sheffield we have undertaken work to examine the extent of the problem. Data from Sheffield Teaching Hospitals show that 210,000, out of 2 million appointments, were missed. Analysis indicated that 19% of patients who missed an appointment were from a BME background.

Aims and objectives
Recognising the need for robust local evidence to gain insights into the problem of do not attend (DNA) among black and minority ethnic communities we are proposing an exploratory, small scale community based study.   The twelve month project (October 2012-September 2013) will seek to:

  • Explore experiences and reasons for non- attendance at outpatients clinics in Sheffield.
  • Provide Sheffield Teaching Hospitals NHS Foundation Trust and other local services with primary evidence/ information to help them target interventions towards BME groups (reducing inequalities leading to better outcomes for patients).
  • Contribute evidence in the form of background data for a research bid to the National Institute for Health Research (NIHR).

We will use focus groups with BME groups who we will identify with the Trust as having the highest non- attendance rates. 


It is anticipated that this study will contribute to:  

  • Further grant capture: by providing local evidence to underpin a future grant application to the NIHR  which will be included in CLAHRC 2.
  • Service improvement: findings from this study will be used to target intervention towards BME groups, reduce inequalities and contribute to better outcomes for patients.
  • Outputs: a peer reviewed publication, presentation at the local/national level to disseminate findings.

Partners include Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Hallam University and CLAHRC SY.