Many patients are regularly missing GP appointments according to the largest ever analysis of NHS patients who fail to attend.
The most important indicator of which patients will miss multiple appointments is socio-economic deprivation according to researchers.
The paper in The Lancet Public Health led jointly by Dr David Ellis of Lancaster University and Dr Ross McQueenie from the University of Glasgow examined the characteristics of patients who do not keep appointments with their doctors, sometimes on dozens of occasions.
This is estimated to cost the NHS millions of pounds a year and means patients are not getting the medical care they need.
This is the largest survey on missed appointments to date and tracked the appointment histories of over 500,000 patients in Scotland for 3 years from 2013-2016 using NHS data provided on condition of patient and practice anonymity.
It is the first ever survey of patients who miss not one but multiple GP appointments and revealed that:
Nearly 20% of patients missed more than two appointments over a 3 year period
46% of patients missed one or more appointments over the same 3 year period
The research revealed that patients most likely to miss multiple appointments are "significantly more likely" to be:
Aged over 90 years old
Dr Ellis said: "Despite this, the most important patient-level factor to predict the likelihood of serially missing GP appointments remains high levels of socioeconomic deprivation."
Patients were also more likely to miss multiple appointments if they were registered in GP practices which:
Offered appointments in 2-3 days following a booking request
Were located in affluent urban areas
Dr McQueenie added "Our results suggest that socioeconomically deprived patients attending practices based in more affluent areas might have particularly high levels of unmet health need in primary care settings."
The work is based on the theory that serial missed appointments are 'health harming behaviours'-complex behaviours that have their roots in experienced adversity with future ways to increase attendance aiming to focus on positive strategies to support patients' attendance.
Dr Andrea Williamson the academic GP who set up the study also said- ' These first results about the profiles of patients who struggle to attend GP appointments support clinical intelligence that patients who serially miss, have high levels of social and health vulnerability. Further analysis of our large data set examining health and social outcomes is investigating this further and will be published soon.'