The report by Developing Patient Partnerships (DPP) found that nine million GP appointments were missed at a cost to the NHS of �160m.

However, the British Medical Association disagree with fining patients for not turning up for doctors appointments.

Do you think patients should be fined for missed appointments? Is there another way to encourage attendance? Send us your views.

This debate is now closed. Thank you for your comments.

The following comments reflect the balance of opinion we have received so far:

SUGGEST A DEBATE This topic was suggested by Ruth Kay, UK: Missed GP Appointments - why does this happen and how could it be improved? Send us your suggestions for Have Your Say debates

Not only should missed appointments be paid for, but a small fee should be paid each time one sees a doctor, as we do in France. The state then refunds a large chunk of the fee and one's mutual insurance the rest. It is having to pay up front that is the best discipline. Obviously, if one is so poor that even that is not possible, then the state steps in to help. The NHS would benefit enormously if we had a similar system - not so much from the fee, but because the system would be 'freed up' by unnecessary visits.
Barry Rochfort, Assac, France

There are so many reasons why someone would miss an appointment. There a bit too paranoid that day. They fell asleep. People don't tend to make an appointment at the doctors if there feeling 'ok'. A lot of the sickest people in the country, the ones who will probably miss most appointments, are also the poorest.
Olive Stieber, Reading

Instead of fining people for missing an appointment, most of whom will then claim they cannot pay, why not charge people up front when they book the appointment and refund the money when they turn up on time ?
Graham, Oxford, UK

If the person is not impaired and it's clearly their fault for not turning up because they forgot or couldn't be bothered, then yes a fine based on ability to pay is a good thing. That money should be channelled into improving the service for others. Also those that miss appointments should have a lower priority for appointments unless it's a serious need.
David, UK

We already get charged for missed dental appointments so why should doctor's appointments be any different. It may stop people making appointments which were unnecessary in the first place.
Colin Bennett, Dukinfield UK

Yes by all means fine patients for non attendance. What about fining doctors who keep patients waiting?
Gary Huckins, Middlesbrough UK

Yes! Only I'd do it differently anyway and make people pay for a doctors appointment (even �5 would do), so it has some worth to them. That's everyone, no exceptions. The system is abused because it's 'free'.
Paul, Taunton, Somerset

Maybe if it wasn't such a pain trying to obtain an appointment in the first place, knowing that you'll be put on hold for ten minutes before speaking to a receptionist and then going through the same rigmarole to cancel your appointment. If they had a dedicated line so you could leave a message - people would call to cancel.
N.Morgan, Manchester,UK

Being able to see a GP on the day you feel ill makes more sense than having to predict your illness Miss Payne, Hucknall, Nottinghamshire

The GP's surgery I am registered with works on a very successful first come first served system. You can go to the surgery when you need to and wait to see a GP - this is a lot better than the very dated 'appointment' system - where inevitably patients are likely to feel better by the time their appointment comes around - sometimes weeks in advance. Being able to see a GP on the day you feel ill makes more sense than having to predict your illness to ensure seeing a GP when you need to. However - I do agree that patients need to be responsible for cancelling any appointment they do not wish to keep or face further action.
Miss Payne, Hucknall, Nottinghamshire

Having worked at various outpatient clinics within the NHS it is quite shocking the number of patient's who fail to turn up for appointments. We used to call people who didn't show up and some of the excuses were quite ridiculous, one lady said she had to wait in for a parcel to be delivered, another patient said she couldn't come in at the appointment time given because she had to drop her children at school (so why did she take the appointment in the first place). I suppose it is a bit much to expect a phone call from these people. Unfortunately, I don't think there is a practical way of fining patients. The idea of restricting access to the GP until a fine is paid is just not going to work in my opinion.
Jamie Reeves, Hounslow

Why don't GPs do what my surgery has done and do book on the day appointments. you phone at 8 am for a morning appointments and at 1 pm for afternoon ones. Makes perfect sense as when you're sick you need an appointment that day and not in 3 weeks time.
Rebecca, London

Fining people won't solve anything - we don't want healthy people keeping appointments, we want sick people to make them. A better solution would be to ask for a deposit when the appointment is made, and refund it when the patient attends.
Chris Gilmore, Reading, UK

I don't think patients should be fined. What about patients who have made an appointment and don't get to see the doctor until half hour after their appointment time. This is a real inconvenience especially when you have to go back to work.
Asia Khatun, Cardiff, Wales

The system doesn't work. It takes so long to get an appointment I simply don't bother. My wife recently had to wait 4 weeks to have some minor treatment which took less than 2 minutes!
Steve Bell, Ingleby Barwick, England

Are the doctors going to compensate patients for poor waiting times and rude reception staff?! Jon, Newport, Wale

Are the doctors going to compensate patients for poor waiting times, giving bad diagnosis and rude reception staff?! I went to see my Doctor about a bad ear infection and all he did was give me a prescription and gave me some printed material off the internet. It felt as though I was an inconvenience!
Jon, Newport, Wales

I think that GP's themselves contribute to the number of 'no shows' by being so inflexible in their appointments system. In my GP's surgery there is a large notice complaining about the number of missed appointments, yet when I was wanted to arrange an early appointment and was told (as usual) to wait 2 weeks, I offered to come within 10 minutes of a 'no show' they could just pull forward the next appointment whilst I travelled to the surgery. Of course it was too much trouble for the staff to organise. They prefer to just moan about it.
Robert, England

If so many people are missing appointments then how come I still have to wait for over an hour (on average) whenever I go to the doctor's? I costs my business money as well to have me sitting in a waiting room for an untold length of time (for I can only get an appointment in office hours) when I should be at work.
Sue, Herts

The question is how much would it cost to implement? Missing 5% of appointments means about 1 an hour for a surgery with 5 minute appointments and 2 GPs seeing patients. Which is cheaper, paying for additional GPs to cover the 5% missed appointments or paying someone to recover the fines? Probably having more GPs. Therefore fines will cost money and so are pointless. Striking people off a GPs list is another matter though, 3 strikes and you're out seems reasonable...
Tim, Fareham, UK

Too many people expect to get their rights without accepting their responsibilities Barry Trewern, Essex,

When all our Health Service resources are under such pressure I believe that some form of sanction is required in this and many other areas to stop irresponsible or frivolous actions on the part of some patients wasting appointments or other resources. Too many people expect to get their rights without accepting their responsibilities.
Barry Trewern, Wickford, Essex, England

My local surgery put the phone onto answer phone once their list is full for the day. How are patients supposed to cancel ?
Stephen Lewis, Twickenham, UK

And just what is the cost to the economy of the time wasted by patients sitting in waiting rooms while doctors fail to keep to appointment times?
Peter, Bristol, UK

Definitely! With so many people unable to register for NHS treatments, it is outrageous that people miss appointments, wasting doctors and dentists valuable time. My partner is a dentist and estimates 10% of his patients don't turn up (more if it's sunny). If these people are called to ask why they have no explanation - often it's because they were having dinner or were home late from work. I think if you miss an appointment and don't call in advance, with no valid explanation, then you should no longer be entitled to receive treatment from that dentist, doctor so that they can make way for new genuine, unselfish patients.
Tracy, St Albans

You ring up in the morning, you see the doctor the same day Ruth, Oxon, UK

The best answer is to move - as my surgery has done - to a system of 'same day' appointments. You ring up in the morning, you see the doctor the same day. It's very unlikely you'll forget, nor get better before the appointment, which I understand are the two main reasons for missed appointments. It's simple, and with two small children subject to the usual childish ailments the ability to see a doctor the same day is brilliant.
Ruth, Oxon, UK

As a practising GP I frequently am irritated by patients who miss or are late for appointments, however the majority have good reasons when confronted, others are simply not capable of the organisation required to turn up on time and thus need my support not punishment. (I also have no desire to collect cash thanks) As regards running late, almost all GPs HATE to run late but, unlike machines, humans have differing requirements - the only reason I ever run late is because a patient has needed that extra bit of time, makes you think doesn't it.
Helen Stokes-Lampard, Sutton Coldfield, West Mids

I haven't heard any explanation as to why the obvious solution isn't used: give the missed appointment to the next person on the list. Why is that not the immediate and automatic reaction to someone not turning up for an appointment? If the late-comer does turn up, they can then take their turn after all the people they would otherwise have inconvenienced. Simple? Sounds like it to me.
David Hazel, Fareham, UK

The proceeds should go to opening the surgeries outside of normal office hours Jo, Bristol, UK

Yes - people who miss an appointment should be fined, and the proceeds should go to opening the surgeries outside of normal office hours - I have to take a half day off every time I want to see the nurse to get my pill renewed.
Jo, Bristol, UK

This is a non-starter, imagine the army of administrators required to collect the fines, and what if people refused? The only answer may be to drop persistent offenders from the practice list. But then, perhaps people can't get through to the surgery to cancel..
Sue, UK

Just the other week I needed to cancel an appointment, which I tried to do on several occasions over about three days , but every time I rang the phone was engaged. Should I have paid for not attending the appointment? I think not!
Mark, UK

If patients are to be fined for missing appointments (which I agree with up to a point) can Doctors also be fined for missing appointment times (waiting for around 45min after your appointment time is rather annoying!) or cancelling appointments at the last minute (as it can take a lot of effort by the patient to arrange transport and time off work to attend the appointment)?
Sharon, Sheffield, England

I think people should be fined - it takes no time to pick up the phone to cancel. It would certainly make people think twice. I struggle to get an appointment at my local clinic and this is one of the reasons why.
Alan, Scotland

Patients should not be fined. We pay our taxes and that should be enough until the service the NHS provides improves. Should doctors be fined for running late? Surely they should have no excuse for this as there are so many people missing appointments
Paul, UK

The way to cut missed appointments to zero is to scrap the appointments system Dave Hough, Nottingham, UK

The way to cut missed appointments to zero is to scrap the appointments system. Basically, if you turn up at the doctor before say 3.30 p.m. and join the queue then you'll get to see the doctor. Simple. It works at the NHS drop in centres perfectly well.
Dave Hough, Nottingham, UK

I think all appointments should be paid for by the patient. Whatever happened to that �10-per-visit suggestion? The �10 should, of course, be payable even by those who miss their appointments.
Andrew, Cardiff, UK

Don't be daft. It simply wouldn't work. Those on benefit would be 'exempt' from the fine, some would simply say "no" and the rest would some-how manage to prove they had a good reason for not turning up. People who consistently miss appointments should be forced to find another practice. After being moved on a few times I think it would sink in.
Glen, Welling, UK

I have missed two appointments this year: one because I broke my ankle on the way to the dentist and one because I was in a car accident on the way to the doctor. I may be an idiot, but I'd rather not be fined for it.
Anonymous, UK

I would go one step further and say that if you miss three appointments you get struck off the surgery register Cate, Berkshire

Yes, people who consistently miss appointments are time wasters and cost tax payers millions. I would go one step further and say that if you miss three appointments you get struck off the surgery register then perhaps they can see how serious it is to waste the doctors time.
Cate, Berkshire

I think that the reasons for missing appointments should be looked at. I agree that it is outrageous, and that the NHS certainly shouldn't have to use their precious resources on it. But to charge patients might discourage them from getting the treatment they need.
Alice, London, UK

In my previous doctors surgery they had a board that showed the number of appointments made and the number attended. The difference always made see red. All it takes is a phone call. Fining is a good idea but how would the monies be collected?
Carol Braithwaite, Hampshire

There should be an automatic on the spot fine of �30 for each missed appointment with no access to any medical facilities until it has been paid regardless of whether the person is at death's door or not.
Robert Warner, Warwick UK

People who miss them are selfish and make the rest of the population suffer needlessly David, Edinburgh

In a word, yes. People who miss them are selfish people who make the rest of the population suffer needlessly.
David, Edinburgh

Damn right they should have to pay. I'd prefer to see the NHS privatised and monthly charges reduced to say �40 a month for everyone to cover those that can't afford private health care. It works in the US why not here. As we all know the NHS is a financial black hole and is consistently costing millions more every month.
Damian, UK

The answer is a simple YES....Perhaps the people that don't turn up for appointments could make room for those people that genuinely need to see a doctor! Maybe a fine would help the matter. I currently have to wait 3 weeks to see my GP - perhaps this could help the situation?
Alan Farrow, Romford, UK

Patients should be fined without a doubt. I've just had to wait 6 weeks to see my GP for a routine appointment to renew my repeat prescription, so anything that makes it easier to get an appointment needs to be brought in ASAP.
Matt, Burnley, England

It is an excellent idea but there is one question - how will the fines system be implemented ? Will it be via the tax/benefit system (i.e. the patient in the pocket directly) or like the parking tickets - notification through the post? I prefer the former method
Rosemary, Lozells, Birmingham

It would be difficult to know where to draw the line. The only way to enforce it would be to fine patients whatever their reason for missing an appointment. However, what's a reasonable reason for missing an appointment? Would you be happy to pay a fine for missing an appointment even though it wasn't your fault?
Nick, London

Yes, unless you have a note from the doctor explaining why you missed it.
Al, UK

I believe it is an excellent idea as it will make people think about their responsibilities Roshan, UK

I believe it is an excellent idea as it will make people think about their responsibilities and realise that the GP's time is a valuable commodity. It will also mean that appointments are being made for genuine reasons.
Roshan, UK

Yes as long as it also means that I am guaranteed to get an appointment within 24hrs. The present wait of over 10 days is totally unacceptable.
Keith, UK

If I was ill and had made an appointment with a doctor, then I would attend the appointment. If I were to miss the appointment with no warning, it would have to be for something pretty serious, in which case paying for the appointment becomes a triviality that I'd be happy to do.
John, Southampton, UK

GP practices must introduce appointments schemes that make it possible for working people to see their doctor Tina, Manchester, UK

You'll probably find that the main culprits are those that would be exempt from payment anyway. In the meantime, GP practices must introduce appointments schemes that make it possible for working people to see their doctor.
Tina, Manchester, UK