Up to 62% of missed NHS outpatient appointments can be blamed on patient apathy, research suggests.

Nearly one third of non-attendees simply forget to turn up.

Dr Tony Tham and colleagues at the Ulster Hospital in Belfast followed up patients who had missed appointments at a gastroenterology clinic.

They found that on average, 14% of patients did not keep their clinic appointments.

Every time a patient misses an appointment it is estimated to cost the NHS �65.

This means that if the same absenteeism rate was recorded across the NHS it would cost the health service approximately �300m in England alone.

The survey found a quarter of those who had missed an appointment during the seven months of the survey had missed at least one other appointment in the past.

Some 26% of respondents gave no reason at all for not coming to the clinic, while 30% "forgot".

A minority of people blamed clerical errors and "fear of medical staff".

Counter productive

The problem is even worse in the US, where one group of researchers found the average rate of non-attendance to be between 13-26%.

The authors argue that solutions which work in some studies, such as phoning patients with reminders or getting them to make and confirm their own appointments, are unlikely to work long-term across all kinds of outpatient clinics, and are themselves a drain on resources.

They suggest that clinics should expect a certain amount of patient apathy and "overbook" to take this into account.

The government aims to introduce electronic booking across the NHS to try to minimise the problem.

But the researchers said it remained to be seen whether such an approach would have any effect.

Dr Simon Fradd said education initiatives were vital

Dr Simon Fradd, chairman of the Doctor Patient Partnership said the results were not surprising.

He said: "Missed appointments seem to be a problem across specialities and across sectors."

A Doctor Patient Partnership survey of missed GP appointments showed that over 89% of health professionals felt that missed appointments are a problem in their surgery and over 87% felt that a reduction in missed appointments would lead to shorter waiting times.

Dr Fradd said: "There are a whole host of reasons for patients missing appointments and these vary from inner city areas to more rural areas.

"Problems in getting through to cancel appointments, booking appointments so far in advance that they get forgotten and simply not recognising the value and cost of the appointment have all be cited by health professionals as reasons for patients missing their appointments.

"To get the message across to patients that their appointments are valuable whilst offering advice to practices on how to help their patients avoid missing their appointments is vital."

The research is published in the Journal of the Royal Society of Medicine.