With the growing use of remote appointments within the NHS, including telephone, video and voice messaging services, there is a need to understand potential barriers of access to care for some patients.

A team of researchers at Imperial College London, UCL and King’s College London analysed adult outpatient appointments at Imperial College Healthcare NHS Trust in northwest London in 2021.

Their observational study, published in the Journal of Telemedicine and Telecare, analysed over 874,000 outpatient appointments for 189,882 patients, examining missed appointments rates, and comparing remote and in-person appointments among different patient groups.

Key findings

  • During 2021, 10.3% of appointments at Imperial College Healthcare NHS Trust were missed, a total of 90,298 missed appointments.
  • Where a patient was invited to a first appointment in an episode of care, remote appointments were missed more frequently than in-person appointments (12.5% vs 9.2%).
  • Follow-up appointments had similar attendance rates regardless of whether they were remote or in-person (10.4% vs 10.7%).

Understanding sociodemographic differences

The researchers found sociodemographic differences in appointment attendance were largely similar between remote and in-person appointments. This suggests no widening of inequalities due to the mode of appointment.

However, the researchers did find evidence of inequalities in an individual’s likelihood to miss appointments. Younger patients, people living in deprived areas, and people of Black, Mixed and other ethnicities had lower attendance rates overall compared to people of White ethnicity.

Men missed more in-person appointments, especially when younger, but gender differences were minimal for remote appointments.

Patients with long-term conditions missed more first appointments, whether remote or in-person. But they missed fewer remote follow-ups compared to in-person follow-ups.

Implications for health policy and practice 

The researchers suggest that these findings provide some reassurance that remote appointments do not exacerbate existing healthcare inequalities. However, they highlight that targeted support is needed to improve accessibility and attendance for certain sociodemographic groups.

Policymakers and health providers should explore ways to identify individuals at risk of missing appointments, with a view to establishing interventions to mitigate this risk

Dr Mariana Pinto da Costa, senior lecturer, King’s College London and consultant psychiatrist at South London and Maudsley NHS Foundation Trust

The researchers also suggest a possible patient preference for in-person first appointments.

While we identified minimal difference in non-attendance rates of follow-up appointments based on appointment mode, first outpatient appointments were more frequently missed when remote, compared to in-person. This suggests that patients may prefer to have their first outpatient appointments in person. Healthcare providers should consider this when designing new remote consultation pathways

Professor Fiona Gaughran, professor of physical health and clinical therapeutics, King’s College London and ARC South London’s applied informatics lead

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