Filling a gap at short notice, and why the waiting list never gets worked

A cancellation is not a no show #

They get counted together and they should not be. A cancellation gives you some notice, which makes the slot recoverable. A no show gives you none, so the hour has already gone by the time you find out. The NHS Fife physiotherapy service written up in CSP Frontline on 5 July 2017 tracked them as separate figures for exactly this reason, reporting cancelled and did not attend rates independently for new and review appointments.

Keeping them apart changes what you would do. A high no show rate is a question about reminders and about how far ahead you book. A high short notice cancellation rate with an unfilled diary is a question about recovery, and recovery is a different, much more mechanical problem. If the two are merged in your reporting, you will attack the wrong one. The no show figures page covers the other half.

What the hour is worth #

There is very little published on this, and what exists should be handled carefully. Speaking to Dentistry.co.uk on 20 September 2021, a dental practice manager put her practice's hourly cost at these figures.

That is one practice, in one discipline, five years ago, described in an interview rather than a study. We quote it because it is the only UK figure of its kind we could source, and because the shape of it is the point.

Your own version of that number is a five minute job from your accounts, and it beats anything published. The free tools will take your figures and give you the hours and the money without asking you for anything in return.

Why the list does not get worked #

Every practice has a list of people who said they would take a cancellation. Almost none of them work it reliably, and the reason is structural rather than a failure of will:

1. The gap appears with hours of notice, often less.

2. Filling it means calls, because a message sent to twenty people creates a race.

3. Calls take an uninterrupted stretch of reception time.

4. Reception is, at that exact moment, dealing with the person who cancelled and the two in the waiting room.

5. So the list is opened, three names are tried, nobody answers, and the slot is written off.

The same dental practice manager described the wider version of this: the courtesy calls her practice used to make simply stopped once things got busy. The list is not neglected because anybody undervalues it. It is neglected because it competes for the scarcest resource in the building at the worst possible time, which is also the subject of the phone during a session.

Which parts of this run on rules #

The last row is the one practices most often miss, and it is pure bookkeeping. That is a rule you could write on an index card, applied to data you already have.

The judgement that stays put #

Who gets offered the slot is not a first come first served question in any clinic worth attending. Somebody in pain, somebody mid course of treatment, somebody who has already been bumped twice and somebody who simply replied fastest are not equivalent, and ranking them is a clinical and human decision. Nothing on this site suggests that a system should make it. Whether to charge a late cancellation fee, and to whom, is the practice's call as well.

One data protection point #

An offer of a cancelled slot tells the recipient nothing new about themselves, but it does say that they are your patient, which is information about their health and therefore special category data under UK GDPR. Your practice stays the controller whichever supplier sends the message. The obvious trap is a group message that exposes one patient's details to another. The patient data page points at the ICO rather than interpreting the law here.

What to look at first #

Pull last month's cancellations, mark which slots were refilled, and count the ones that were not. Then count how many of those patients have rebooked at all. Those two numbers tell you whether you have a recovery problem or a retention problem, and they will not be the same size.