Patients failing to attend general practice appointments has substantial time and cost implications for health care. In 2019, approximately 7.2 million GP appointments were missed annually in England, costing the NHS around £216 million.1 Missed primary care appointments add to the already over-stretched capacity of GPs and healthcare professionals. In addition to this, patients failing to attend appointments potentially leaves already vulnerable patients living with unmet need, and delays appropriate treatment and diagnoses, adding to longer or more severe conditions with increased cost to the NHS.2

A review of studies from five countries found a mean of 15.2% of booked primary care appointments were missed in recent years. Patients of non-white or minority ethnicity, low sociodemographic status, younger age, or with mental health or multiple physical health conditions were more likely to miss appointments.3 Common reasons for missing general practice appointments included work or family commitments, forgetting the appointment, difficulties with transportation to get to the appointment, and appointments not being with a preferred GP.3

The rise of ‘total triage’ approaches in general practice has been well documented in the years leading up to the COVID-19 pandemic4 with ‘telephone first’ and ‘digital first’ approaches emerging as a way to manage demand. The COVID-19 pandemic accelerated the implementation of these approaches as they offered a way to help patients remotely where possible, during the national lockdowns. Total triage can …