The hidden cost of missed appointments in the NHS—and how tech is closing the gap

Missed appointments have long posed a silent financial drain on the National Health Service, but a wave of digital innovation—anchored by the NHS App, artificial intelligence technologies, and intelligent messaging—is beginning to yield measurable results. In the 2023–24 cycle, England’s NHS recorded roughly eight million missed outpatient appointments, officially tallying a cost burden upward of £1.2 billion in wasted clinical time and administrative overhead. With NHS England increasingly focused on leveraging technology to reduce these inefficiencies, recent data suggests progress is being made.

Why do so many patients miss NHS appointments?

Missed appointments, commonly referred to as “did not attends” (DNAs), occur for a variety of reasons. Patients frequently cite forgetfulness, logistical barriers such as transport, or unclear communication as contributing factors. These missed sessions not only delay treatment for individuals but also exacerbate waiting lists, particularly in elective and outpatient services. The root causes lie in both patient behaviour and outdated communication systems that fail to engage effectively with modern lifestyles.

How much money is lost to missed NHS appointments?

Official statistics confirm that out of 124.5 million scheduled outpatient visits in 2023–24, around eight million were unfilled—representing approximately 6.4% of total bookings. Each appointment is estimated to consume £165 of NHS resources, combining clinical and administrative costs, resulting in the £1.2 billion annual figure. Internal analyses suggest the average NHS trust absorbs losses of more than £8 million per year, with high-density hospital trusts in London facing liabilities upward of £50 million. These financial drains reduce available clinical hours and exacerbate the strain on under-resourced departments.

What digital tools are being used to reduce no-shows?

NHS England has significantly expanded digital intervention tools across its trust network. The NHS App, now installed by more than 20 million users, allows patients to receive appointment reminders, cancel or reschedule visits, and receive real-time health messages. Between July 2024 and April 2025, NHS England reported that the App helped prevent 1.5 million missed hospital appointments and saved 5.7 million staff hours. These gains translated to approximately £622 million in productivity value. App integration is now live in over 87% of NHS hospitals, exceeding the government’s initial 85% target for elective care digital engagement.

Artificial intelligence is also being piloted in predictive use cases. At Mid and South Essex NHS Foundation Trust, a machine learning model was deployed to assess DNA risk by analysing weather data, transport access, and patient-specific scheduling patterns. The system led to a 30% reduction in non-attendance rates and facilitated nearly 2,000 additional patient contacts over six months. Trust officials estimate the annualised savings from this deployment at £27.5 million. Meanwhile, at University Hospitals Coventry and Warwickshire NHS Trust, a process-mining AI tool was used to optimise reminder timings—shifting notifications to 14 days and 4 days prior to appointments. This adjustment helped bring DNA rates down from 10% to 4% among targeted patient groups.

Are tech-driven reminders really working for the NHS?

Preliminary results suggest the digital-first approach is delivering tangible performance improvements. According to NHS Digital data, trusts that enabled NHS App notifications recorded a three percentage point increase in patients treated within 18 weeks in November 2024. That gain alone translates to roughly 211,000 additional completed treatments across the system. The reduction in no-shows also delivered operational benefits, such as lower administrative loads, streamlined rebooking flows, and improved workforce allocation.

In financial terms, digitising reminders has reduced reliance on paper and SMS. NHS England projects a savings figure of £5.2 million in postage costs through reduced reliance on letters, alongside the avoidance of 15.7 million SMS message sends. Independent studies also indicate that applying behavioural economics to messaging—such as referencing the broader public cost of missed appointments—can reduce DNAs by up to 30% at virtually no marginal cost.

What are the future plans to cut appointment waste?

The future roadmap includes more personalised and proactive interventions. Upcoming NHS App enhancements will allow patients to cancel or reschedule directly with two-way messaging, receive reminders based on live travel data or forecast conditions, and choose hospital locations based on real-time wait times, transport convenience, or appointment slot availability. These features will support wider goals under the NHS 10-Year Health Plan to give patients greater control over elective care.

Plans are also in motion to embed video consultations into the NHS App interface for specialties where remote care is feasible. Further integration of AI for patient-level recommendation logic is under discussion, including smart nudges for attendance, alternate time suggestions, and behavioural feedback loops.

How health policy experts view the NHS’s digital push to reduce no-shows

Health policy experts from organisations such as the King’s Fund and Nuffield Trust have broadly supported the expansion of digital communication tools. They have characterised the shift as a pragmatic and cost-effective response to longstanding structural challenges facing the NHS, including rising patient demand and staff shortages. However, they continue to call for sustained funding in system interoperability, local IT integration, and frontline training to ensure that digital tools can operate effectively at national scale.

Clinicians involved in early deployment have offered measured optimism. Several trusts have reported that streamlined digital workflows allow care teams to focus on clinical complexity rather than rescheduling or tracking non-attenders. At the same time, concerns remain about equity and access—particularly for older populations, rural patients, or those without regular smartphone access.

From an institutional perspective, NHS England’s leadership views appointment innovation as a foundation for broader digital transformation. By reducing friction in the most frequent and resource-heavy operational process—appointments—the system builds the framework for AI-driven triage, digital consultations, and resource-efficient clinical pathways. Progress in this space could unlock measurable impact across elective care backlogs, cancer wait times, and even preventive screening programmes.