Patients who fail to turn up for hospital appointments should be given a second chance, GPs in Wales have said.
Nearly 1.5 million outpatient appointments were missed in the past five years, costing about £240m.
But it means many patients need to go back to their GP for a new referral which takes up surgery appointments.
GP leaders say no-shows are not always deliberate but the Welsh Government said it was up to the patient to let hospitals know they cannot attend.
Missed outpatient appointments
% missed by health board, 2018/19
According to official statistics, 1,459,096 outpatient appointments were missed at hospitals across Wales over the last five years, of which 408,559 were new appointments.
There were more than 15.3 million appointments over that period. Cwm Taf and Cardiff and Vale health boards have consistently had the highest proportions of missed appointments.
Freedom of information requests have suggested the average cost of a missed appointment is £157.
Dr Peter Saul, joint chairman of the Royal College of GPs in Wales said people not turning up was a “wasted opportunity” and “depriving” someone else of an appointment.
“At most hospitals in Wales if you miss one you will get kicked out of the clinic and then they have to come and see the GP – wasting one of our appointments asking to be referred again,” he said.
“If somebody misses their appointment we haven’t been able to fit somebody else in and that’s quite critical given stresses on the system.”
He added: “People will then go to the A&E or out of hours and say they couldn’t get an appointment at their GP practice.
“So the person who doesn’t turn up for the GP appointment could be lengthening queues at A&E.”
Dr Phil White, chairman of the British Medical Association’s GP committee, also wants to give patients a second chance.
He added: “From a GP’s perspective, we do get people who say they missed one appointment but they say they have phoned in or didn’t receive the letter.
“What has got worse is the lack of an offer of a second appointment. Now they [hospitals] have taken this draconian attitude of you’ve missed an appointment and you’re off the list.”
Hospitals have started sending texts to remind patients which health boards say has helped reduced the amount of missed appointments.
Figures show there were just under 20,000 fewer missed appointments in 2018/19 compared to 2014/15 with year-on-year falls recorded.
But health boards have admitted there is still work to do.
John Palmer, chief operating officer at Cwm Taf Morgannwg University Health board, said offering another appointment is based on a number of things including the nature of the treatment, the speciality, the number of times an appointment has been missed and why they were unable to attend.”
Cardiff and Vale University Health Board said where patients did not show up, they could be be rebooked “if there is a good clinical reason” but it was looking to reform outpatient services which would reduce the need for face-to-face appointments.
Sue Wood, outpatient services improvement project lead for Betsi Cadwaladr University Health Board said a survey had helped to understand why patients miss appointments.
She added: “Patients asked us to add additional information to the text reminders… however, we really need our patients to help by consenting to this new information.”
Richard Evans, executive medical director Swansea Bay University Health board, said it plans to work with patients to “develop appropriate strategies for a long-term solution to this problem”.
Andrew Carruthers, director of operations at Hywel Dda University Health Board, said text reminders had “already had a significant impact on non-attendance”, while Aneurin Bevan university health board said mobile phone numbers are collected “to ensure as many receive text reminders as possible”.
Powys Teaching health board said when appointments are made patients are given a choice of appointments to reduce the likelihood of non-attendance.
A Welsh Government spokesman said: “There is a responsibility on the patient to let the hospital know when they are unable to attend appointments so that those appointments can be offered to other patients.
“For those patients who do not attend, the hospital will write back to the referrer and say the patient did not attend and they will be removed from the waiting list.”