Missingness in healthcare paper highly commended by Royal College of GPs

A research paper co-authored by Professor David Ellis was highly commended by the Royal College of GPs Research Paper of the Year 2024 award in the ‘Health Service Research’ category.

The accolade was announced at the College’s annual conference in October 2025. It was one of only three such commendations awarded for the year.

The RCGP Research Paper of the Year Award gives recognition to an individual or group of researchers who have undertaken and published an exceptional piece of research relating to general practice or primary care.

“This recognition highlights the critical need to move beyond simply viewing missed appointments as a service problem, and instead understand the complex, interconnected factors that prevent patients from accessing the care they need,” says David. "Our research shows that 'missingness' is often a symptom of deeper systemic issues rather than individual patient failing."

He continues:

“The realist review approach allowed us to synthesise evidence across nearly 200 papers to reveal how factors such as socioeconomic disadvantage, poor communication experiences, competing life demands and inflexible appointment systems create barriers to consistent healthcare engagement. This understanding is essential for developing more effective, patient-centred interventions”

Cause and effect

'Understanding the causes of missingness in primary care: A realist review', published in BMC Medicine in June 2024, was the result of work carried out by academics at Bath and the Universities of Glasgow and Oxford.

The research reviewed evidence from 197 prior papers to identify causes of ‘missingness’ – where patients miss multiple healthcare appointments. It found a complex set of interlinking factors, including travel issues, power imbalances and patients not feeling a need for the appointment.

The research could be used to to inform policy and practice to address missed appointments, helping to improve patients’ overall health.

David explains:

“Rather than simply implementing one-size-fits-all solutions like reminder texts, our findings suggest that healthcare systems need tailored approaches that address multiple causes simultaneously. This means considering everything from appointment booking systems and staff training to addressing broader social determinants of health. The goal is to create services that are genuinely accessible to those who need them most.”