MILLIONS of patients are missing appointments with their GPs - and nearly two-thirds of doctors would like to see them 'fined'.

A survey suggests that across Britain, nine million people a year miss their appointments, costing the NHS '160 million.

In Greater Manchester alone, the cost of the estimated 363,781 lost appointments is '6.5m a year.

Some Manchester GPs claim as many as one in ten patients a day don't turn up, at a cost of '18 each.

But experts fear the true total cost could be even higher, because an estimated 106,635 patients in Greater Manchester also fail to show up for practice nurse appointments, which could boost the bill to about '8.4m - enough to pay for 1,800 hip replacement operations a year.

There is now support for a system of reminders including the use of e-mail and text messages.

The shock figures were revealed today by the health education charity Developing Patient Partnerships (DPP) and the Institute of Healthcare Management.

In Greater Manchester, eight in ten of the 555 GP practices polled said that missed appointments were increasing waits for other patients in their practice. And 97 per cent reported that it was a waste of NHS money and resources.

In one surgery in Stockport used by 3,500 patients, 60 appointments are missed a month - at a cost of around '1,800 a month taking a GP's salary and time into account.

But less than half of the family doctors in Greater Manchester back 'fines' for wasting their time, as many think it would be impossible to enforce and most said patients simply forget about appointments.

Half the GPs supported using text messages, e-mail or phoning to remind them.The spokesman for the British Medical Association in Manchester, Dr Kailash Chand, said many patients did not care about missing appointments because there was no financial penalty.

The GP, who runs a surgery in Ashton under Lyne, did his own research and found 10-15 per cent of patients who booked did not turn up.

'It's a major problem in east Manchester and it is very worrying for the NHS,' he said.

'We are all paying for this as taxpayers and patients are suffering as a result.'

He rejected one excuse that surgeries closed at 6pm, leaving 'after-work' patients little margin for error if delayed.

'Six o'clock closing has been in since 1948,' he said. 'If people want to go to the barbers or somewhere else they can find time.'

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