Every practice expects the occasional unavoidable cancellation. Illness, emergencies and family issues will always exist. But when cancellations become a weekly pattern, the rota starts to feel fragile—and the whole practice feels it.
This guide focuses on what you can directly control as a practice or PCN manager: structures, communication, and booking practices that dramatically reduce last-minute cancellations.
1. Find out why cancellations are really happening
Before fixing cancellations, you need to understand their patterns. Are they mostly:
- Locums cancelling?
- Permanent staff sickness?
- Miscommunication about rota changes?
- Clinics booked without confirmed clinicians?
Look back over the last 4–8 weeks and list each cancellation with a simple tag: staffing, illness, miscommunication, double-booking, or other. You’ll nearly always see a pattern.
5-minute cancellation log
- What clinic? (e.g. AM duty, LTC, vaccinaton)
- Who cancelled? (locum, salaried, ANP)
- When did you find out?
- Reason given?
- Was there a clear backup plan?
2. Protect critical clinics first
Not all cancellations are equal. Some sessions can be absorbed with phone triage or rebooking; others cause immediate safety and access issues. Your first step is to ring-fence the most critical clinics.
High-risk sessions typically include:
- Morning acute / duty clinics
- Same-day access or on-the-day triage
- Child or frailty reviews
- Vaccination and immunisation clinics
These sessions should either:
- Be staffed by your most reliable permanent clinicians, or
- Have pre-booked and trusted locums assigned well in advance.
3. Shift from reactive to proactive locum booking
Many practices only reach out to locums when a problem appears. That almost guarantees last-minute cancellations because:
- Locums are already committed elsewhere
- Details are rushed and prone to misunderstanding
- There’s no time for proper onboarding or orientation
Proactive booking habits
- Pre-book high-risk clinics 4–6 weeks in advance
- Offer recurring sessions to your most reliable locums
- Reserve a small number of “buffer” locum sessions in busy periods
- Keep a shortlist of preferred clinicians who know your systems
Locums are far less likely to cancel when they have clear, recurring sessions with a practice they know and trust.
4. Reduce cancellations caused by miscommunication
A surprising number of cancellations stem from simple confusion: unclear session times, wrong location, misaligned expectations about workload or IT systems.
Standardise your booking confirmation
Every confirmed session—whether via platform, email or phone—should include:
- Exact times (including admin time before/after)
- Site/location (especially for PCNs or multi-site practices)
- Session type and typical appointment length
- Expected admin / results / prescriptions load
- Named contact on arrival
5. Build a small resilience buffer into the rota
If your rota is always operating at maximum capacity, any absence becomes a crisis. A small resilience buffer absorbs the shock.
Examples of buffer design
- One flexible clinician session each week (can switch roles)
- A pre-booked locum session in your highest-risk day of the week
- Protected admin blocks that can be converted to clinical time in emergencies
Impact example
“After adding a single buffer session on our busiest day, we reduced same-day cancellations affecting patients by over 40%.”
6. Tighten how you handle repeat cancellers
Patterns matter. If certain clinicians (locum or permanent) repeatedly cancel at short notice, that is a rota risk that needs active management.
Steps you can take
- Track individual cancellation history over 3–6 months
- Reduce priority for clinicians with frequent last-minute cancellations
- Offer more stable, recurring patterns to reliable clinicians
- Have a transparent, fair policy on cancellation notice periods
7. Use your data to change behaviour
Once you track cancellations properly, you can start using your own data to make better decisions:
- Which days are most fragile?
- Which clinics are most often affected?
- Are cancellations clustered around school holidays or specific months?
- Which locums and staff are consistently reliable?
Sharing this data with your team and your locums creates shared ownership of the rota. People are more likely to support the system when they see its impact clearly.
Final thoughts
You cannot eliminate every cancellation. But you can significantly reduce last-minute disruption by protecting critical clinics, pre-booking locums proactively, improving confirmation details and building a small buffer into the rota.
When cancellations become the exception rather than the norm, your practice feels calmer, patients experience fewer disruptions, and your rota finally feels like a tool—not a daily battle.
