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Diary, no-shows and recalls
NHS failed-to-attend policy for a dental practice: what the rules let it say, a policy to copy, and the letter after two missed appointments
An NHS dental practice cannot charge for a missed appointment but must have a written failed-to-attend policy. What it may say, with a policy and a letter.
An NHS dental practice in England cannot charge a patient for a missed appointment, but it must have a written policy on what happens when one is missed. The NHS Business Services Authority (NHSBSA) says a practice "must have an agreed 'Fail to Attend' and 'Short Notice Cancellation' policy", and that all members of the practice "must be familiar with the policy and always follow it".
Since 23 June 2026 there is a second reason. NHS England's guidance on complex care pathways says the contractor should "have a written FTA policy aligned with NHS regulations, which is accessible to patients". The private cancellation policy is a separate document with a charge in it. This is the NHS one.
Free tool
NHS missed appointments letter maker
Fill in the two appointment dates and when you tried to reach the patient. The letter says the course of treatment is recorded as incomplete, that there is no charge, and how to come back.
- Read the practice's NHS contract first. Where it sets how many missed appointments are allowed before a course is recorded as incomplete, follow that number.
- The dentist reviews the record before the letter goes. Decisions about children's appointments are made by the dentist.
- Do not send it where a disability or a health condition explains the missed appointments. Look again first.
- Enclose the missed appointments policy and the complaints procedure.
- Record each missed appointment and each contact in the patient's record, with its date.
The rule this rests on: NHS Business Services Authority knowledge base article KA-01765 (a course recorded as incomplete under the practice's policy); GDS Contracts Regulations 2005, Schedule 3, paragraph 6; NHS website (no fee for a missed NHS appointment). A draft to check and adapt, not legal advice. Regulated work: a GDC-registered professional or the practice manager reviews every patient-facing draft before it is sent; nothing here is clinical advice and the AI assistant writes nothing clinical.
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What the rules allow
| Step | Allowed | Where it says so |
|---|---|---|
| Charge a fee for a missed NHS appointment | No | NHS website: a dentist "should not charge you a fee for missing NHS dental appointments" |
| Record the course as incomplete after repeated misses or short-notice cancellations | Yes, under the practice's policy | NHSBSA article KA-01765 |
| Treat later care as a new course of treatment | Yes | GDS Contracts Regulations 2005, Schedule 3, paragraph 6(4) |
| End a course of treatment yourself | Only in three cases | Schedule 3, paragraph 6(5) |
| Refuse to provide services | Only on reasonable grounds | Schedule 3, paragraph 1(4) |
The three cases in paragraph 6(5) are: violence or threatening behaviour that has been reported to the police, a patient who has failed to pay an NHS charge the practice requested, and an irrevocable breakdown in the relationship where notice has been given to the patient and to NHS England. A missed appointment is not on that list.
Paragraph 1(4) says the grounds for refusing services must not relate to a person's age, sex, religion or belief, sexual orientation, race, cultural and linguistic background, disability, or medical or dental condition. A policy cannot treat a miss caused by a disability or a health condition like the rest.
The NHS website tells patients the consequence in one line: "If you miss your appointment for any ongoing treatment without letting the dental surgery know, you may need to pay again for a new course of treatment."
How many misses
None of the sources we opened sets a number. NHSBSA says a practice "must follow its contract with the Commissioner where it specifies how many missed appointments are allowed" before a course is recorded as incomplete. Read the contract first.
A second NHSBSA answer, which would not open on 1 October 2026, appeared in search results to say the number should not be fewer than two failed visits. We could not confirm it, so check with the commissioner.
NHSBSA monitors incomplete treatment claims and flags unusual patterns to the commissioner, so record every miss with its date and the contact made.
The policy
Missed NHS appointments
- We do not charge for a missed or cancelled NHS appointment.
- Please give us [24 or 48] hours' notice if you cannot attend, by phone on [number] or by replying to your reminder, so that we can offer the time to another patient.
- If you miss an appointment or cancel with less notice, we will contact you to rebook and make a note on your record.
- If you miss or cancel at short notice [two] appointments in one course of treatment, the dentist will review your record. We may then record the course of treatment as incomplete and write to tell you why.
- If you need care after that, it will be a new course of treatment and a new NHS charge may apply.
- We apply this policy in the same way to every patient. Tell us if a disability, a health condition or caring duties make appointments hard to keep, and we will take that into account. Decisions about children's appointments are made by the dentist.
- If you think we have applied this policy unfairly, you can use our complaints procedure.
The bracketed figures are yours to set. Put the policy in the patient leaflet and on the website.
The letter after the second miss
Dear [name],
You did not attend NHS appointments with us on [date] and [date]. We tried to reach you on [dates] by [phone, text or email].
Under our missed appointments policy, which is enclosed, the dentist has reviewed your record and we have recorded your current course of treatment as incomplete. There is no charge for the missed appointments.
If you still need treatment, please phone [number]. It will be a new course of treatment, and a new NHS charge may apply unless you are exempt.
If something made these appointments hard to attend, tell us and we will look again. Our complaints procedure is enclosed.
[Name, role]
The letter closes a course of treatment. It does not end the relationship with the patient.
To stop seeing a patient altogether, GDC standard 1.7.8 applies. The decision must be fair and justified, and must not be made "solely because of a complaint the patient has made". The practice "should write to the patient" with its reasons and "take steps to ensure that arrangements are made promptly for the continuing care of the patient". Under paragraph 5 of Schedule 3, the contractor gives the patient notice and may then notify NHS England that it will no longer provide services. If the patient objects, the complaints procedure applies.
Complex care pathways
For a patient on a pathway, the guidance adds four steps: tell the patient at the start what may lead to removal, rebook a missed appointment as soon as possible, suspend the pathway if the new appointment cannot fall in the same declaration month, and give the reason for any removal. An incomplete pathway cannot be reopened.
Before the policy is needed
The guidance names appointment reminders, easy rebooking and attendance monitoring as ways to cut misses. The recall and reminder planner sets the reminder dates, and the failed-to-attend cost calculator prices the rate. Urgent slots have their own rules: see unscheduled care in the 2026/27 contract.
In the practice
Overlyft can set up an AI assistant that schedules the reminder sequence, records each recall contact with its date and channel, and reports the failed-to-attend rate each month. It never quotes a charge on an NHS appointment. A GDC-registered professional or the practice manager reviews anything a tool drafts before it reaches a patient. This page is general information, not clinical or legal advice.
Short answers from this page
What can an NHS dental practice do about a patient who keeps missing appointments?
It cannot charge a fee. Under its written fail-to-attend policy it can record the course of treatment as incomplete, and later care is then a new course. The contract regulations let a contractor end a course itself only for violence reported to the police, an unpaid NHS charge, or an irrevocable breakdown notified to the patient and NHS England.
Source: NHS website; NHSBSA knowledge base article KA-01765; GDS Contracts Regulations 2005, Schedule 3, paragraph 6
Every short answer for dental, physio and aesthetics clinics
Where this comes from: NHS website, "What happens when you visit an NHS dentist" (page last reviewed 13 March 2025); NHS Business Services Authority knowledge base article KA-01765, "When can I claim a course of NHS dental treatment as Failed To Return (FTR)?"; NHS England, "NHS dentistry: quality and payment reforms contractual guidance" (version 2, last updated 29 July 2026), sections 4.9 and 4.10; GDS Contracts Regulations 2005, Schedule 3, paragraphs 1, 3, 4, 5 and 6; GDC Standards for the Dental Team, standard 1.7.8. All read in a browser on 1 October 2026. Not legal advice; the contract holder and a GDC registrant approve the policy before it is used.
AEO Lookup editorial team
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