Iacobucci points out that missed GP appointments have been the subject of intense political interest, much of it misleading and designed to blame “feckless” patients.1 In a recent article in BMC Medicine, we described an extremely strong association between repeatedly missing appointments and a greatly increased risk of mortality independent of the presence of known long term conditions.2 These findings persist after correcting for the number of appointments made. Around 5% of patients who missed more than two appointments a year over a three year period had died within a year of follow-up.The increased risk of all cause mortality shows a dose based response with increasing number of missed appointments. Patients with long term mental health conditions who missed more than two appointments a year were over eight times more likely to die (all cause mortality) than were those who missed no appointments. These patients died prematurely, commonly from non-natural external factors such as suicide.Missed appointments are a major risk marker for all cause mortality, particularly in patients with mental health conditions. For these patients, existing primary healthcare appointment systems may be ineffective. Clinicians (and politicians) should carefully consider the causes of repeated missed appointments rather than ascribing blame.