Patients who miss appointments could be struck off by GPs battling the cost of surgery time-wasters.

One Bradford practise has already introduced a 'three strikes and you're out' policy for patients who repeatedly skip appointments.

And today a doctor's leader called for GPs across the district to be able to follow their lead and strike off patients who continually miss appointments.

The call comes as a new survey published today reveals a massive 10 million GP appointments are missed each year, costing the NHS £180 million a year.

The survey found that 80 percent of GPs would consider axing patients who repeatedly miss appointments. Each one wasted costs surgeries about £18.

Last week practises in North Bradford Primary Care Trust had 352 missed appointments - almost 30 missed appointments each - with one having 71 in the week.

In Airedale Primary Care Trust there were 178 missed appointments last week across its 16 practises, with one having 37, the equivalent of eight hours of wasted time.

Bradford South and West and Bradford City Primary Care Trusts do not collate the figures but they are monitored by practises instead.

In Bradford, Ashwell Medical Centre in Ashwell Road, Manningham, has introduced a policy of writing to people who miss three appointments.

Patients are warned that if they persist in their behaviour they will be removed from the list. The stark warning has had a dramatic effective of slashing the amount of GP and nurse hours wasted.

Dr John Givens, secretary of the Bradford Local Medical Committee, a body which represents GPs, supported the scheme introduced at Ashwell and called for more support for doctors who take a hard line on time-wasters.

He said: "It is an understandable reaction by GPs.

"Missed appointments are a significant waste which adds to the problem of access to GPs. It is an example of very irresponsible behaviour by patients.

"They deprive others of getting an appointment. It is irresponsible not to phone.

"It should be within GPs' power to strike off patients who repeatedly offend."

However Dr Givens added that regulations made it "very difficult for GPs to justify such a removal" and called for them to be given legal powers to strike off patients.

Eighteen months ago Ashwell Medical Centre introduced several innovative measures after if was found the practice lost the equivalent of one full-time GP's working week - 40 hours - to missed appointments.

The surgery, which has seven GPs looking after 6,700 patients including some part-time, has now reduced missed appointments to 30 a week - the equivalent of seven hours.

Anne-Marie Pemberton, practise manager, said: "Previously we booked four weeks in advance, now we only book for the current week.

"If people don't attend two appointments they receive a phone call and if there is a recurrence of the problem for a third time they are contacted by letter warning them they could be removed from the practise."

So far no one has been removed from the list and the letter usually results in people phoning to apologise for their behaviour.

The survey is published by Developing Patient Partnerships (DPP), a health education charity, and the Institute of Healthcare Management.

In Yorkshire and the Humber the survey found there were 942,217 missed appointments with a GP and 531,350 with a nurse. Eighty per cent of practises said they would consider striking a patient from their list who repeatedly missed appointments.

DPP spokesman Dr Terry John said: "These results are disappointing, especially if we consider that each GP appointment costs £18.

"On the bright side, most practises believe that this figure can be reduced through effective communication about the impact of missed appointments."