Did Not Attend (DNA) Policy
Did Not Attend (DNA) Policy
Introduction
More than 15 million general practice appointments are being wasted each year because patients do not turn up and fail to warn surgeries that they will not be attending.
There are around 307 million sessions scheduled with GPs, nurses, therapists, and other practice staff every year and 5% – one in twenty – are missed without enough notice to invite other patients. That works out as around 15.4 million missed slots.
Of these, around 7.2million are with busy family doctors, which adds up to more than 1.2 million GP hours wasted each year – the equivalent of over 600 GPs working full time for a year.
Each appointment costs an average of £30, putting the total cost to the NHS at more than £216million pounds on top of the disruption for staff and fellow patients that would pay for:
- The annual salary of 2,325 full time GPs
- 224, 640 cataract operations
- 58,320 hip replacement operations
- 216,000 drug treatment courses for Alzheimer’s
- The annual salary of 8, 424 full time community nurses
(Source: https://www.england.nhs.uk/2019/01/missed-gp-appointments-costing-nhs-millions/)
In the last year the Practice had 2,405 (0.05% of the booked appointments) ‘Did Not Attend’ (DNA) - i.e. the patient did not turn up for the appointment and did not contact the surgery in advance to cancel/change appointment. This is approximate 240 hours of wasted clinician’s time, equivalent to approximately just under 6½ hours per week.
The effects of this are:
- An increase in the waiting time for appointments
- Frustration for both staff and patients
- A waste of resources
- A potential risk to the health of the patient
General Policy
The DNA policy is agreed as a Practice and patients are made aware of the policy and the reason for implementing. Whilst it is important to be consistent, there will always be exceptions on an individual case-by-case basis.
A copy of the policy is available on the Practice website.
If a patient fails to attend a pre-booked appointment on 3 occasion(s) in the space of 12 months, an informal warning letter will be sent to the patient, advising them that a further occurrence could risk removal from the Practice.
If the patient fails to attend another appointment, the matter will be discussed at the next Practice meeting and a majority agreement will be reached as to whether the patient will be removed from the Practice list. In this case a formal warning letter will be issued.
Warning letters are valid for a period of 12 months. Removal based on warnings greater than 12 months old will be invalid – in this case a further formal warning and period of grace will be required.
Screening Appointments
Where a patient with a chronic condition, or who is otherwise deemed to be “at risk”, fails to attend a screening or a recall appointment there may be an implied duty on the Practice to follow-up the reason for non-attendance to ensure that the patient’s health is not at risk.
The responsible clinician (usually the doctor or the nurse holding the clinic) will be responsible for initiating action to contact the patient by telephone to determine the reason for the failure to attend and, where possible, re-arrange the appointment.
Where a new appointment is arranged, this will be followed up with a text reminder of confirmation, the day prior to the appointment date.
The DNA is coded onto the clinical system at each non-attendance. This is coded in the Appointments record and not in the patient’s medical records.
A nominated Administrator will be responsible for the issue of a monthly DNA clinical system report for Practice Manager and/or clinician review.
First letter (INFORMAL warning)
Dear
I have noticed from our records that you failed to attend 3 consecutive appointments at the surgery.
This may have been an oversight on your part, but I need to bring to your attention that the Practice has a policy regarding missed appointments and I enclose an explanation leaflet for you to explain the procedure.
If you have specific problems that you wish to discuss that are preventing you from informing us when you cannot attend for an appointment, then please ring me on the above telephone number and I will try and help where I can.
Thank you for your co-operation in this matter.
Yours sincerely,
Practice Manager
Second letter (FORMAL WARNING)
Dear
Further to my previous letters dated _______________ I have been made aware that you failed to attend another appointment on _____________________.
As explained in the leaflet I sent you and the notice on display in the Practice reception area, the Practice takes repeated missed appointments very seriously. As a result, this letter represents a formal warning that should a further appointment be missed you will be removed from the Practice list without further notice.
If you would like to discuss the circumstances surrounding your appointments please contact me at your earliest convenience.
Yours sincerely,
Practice Manager
Poster for Reception
Patient Leaflet