Introduction to ‘Did not Attend’ appointments

 ‘Did Not Attend’ (DNA) is when the patient does not turn up for a pre-booked GP appointment and does not contact the surgery in advance to cancel/change appointment. Many valuable appointment slots are missed every month i.e. the patient does not turn up for the appointment and does not contact the surgery in advance to cancel/change the appointment.  The affect of these 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

Our Objectives

• To free up appointments for those who genuinely need them
• To reduce the waste of clinical time
• To reduce the pressure on all staff in being able to offer prompt appointments

Willowfield Surgery is committed to ensuring that the best possible service is provided to all patients registered with the practice.

Consistent application of the DNA policy by all practice staff (clinical and non-clinical) plays an important role in encouraging patients to assist in ensuring that clinics are managed as efficiently as possible. Practice staff will code DNA's using the agreed read codes.

This policy relates to the handling of DNA’s and outlines the expectations of patients and staff in the management of these instances.

A weekly search will be performed by the Data Administrator to identify patients who have not turned up for GP appointments that week. This report will be reviewed by the GPs to identify patient's who should be excluded from the general policy for clinical reasons e.g., memory loss. Once reviewed the list will be given to the Data Administrator to action.

If a patient fails to attend a pre-booked GP appointment on more than one occasion in the last 6 months, they will receive an informal warning letter advising them how to cancel or change their appointment if needed.

If the patient fails to attend another pre-booked GP appointment within 6 months of receiving the informal letter, a formal warning letter will be sent reminding them that a further recurrence may result in them being removed from the practice list.

Failure to attend one further pre-booked GP appointment will result in the patient being invited in to meet with the Practice Manager to discuss the reasons for non attendance. If patient's do not attend this meeting their name will be added to a list of patients' who may be removed due to failure to attend appointments.  The partners will discuss, taking into consideration all relevant information and  make a decision which may result in removal from the practice list.

Warning letters are valid for a period of 6 months.

 

Screening Appointments for Patients with Chronic Conditions deemed to be “at risk”

Where a patient with a chronic condition or 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 e.g., put message on reception team messages asking them to contact the patient to determine the reason for the failure to attend, and where possible re-arrange the appointment.

Where a new appointment is arranged, this is to be followed up with a letter of confirmation, and a telephone call or email reminder the day prior to the new appointment date.

The clinician will have overall responsibility for the individual patient follow-up and attendance, although the administration aspects will be delegated.

 

Effective Communication to reduce DNAs

Appointment cards/letters should be easy to read and understand.

Letters for clinics should arrive in a timely fashion to allow the patient to make arrangements to attend or cancel their appointment.

 

Cancelling the appointment

Patients may cancel an appointment in the following ways:

Directly face to face with reception staff or clinician

Via the telephone by speaking to a member of staff (a family member or friend or advocate can call on your behalf if for any reason you are unable to do so yourself.)

 

Appointment reminders

Currently appointment reminders are in place for new applicants attending medical assessment appointments and patients deemed to be at risk.

 

New Applicants

If a person applying to register with the practice repeatedly fails to attend New Patient assessment appointments, they will be sent a letter warning them they may be at risk of removal with details of the missed appointments and explaining the reasons for this, unless the partnership have reasonable grounds for believing that the issue is such that a warning would be harmful to the physical or mental health of the patient (see Removal from the Practice List Policy/Procedure.

 

Coding

The DNA must be coded onto the clinical system at each GP appointment non-attendance by the practice staff.

Appointment slots on system - Clinicians are asked to leave patient appointment slots unmarked if a patient DNAs to aid accurate activity reports.

 

Removal from the practice list

See Removal from Practice List Policy/Procedure

 

Created	December 2013
Reviewed	June 2016