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DNA Policy

Due to an increase in the number of wasted appointments through patients failing to attend without informing the surgery, it has become necessary to implement a Did Not Attend policy in an attempt to resolve this. A DNA is someone who “Did Not Attend” an appointment at the surgery and did not tell us beforehand. The Doctor or Nurse were waiting, but the patient did not attend.

DNAs are a serious problem for the NHS. Research shows that around 13 million GP appointments and 6 million practice nurse appointments are missed each year. At our practice alone, in the last 12 months, 1,360 appointments were wasted.

The practice recognises that patients with busy lives can sometimes forget about an appointment until after the event. These patients are usually apologetic, embarrassed, rebook and it doesn’t occur again. However, there are a few patients that will frequently DNA, and don’t appear to understand or accept the impact it has on other patients.  The practice has created a policy that tries to change the behaviour of the more frequent non-attenders.

The outcome we are hoping for are to…

  • Help to reduce the number of DNAs
  • Find out a solution to the common reasons as to why people DNA
  • Help people who frequently DNA to find solutions as to why they DNA
  • Free up wasted appointments which are lost by people who DNA
  • Encourage people to cancel appointments if they cannot attend
  • Make allowance for those patients who DNA because their lives are in turmoil (like mental health patients)

 

How to cancel a GP appointment

  • Call the surgery - Call the surgery at least 30 minutes before your appointment time 

  • Use the NHS App- If you're signed up for the NHS Wales App, you can cancel your appointment online 

What happens if you don't cancel your appointment?

  • If you don't cancel your appointment or don't give enough notice, it will be recorded as a "Did Not Attend" (DNA) on your record 
  • If you fail to attend multiple appointments in a row, you may receive a letter from the surgery 
  • Your GP surgery may decide to stop offering you appointments 

Why should you cancel your appointment? 

  • Canceling your appointment allows the appointment to go to someone else
  • It helps avoid wasting GP resources
  • It can help reduce wait times

 

The Practice of Health DNA Protocol

Patients who DNA three times or more in a 12 month period may be removed from the list if their behaviour cannot be adequately justified or changed. Therefore, if a patient  DNA’s an appointment (with either nurse or doctor)….

  • 1st DNA occurrence –Patient DNAs face-to-face appointment. Admin send 1st patient SMS informing of DNA “You missed your appointment at ????? on ??????. If unable to attend please call to cancel. See the practice DNA policy on our website. POH” Note that 2 x failed encounters for teleconsults are also treated as a DNA.
  • 2nd DNA in past 12 months – deputy manager advised by admin. 1st DNA letter sent/ ‘surgery 2nd DNA warning’. Information of recent missed appointments enclosed. Inform patient that they may be removed from the practice list is repeated instances of DNA. Encouraged to call to discuss if any extenuating circumstance.
  • 3rd  + DNA in past 12 months –– look to remove the patient from the list or not?  The aim here is to see if there are any clinical issues that might help put the DNAs into context (like mental health issues) and thus help us to adopt a more flexible approach.  The ultimate decision is whether to take off our practice list or not.
    • If Yes take off list = Admin send ‘removal DNA apts’ letter to patient. Patient advised will now be removed from the practice list. Information of LHB enclosed. Request for 30 day deduction from practice list sent to BSC.
    • If No – (as has clinical issues contradictory to this action) – deputy manager may send a further surgery 2nd DNA letter/ telephone the patient to discuss and understand (i.e.  decided to keep this time but will reassess if another DNA – mark on record GP information not remove from list.)

NOTE:   If the second/third DNA occurs within 2 weeks of the previous occurrence, PLEASE take into account the timings.  In other words, the possibility that the patient may not have received the first letter and hence may may not have had the time or the chance to change his or her behaviour.  In which case, you may wish to overlook the subsequent DNA occurrence on this occasion and see if it happens again.

 

Other actions to reduce DNAs

  • Monthly DNA umbers from DNAs will be advertised on our practice data activity
  • 24 hour SMS reminder for all face-to-face appointments automatically generated from the system, with the option to reply to cancel the appointment if unable to attend
  • Opportunistic social media campaigns e.g. Facebook
  • Staff to consider making a phone call will be made to those who miss:
    • Double (20+ minute) appointments
    • Appointments for patients with cognitive impairment e.g. Dementia, Learning Disabilities
    • Mental health review appointments
  • Opportunistically, please encourage patients…
    • to inform the practice if they cannot attend the appointment, and cancel with enough nmotice
    • to contact the surgery if they are expected to be more than 5+ minutes late rather than not attending, as the appointment could be cancelled or other arrangements may be able to me made for the patient
    • to keep their appointments as much as possible
    • to inform the surgery of any issues, problems or complaints to enable them to be dealt with quickly

 Complaints

Complaints about access and other issues should be channelled through the normal complaints process.

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