Dealing with DNAs (Did Not Attend / Non-attenders)

Practice Leads

  • Admin: Chris Rushton & Sallie Parker

Date Reviewed

6th July 2016

Date of Next Review

September 2017

The practice recognises that patients can from busy lives 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, don’t appear to understand or accept the impact it has on other patients.  So we have tried to follow a policy that  tries to change the behaviour of the more frequent DNA’ers.

The outcome we are hoping for is 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 keep the surgery informed of problems.
  • 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).

The protocol

Essentially: patients who DNA three times or more in a 6 month period may be removed from the list if their behaviour cannot be adequately justified or changed. Therfore, if a patient  DNA's an appointment (with either nurse or doctor)....

  • 1st DNA occurrence – Code SYSTONE Patient DNA (marks in green), - Admin sent 1st letter informing of DNA, suggesting they keep a diary/calendar and opt into our SMS service.
  • 2nd DNA in past 6 months – 2nd stronger letter sent, info of DNA, inform that they might not be able to stay with the practice if further DNA.
  • 3rd DNA in past 6 months – admin consults the GP regularly seeing the patient – looking to take off 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 3rd template DNA letter + cc fax to WYCSA.
    • If No – (as has clinical issues contra to this action) – admin send the 4th template DNA letter (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 recieved 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 occaision and see if it happens again.

Other actions to reduce DNAs

  • Monthly missed appt numbers from DNAs will be entered onto the patient calling-in screen in order to educate patients.
  • Staff to consider making a phone call will be made to those who miss:
    • Asthma Review
    • Hospital Appointments
    • Diabetic reviews
    • Medication reviews on GP’s advice
    • Smoking cessation appointments
  • Opportunistically, please encourage patients...
    • to inform us if they cannot make the appointment.
    • to contact the surgery if they are late rather than not attending, as the appointment can be cancelled or other arrangements may be able to me made.
    • to keep 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.