It is good practice to carryout regular reviews of missed appointments to help identify whether there are particular issues for certain groups e.g. for children, for older people or whether the appointments system needs to be adjusted. Practices should ensure that patients are aware of all available methods to cancel an appointment and that cancelling is as easy as possible.
People lead very busy lifestyles. The use of text reminders and telephone calls in advance (at least the day before) is common practice. If practices do not have the resources to remind all patients, then perhaps consider targeting certain groups with appointments such as the elderly with carers and parents with young children.
To ensure patient safety, Practices should consider having a process in place to check missed appointments daily and any patients with any of the following should be brought to the attention of the GP and perhaps called by an HCA or a receptionist;
- Safeguarding concerns
- Vulnerable patients
- First language other than English
- Communication need or sensory loss
- Mental Health
- Learning difficulties
- Elderly with carers
- Suspected coercion
- Patients that repeatedly DNA
- Any other concerns
In addition to the above, if the reason for the appointment was for the clinician to give the patient some important information, perhaps about a result or a diagnosis, then the missed appointment should be followed up as a matter of urgency.
A separate article is available for 'children missed appointments'.
Practices will generally be aware of the patients that repeatedly miss appointments. However, many more patients who DNA less frequently can easily go unnoticed.
There are reports that practices can use to identify and audit patients who have DNAd in the last month. These can be found in 'Reporting > Clinical Reporting > Ardens > Appointments > Missed appointments'.
Recording actions and outcomes
A data entry template can be found under ‘Auto – consultations > Ardens General > DNA Adult’.
Letters to patient
There are four stages of review, these do not automatically require you to send a DNA letter. As part of the daily DNA checks and followup mentioned above it may be discovered that there was a perfectly good reason for the patient not attending. On each stage safeguarding concerns can be recorded, a letter sent (if appropriate) and a follow up scheduled (if required);
- DNA Letter
- Warning letter
- Removal letter
The letters have merge fields that display DNA history and the contents increase in severity for each stage to the point where you request removal.
NB: Please do consider that occasionally, due to computer issues, some appointments do get marked as a DNA inappropriately.