Introduction At LL Medical Care Ltd, a significant number of appointments per week are classified as
‘Did Not Attend’ (DNA). DNA refers to patients not turning up for their appointments without
contacting the surgery in advance to cancel or reschedule. The impact of DNAs includes:
• Increased waiting time for appointments
• Frustration for both staff and patients
• Wasted resources
• Potential health risks for the patient
By reducing the number of DNAs, we aim to:
• Enable more effective booking
• Allow efficient running of clinics
• Reduce costs
• Increase productivity
Policy
1. Initial Response to DNAs
o If a patient fails to attend a pre-booked appointment on more than one occasion
within a week, a text message will be sent to the patient or an
informal letter for patients without a mobile number.
2. Repeated Non-Attendance
o If a patient fails to attend more than three appointments within a six-month period,
an informal warning letter will be sent.
o If the patient misses another appointment within the next three months after the
initial warning letter, a second warning letter will be sent.
o Continued non-attendance after the second warning will result in the case being
reviewed by the Practice Manager and a Senior Partner to decide if the patient
should be removed from the practice list.
3. Considerations for Vulnerable Patients
o Specific consideration will be given to vulnerable patients who might have valid
reasons for not cancelling their appointments. Removals will only be approved if
deemed appropriate by a doctor familiar with the patient, following warnings and
opportunities for improvement.
4. Validity of Warning Letters
o Warning letters are valid for 12 months. Any removal based on warnings older than
12 months will be invalid. Only DNA appointments within a 12-month period will be
reviewed to determine the applicable stage of the policy.
5. Recording and Tracking DNAs
o DNAs will be recorded by clinicians and coded onto the clinical system.
o The Senior Administrator will run weekly searches on the DNA read code and
appointment book, sending out weekly texts, first and second warning letters, and
informing the Practice Manager.
6. Screening Appointments
o For patients with chronic conditions or those deemed “at risk” who fail to attend
screening or recall appointments, there is an implied duty to follow up. The
responsible clinician will contact the patient by telephone to determine the reason
and, if possible, re-arrange the appointment.
7. Monitoring and Reporting of DNAs
o The Senior Administrator will run weekly DNA searches, provide numbers to the
Practice Manager, and update the DNA tracker tool. Results will be periodically
reviewed by the Practice Manager and partners to monitor DNA levels.
8. Removing Patients from the Practice List
o Removal of patients from the practice list for repeatedly missing appointments will
comply with The NHS General Medical Service Regulations 2015. This includes
warning the patient of the risk of removal and explaining the reasons. A written
record of the removal, including the reason, circumstances, and grounds, will be
maintained.
o The Practice Manager will inform NHS England and request the patient’s removal
from the registered list, effective eight days after notification.
9. Late Arrivals
o If a patient arrives more than halfway into their appointment allocation time, they
will have to rebook their appointment unless under extreme extenuating
circumstances. To cancel an appointment, patients must do so at least one hour before the appointment time so it can be offered to another patient. Failure to do so
will result in it being recorded as a DNA.