DID NOT ATTEND POLICY & PROCEDURE
Introduction
A large proportion of available appointments per week are wasted due to patients failing to attend appointments. The effects of these are:
- An increase in the waiting time for appointments
- Frustration for both staff and patients
- A waste of resources
- Poor patient satisfaction
It has been noted that some patients consistently miss appointments; these include emergency appointments which patients will have booked on the day.
Practice Procedure should a client continuously fail to attend:
- The clinical appointment system will automatically record any patient Did Not Attend’s (DNA) as they occur in the appointment schedules.
- The clinician (usually the doctor or the nurse holding the clinic) should initiate action to contact the patient by telephone to determine the reason for the failure to attend and, where possible, re-arrange the appointment.
- If a patient DNA’s an appointment, a text should be sent to the patient advising of the practice policy for DNA’s (appendix 1)
- If a patient DNA’s a second booked appointment, the appropriate first letter (see appendix 2 & 3 ) which includes a copy of the practice notice which explains the practice policy should be sent.
- If the patient subsequently fails to attend, the patient will be sent the appropriate second letter (see Appendix 4 & 5) asking them to contact the practice to discuss any reason which may be preventing them from attending appointment.
- If the patients subsequently fails to attend a further appointment, the patient will be sent a final warning and any further DNAs may result in removal from the list.
Exceptions
The partners have agreed the following rules for exceptions in the practice policy:
- Cannot “blanket” remove a family if one person does not attend.
- Patients with ongoing safeguarding issues should not be removed.
- Appointments with other health care professionals (Smoking cessation, MacMillan etc are excluded from the DNA policy.
- Patients who are under the age of 19 and/or patients with safeguarding concerns will be reviewed by a GP prior to removal as pre-caution.
CHILD NOT BROUGHT IN FOR APPOINTMENTS
It is important for clinicians have policies and procedures in place that clarify what they should do if a child is not brought to a GP appointment. Such a non-attendance should not only be coded correctly; but also trigger an appropriate response:
- Child not brought to GP appointment – clinician should review records (reason for appointment, history etc) and if appropriate contact parents to enquire as to the reason for the missed appointment and document this in the patient’s record. The appointment should be rebooked if required and parents reminded of the surgery’s DNA policy.
- Child not brought to Nurse / HCA appointment – the Nurse or HCA will contact parents, document the reason for the missed appointment and rebooked the appointment if required. They should also remind the parents of the surgery’s DNA policy.
If there are more than 2 DNA’d appointment within the last 12 months or any reasons for concern this should be discussed with the duty doctor or Safeguarding Lead to consider a follow up telephone consultation for further investigation. This also applies to vulnerable adults.
CANCELLING APPOINTMENTS
Patients who cancel their appointment in sufficient time for the appointment to be utilised by another patient, will not be recorded as a DNA. However, patients are kindly asked to notify the Practice that they wish to cancel their appointment ideally a minimum of 2 hours before the appointment time.
PROTOCOL FOR DNA’s
Where no reasonable circumstances for DNA have been identified, for example, hospital admission, the following warnings will be given:
FIRST DNA
If a patient fails to attend their first pre-booked appointment in the previous 12 months, a first DNA warning SMS or phone contact should occur with the patient, advising them of the effects of not keeping their appointments. (See page 7 for wording of SMS).
SECOND DNA
If the patient fails to attend a further appointment, a DNA warning letter is sent to the patient.
THIRD DNA
If a patient fails to attend a 3rd pre booked appointment, a final formal warning should be forwarded to the patient advising any further DNA’s will result in the patient being removed from the Practice and the patient will need to register with an alternative medical practice
FOURTH DNA
If a further DNA occurs, this matter is then discussed with the Practice Manager/Partner and if deemed appropriate a deduction letter advising the patient that they will be removed from the surgery register will be sent.
Acknowledgement
The practice would like to thank the Practice Patient Participation Group (PPG) members for their help in the production and endorsement of this policy.
Appendix 1
FIRST SMS MESSAGE (INFORMAL WARNING)
Forename, we note that you did not attend your appointment today, this may be an oversight on your part, however we would grateful if you were unable to attend any future appointments, please let us know. The appointment may then be offered to another patient and reduce waiting times.
Thank You
DID NOT ATTEND POLICY & PROCEDURE
Introduction
A large proportion of available appointments per week are wasted due to patients failing to attend appointments. The effects of these are:
- An increase in the waiting time for appointments
- Frustration for both staff and patients
- A waste of resources
- Poor patient satisfaction
It has been noted that some patients consistently miss appointments; these include emergency appointments which patients will have booked on the day.
Practice Procedure should a client continuously fail to attend:
- The clinical appointment system will automatically record any patient Did Not Attend’s (DNA) as they occur in the appointment schedules.
- The clinician (usually the doctor or the nurse holding the clinic) should initiate action to contact the patient by telephone to determine the reason for the failure to attend and, where possible, re-arrange the appointment.
- If a patient DNA’s an appointment, a text should be sent to the patient advising of the practice policy for DNA’s (appendix 1)
- If a patient DNA’s a second booked appointment, the appropriate first letter (see appendix 2 & 3 ) which includes a copy of the practice notice which explains the practice policy should be sent.
- If the patient subsequently fails to attend, the patient will be sent the appropriate second letter (see Appendix 4 & 5) asking them to contact the practice to discuss any reason which may be preventing them from attending appointment.
- If the patients subsequently fails to attend a further appointment, the patient will be sent a final warning and any further DNAs may result in removal from the list.
Exceptions
The partners have agreed the following rules for exceptions in the practice policy:
- Cannot “blanket” remove a family if one person does not attend.
- Patients with ongoing safeguarding issues should not be removed.
- Appointments with other health care professionals (Smoking cessation, MacMillan etc are excluded from the DNA policy.
- Patients who are under the age of 19 and/or patients with safeguarding concerns will be reviewed by a GP prior to removal as pre-caution.
CHILD NOT BROUGHT IN FOR APPOINTMENTS
It is important for clinicians have policies and procedures in place that clarify what they should do if a child is not brought to a GP appointment. Such a non-attendance should not only be coded correctly; but also trigger an appropriate response:
- Child not brought to GP appointment – clinician should review records (reason for appointment, history etc) and if appropriate contact parents to enquire as to the reason for the missed appointment and document this in the patient’s record. The appointment should be rebooked if required and parents reminded of the surgery’s DNA policy.
- Child not brought to Nurse / HCA appointment – the Nurse or HCA will contact parents, document the reason for the missed appointment and rebooked the appointment if required. They should also remind the parents of the surgery’s DNA policy.
If there are more than 2 DNA’d appointment within the last 12 months or any reasons for concern this should be discussed with the duty doctor or Safeguarding Lead to consider a follow up telephone consultation for further investigation. This also applies to vulnerable adults.
CANCELLING APPOINTMENTS
Patients who cancel their appointment in sufficient time for the appointment to be utilised by another patient, will not be recorded as a DNA. However, patients are kindly asked to notify the Practice that they wish to cancel their appointment ideally a minimum of 2 hours before the appointment time.
PROTOCOL FOR DNA’s
Where no reasonable circumstances for DNA have been identified, for example, hospital admission, the following warnings will be given:
FIRST DNA
If a patient fails to attend their first pre-booked appointment in the previous 12 months, a first DNA warning SMS or phone contact should occur with the patient, advising them of the effects of not keeping their appointments. (See page 7 for wording of SMS).
SECOND DNA
If the patient fails to attend a further appointment, a DNA warning letter is sent to the patient.
THIRD DNA
If a patient fails to attend a 3rd pre booked appointment, a final formal warning should be forwarded to the patient advising any further DNA’s will result in the patient being removed from the Practice and the patient will need to register with an alternative medical practice
FOURTH DNA
If a further DNA occurs, this matter is then discussed with the Practice Manager/Partner and if deemed appropriate a deduction letter advising the patient that they will be removed from the surgery register will be sent.
Acknowledgement
The practice would like to thank the Practice Patient Participation Group (PPG) members for their help in the production and endorsement of this policy.
Appendix 1
FIRST SMS MESSAGE (INFORMAL WARNING)
Forename, we note that you did not attend your appointment today, this may be an oversight on your part, however we would grateful if you were unable to attend any future appointments, please let us know. The appointment may then be offered to another patient and reduce waiting times.
Thank You