What can the NHS do to reduce missed appointments?
Elliot Bidgood, 13 August 2013
Over the weekend it was reported that missed appointments, known in the NHS as DNAs (‘Did Not Attends’) have risen to 771,421 in Scotland, an increase of 24,729 from last year. Last August, it was reported by the UK Department of Health that in England 5.5 million (about one in ten) were missed, though this did represent a drop of 250,000 from the previous year.
These statistics raise questions about what causes missed appointments – simple thoughtlessness, or genuine barriers – and what the best approach is to reduce the problem, as each DNA can set the NHS back by around £100 and the cumulative cost could be as much as £700 million a year.
Interestingly, a practice in Huddersfield has published survey results on the views of local residents about DNAs, including suggestions about how to reduce them. Ideas included reminders by post or text, more out-of-hours appointments, reducing waiting times to combat forgetfulness and making practices easier to contact for cancellations (the last three were cited as problems users had experienced). Others suggested tough sanctions such as written warnings, small fines or even removal from the practice register for repeat DNAs. There is a certain moral appeal to this ‘stick’ approach to wasteful irresponsibility and past surveys suggest many GPs may favour it, but a GP writing for Pulse cautioned it would also penalise the genuinely vulnerable, as research into DNAs warns that “the most common reason for not attending a first appointment is feeling better but the most serious is feeling too unwell” and factors such as dementia, psychiatric disorders and low socio-economic status predict non-attendance (some of the Huddersfield residents did however suggest that sanctions should only apply if no “reasonable reason” existed).
Currently, the NHS runs a “Keep It Or Cancel It” campaign to increase awareness and the rollout of Choose & Book e-booking since 2005 has also been argued to make the process somewhat more flexible for patients. Additionally, trials in various areas with methods like asking patients to write down or repeat back the time and date of their appointment as they make it, posters displaying recent attendance statistics, automated and text message reminders and greater use of Skype have found that such initiatives can indeed cut DNAs. This creates a case for their still-broader use and perhaps explains the apparent reduction in England.
I’d personally also suggest adverts that remind the public about the severity of the NHS’s budget challenge – if the service does lose £700,000,000 annually to DNAs, that’s nearly 20% of the near-unprecedented £4,000,000,000 a year it’s being asked to save in this time of austerity and “flat real” health spending. Meanwhile, in light of relative successes, the English NHS should press on with current efforts and Scotland would be wise to learn further lessons.
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