1. Introduction

This Practice invests a significant amount of time trying to create and maintain an appointments rota which will adequately manage the levels of supply and demand. All factors including doctors training, annual leave and known times of ‘higher demand’ (e.g. after Bank Holidays and during the winter months) are taken into account.

Unfortunately, there has been a growing problem with the number of wasted appointments which are caused when a patient does not attend (DNA) a pre-booked appointment with a GP, Practice Nurse, or visiting specialist clinician. Whilst the Practice is committed to providing appointments to meet the needs of patients it cannot replace appointment time lost when a patient fails to show up, or when they cancel their booking so late that the slot cannot be re-used.

DNA’s have a significant impact on the services we provide within the Practice. It is not uncommon for patients who have DNA’d to then contact the Practice and request another appointment – placing further demands on staff resources and the appointments system. They lead to frustration for both those patients waiting to get an appointment with a GP or Nurse and for those working in the Practice.

2. Aims

As a practice we would like to reduce the rate of DNAs by the use of education, a certain amount of pressure and by considering removal from the Practice List those patients who repeatedly offend.

A reduction in our rate of DNAs will:

• Increase the availability of appointments for all patients
• Reduce the pressure placed on all the GPs, Nurses, Administration staff
  and the services offered by the Practice
• Reduce the current waste of clinical time

3. Details

(a) Previously the Practice did not routinely record missed appointments in an individual patient’s records but it has now been decided that all such occurrences will be formally recorded as a ‘Did Not Attend’ event.

(b) At the start of each month the Practice will do a search of its records to identify those patients who have DNA’d on one or more occasions in the previous month. The list of non-attenders will be reviewed by one of the GPs to identify any patients who should be excluded from the general policy for clinical reasons, such as a condition which causes memory problems.

(c) After the initial review the following steps will apply:

(i) If there is a single missed appointment in the previous month and no other DNA recorded in the last year then the date and time of the appointment missed will be recorded together with a note that this is the 1st such event.

(ii) If there is more than one missed appointment in the previous month, or one DNA in that month and another DNA recorded within the last year, then a letter [Letter A] will be sent to the patient, at their registered address, giving details of the missed appointments and a copy of this Policy document to remind them of the difficulties caused by their DNAs.

(iii) If there is a missed appointment in the previous month and the patient has already been sent Letter A within the last year then a 2nd letter [Letter B] will be sent to the patient, at their registered address.

The 2nd letter will inform the patient that their repeated failures to attend appointments are considered to indicate a lack of respect for Practice Policy. The letter will warn the patient that any further missed appointments may result in their name being removed from the Practice List.

(iv) If, despite being sent two previous letters [Letter A plus Letter B], a patient DNAs on another occasion within 12 months of the 1st such event (making at least 4 DNAs within a rolling 12 month period) their case will be discussed at a meeting of the GPs.

[a] If the GPs decide there are exceptional circumstances, which mean it is in the best medical interests of the patient to remain on the Practice List, a 3rd letter [Letter C] will be issued to the patient inviting them to a meeting to discuss their unsatisfactory attendance record and explore what the Practice can do to help prevent ongoing offences.

[b] If the patient fails to respond to the invitation, or doesn’t keep the appointment for the meeting, the process detailed in [c] below will apply.

[c] In all other cases a final letter [Letter D] will be sent to the patient, at their registered address, to inform them:

• • • • • their persistent failure to adhere to Practice Policy is evidence of a breakdown in the Patient/GP relationship.
        • the GPs intend to proceed with removal of the patient’s name from the Practice List
        • they have a 14 day period in which to submit a written appeal against de-registration.
        • of the information required to find & register with another Practice for ongoing GP services.

The Practice will always respond to reasonable appeals and valid reasons.

4. Cancellations

The GPs appreciate that there are a number of circumstances which can prevent a person from attending a pre-booked appointment but would urge patients to give the Practice adequate notice whenever this happens. Ideally notice should be given at least 24 hours before the time of the booking. Cancellations notified within 4 hours of the scheduled appointment will be deemed to be inadequate and will be counted as a DNA event for the purposes of this Policy.

Cancellations can be made via the following systems:

(a) In person – by calling at the reception desk, which is open, Monday to Friday, from 08:30 to 12:30 and 13:30 to 17:30
(b) Telephone – by contacting the Practice on the normal ‘Appointments’ number: 028 9331 5835 or ‘Enquiries’ number: 028 9331 5955
(c) By email – [email protected] – please give 24 hours notice

Special circumstances may occur when, due to an extreme situation, little or no notice can be given. There may also be the odd occasion when someone just forgets an appointment. In such instances it is a courtesy to telephone Reception (028 9331 5955) at the earliest opportunity to explain the reasons and enable the Practice’s records to be updated accordingly.

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