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Introduction to 3 Reduce DNAs

Up to 3. Reduce DNAs
June 15. 2016
Robert Varnam

What it is this?

Non-attendance at appointments is a common problem, with an impact on practices and patients themselves. Reducing DNAs ('did not attend') is important for improving access and helping practices make best use of clinicians' time.

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It is often noted that, for busy clinicians, a DNA may provide a welcome opportunity to catch up, write notes or take a quick comfort break. That is obviously true - however, increasingly practices are recognising that, if it's important for clinicians to have time for those things during a clinic, they should be included in a planned way, rather than leaving it up to chance. 

Almost every practice has done at least something to try to reduce DNAs. However, the evidence shows that it's usually necessary to do several things, and that some of the common approaches need adjusting in order to be successful. By far the most effective means of reducing DNAs appear to be rearranging the appointments system to reduce 'just in case' booking ahead by patients - the DNA rate for these can be as high as 25%. If patients have confidence that, when they need help, they can call on the day, DNAs almost disappear.

Benefits for patients

  • Improves appointment availability.

Benefits for practice

  • Frees up appointments
  • Easier to avoid queues developing, through more accurate matching of capacity with demand.


3.1 Easy cancellation

Rapid access is provided for patients who wish to contact the practice to cancel an appointment. Common approaches include having a dedicated phone number, a text message service and online cancellation functionality.

3.2 Appointment reminders

Patients are sent a text message to remind them about a forthcoming appointment. A reminder is included about how to cancel the appointment if it is no longer wanted.

3.3 Patient-recording

Patients are asked to write their own appointment card for their next appointment, rather than having it done for them. This encourages recall, reducing subsequent DNAs.

3.4 Read-back

The patient is asked to repeat the details of the appointment back, to check they have remembered it correctly.

3.5 Report attendances

Publish information, for example in the practice waiting room, about the number or proportion of patients who do keep their appointment, with an encouragement to cancel unwanted appointments. This is more effective than reporting the proportion who DNA.

3.6 Reduce 'just in case' booking

Creating an appointment system and booking experience which is straightforward and responsive, giving patients confidence that they will be able to obtain help when they need it. This can reduce booking of appointments a long way in advance, which is associated with a much higher DNA rate.



Download fact sheet on reducing DNAs

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