Manager Practice


engagement, which would include letting the GP know if the process has ended without reaching the expected outcome. Patient reminder text messages that include the cost of missed


appointments have proven to be successful in reducing DNAs. This method is also popular within the NHS, being low cost, easy and efficient. Patients should be told that the practice is sending out text reminders for appointments and this should be clearly stated in your privacy notice (with patients reminded at all appropriate opportunities). The messages must relate only to medical care (i.e. not for marketing purposes) and a generic note of the cost of missed appointments could be added to the texts. Practices could also use e-communications to reinforce reminders


for review (as long as patients are aware of the process in advance and it is displayed in your privacy notice). These could include alerts to patients regarding test results and action required, for example: “Please contact the practice within the next seven days as your results have been received and the GP wishes to consult with you”. When a GP or other healthcare professional has initiated a request


for a patient to book an appointment for review or further treatment, there should be a system to check these appointments have been made and also that the patient has indeed attended. Including information in the appointment slot when the patient is booked-in can allow the receptionist to take action when a patient calls to cancel that appointment – this might be as simple as a prompt to re-appoint during the call or a simple message to alert the requesting GP of the cancellation. The clinician is then prompted to assess whether the patient requires further follow-up or any other action. For practice-initiated follow-up appointments, it is advised


that clinicians and other healthcare support workers check the appointment slot for information to assess what the reason for the follow-up was and therefore whether further is required.


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It could also be useful to consider how accessible the practice


is for all patients. Could there be alternative ways of reviewing patients, particularly those with long-term conditions? Options might include telephone appointments, video consultations, extended- hours clinics or even the choice of on-the-day appointments for the purpose of review if there is a risk of non-attendance with pre-booked appointments. Care Navigation* could be considered as an option for some patients but this should not be offered as a substitute for GP appointments for the sake of time saving. The BMA has recognised the need for patients also to take


responsibility in tackling missed appointments. Dr Richard Vautrey said: “Practices will try many ways to address this problem, but ultimately patients do need to play their part. With the NHS finances under historic strain, it’s vital that we don’t waste the resources we currently have.”


ACTION POINTS • Recognise that regular DNA patients may be vulnerable. • Make the effort to understand the patient’s needs and be flexible with appointment types when requesting review.


• Review policies and protocols for missed appointments. •


Practice-initiated appointments should have prompts for further action if a patient calls to cancel or does not attend.


• Keep clear and accurate records of all communications with patients. Kay Louise Grant is a risk adviser at MDDUS


* Care Navigation refers to assistance offered to patients and carers in identifying and accessing the systems and support that are available to them within health and social care and beyond.


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