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December 2020

Change booking system not patients to cut DNAs

Moving from a one-month ahead to just 24-hours in advance booking system can reduce the number of patients who do not keep appointments by more than half, a study in the British Journal of General Practice has found.

NHS England estimates that there are 7.2 million missed general practice appointments annually, at a cost of £216 million.

Practice X was one of 32 practices to participate in a programme to reduce the number of Did Not Attends (DNAs). While the majority of practices undertook work to modify patient behaviour – such as publicising the number of appointments lost to DNAs, sending SMS reminders, or introducing a hotline or text cancellation service – Practice X looked instead at its own appointment system.

It found that >70% of DNAs occurred when the gap between the booking and the appointment was longer than 2 days. The practice tested reducing the advance booking period from 28 days to 1 working day, but recognising that some patients, such as carers, might be disadvantaged these patients were identified and exempted from the policy.

Following the change, DNAs fell rapidly from 9.5% to 3–4%.

For the other practices in the study, practice DNA rates ranged from 2.1–12.2% (mean 7.0%) and this reduced to 5.2% after 24 months. Baseline data for all practices showed a positive association between the DNA rate and the length of time between booking the appointment and the appointment date. Booking beyond 2 days in advance accounted for 75% of DNAs.

The authors concluded that trying to change patients’ behaviours without changing appointment systems had only a modest effect, but changing the system could make a significant difference to the numbers of patients who don’t turn up. ‘To meaningfully reduce non-attenders, it is the appointment system itself that needs to be altered, not just the behaviour of its users,’ they said.

Margham T, et al. Br J Gen Pract 2020; DOI:

Practice Nurse 2020;50(10):6