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How we reduced DNAs by a third, at no cost

Practice managers Debbie Wilkins and Nadia Shaw describe a simple way to dramatically improve DNA rates

As Practice Managers in two very different practices we had both volunteered to take part in a DNA study funded by NHS Bedfordshire.

Wheatfield Surgery has 13,500 patients in a deprived area and Toddington Medical Practice has a population of 7,200 in a rural, affluent area.

The study focused on a completely different way of getting a message across to patients. Instead of taking a negative view of how many people do not turn up for their appointment, we were advised to change this to the positive; how many people do attend.

The concept is very simple – engaging the patient in the process of making the appointment, rather than being a passive bystander. These subtle changes such as asking a patient to write out their own appointment card just involve a few words or actions, but they have a big impact.

The cumulative effect resulted in a 31.4% reduction in DNAs. The study continued for two months and at Toddington the reception staff had not realised the new approach was to continue. In a month without the intervention the DNA rate shot up by 21%, which shows the true value of keeping to the interventions introduced by this study.

Both practices are continuing with the positive message of numbers of patients arriving for their appointments and Toddington have continued the whole concept as the patients have become used to writing their own appointment cards as well as repeating their appointment details back over the phone.

A great advantage of this technique is that it costs nothing apart from the initial training of staff. Perhaps we could all learn from the way behavioural science influences decisions made by patients and use the same measures when encouraging self care in so many areas within general practice.

Debbie Wilkins is a practice manager at Wheatfield Surgery and Nadia Shaw is a practice manager at Toddington Medical Centre, both in Luton.

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