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Outpatient DNA rates 'double at weekends'

DNA rates at hospital outpatient clinics can be twice as high on Saturdays as on weekdays, shows a new study that undermines the case for seven-day working.

Researchers audited figures for the ENT unit at East and North Hertfordshire NHS Trust unit over 12 months and found that the DNA rate for Saturday clinics was 22.1%, but only 10.9% for week days.

The rates were calculated relating to 4,160 appointments during the week and 1,874 on Saturdays.

The Government has signalled a desire for seven-day services across the NHS, with applications recently invited for a £50m fund for GP practices to trial ‘innovative’ ways of improving access by February.

But the researchers in a paper published in this month’s Bulletin of the Royal College of Surgeons of England,concluded: ‘There is evidence suggesting patients find weekday appointments more convenient and it may therefore be efficient to match appointment provision to times of high attendance. This would allow the service to mould to the needs of the patient population.’

It also states: ‘There are a number of reasons why attendance on Saturdays may be inferior to weekday attendance. These include the timings being less convenient to patients, more difficulties with hospital transport and patients being more likely to forget appointments at weekends.

‘Prior studies have suggested a number of ways to improve patient attendance, including levying small charges for not attending an appointment. While such measures are likely to be highly unpopular it may be that tailoring an institution’s outpatient appointments to convenient times (and times when there is a high level of attendance) may be beneficial and could allow us to match the needs of our patient population.’

Bull Roy Coll Surg Eng 2014,1:28-29

Readers' comments (4)

  • Vinci Ho

    (1) part of the argument about '7 days service' in hospital is because in patient mortality was higher in weekends. That has nothing to do with outpatient activities
    (2) Of course. DNA in OPD would be higher in weekends for all those obvious reasons. It would be interesting to know if PRE BOOKED GP appointments would be subjected to the same risk of DNA
    (3) somebody in NHSE was so clever to ask GP to follow Tesco and Sainsbury . But do Tesco and Sainsbury have DNA problem ??? Once again there is a difference between the name 'patient' and 'customer'.

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  • Bornjovial

    In busines parlance this is called "Moral hazard". If there is no consequence to doing something they will do same. The corallary is if people were given free NHS service but have to pay if they DNA/cancel within 24 hrs of appt the DNA rate would be much lower.
    One of PULSE regular columnists wrote how the DNA`s were higher for online booked appointmensts and also on Saturday extended hours appt. We have higher DNA for extended hours appointments.

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  • Increased cost for diminishing returns.Value for money!

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  • Kathrine Thomson

    Just because the DNA rates were higher at the weekend does not say anything about how well used those appointment slots were. Many people have to 'pay' for a weekday OPD appointment by taking time off work.

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