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At the heart of general practice since 1960

Time to jazz up our DNA policy

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Funny how your tastes tend to change as you mature, OK, get older. For example, I used to detest jazz. I genuinely thought it signified a disturbed mind. But now I can’t get through the day without a dose of Miles Davis.

As with jazz, so with DNAs

It works in reverse, too. Take DNAs. I used to love them, and could never understand why they’d cause such hand-wringing among the worthy, the woolly and the whiney. After all, I’d argue, DNAs offer the opportunity for a breather, a catch-up, a biscuit, a coffee, and for the NHS not to grind to a halt, which is what would happen if everyone suddenly started turning up.

But now we seem to be in the grip of a DNA pandemic. Yesterday, our locum had seven in one session. And last Saturday, our supposedly fully booked extended hours surgery featured tumbleweed blowing through the waiting room.

All this despite us pandering to the ‘issues’ of the worst offenders. We write down appointment times for them. We text them reminders. And we offer a cancellation hotline on the basis that one of their excuses is difficulty getting through to cancel an appointment – ironic given that they never have trouble getting through to book one.

So, in one of those many hiatuses between the odd patients who do actually deign to attend, I did a back-of-an-envelope calculation. And I worked out that, if we wiped out our most notable DNA-ers – and, as with much in the NHS, a fairly small number of repeat offenders cause most of the problem – we would gain, astonishingly, about one whole-time-equivalent GP’s worth of appointments. Just imagine that, in the context of our current manpower crisis: a whole doctor, for free, simply by eradicating the feckless.

So that’s what we’re going to do. We can’t actually cull non-attenders, of course, although we’d all agree this is probably the very least they deserve. But we can write with a warning, then a final warning, then, tah-dah, removal. And to any GP cardies or outraged patient groups out there, just look at it this way: these punters have spent a long time honing their non-attendance, all we’re doing is making that arrangement permanent.

The flaw with this plan is, of course, that if other GPs do the same, we’ll be saying goodbye to our cohort of DNA-ers at roughly the same time that we say hello to another horde from the practice down the road. A stupid game of musical chairs, in other words. But with empty chairs.

So, as with jazz, so with DNAs. My view has completely about-faced. No quantity of opportunistic Hobnobs can compensate for the waste of time and resources DNAs represent.

The answer must be to view habitual non-attendance as an act of passive-aggression, and so treat DNA-ers just like violent patients. Take them out of the primary care mainstream into a Non Attending Patient hub somewhere. And we wouldn’t even need to bother staffing it.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (4)

  • At 23 I found Bitches Brew a tuneless cacophony , and 30 years later I still think jazz is musical masturbation. I love my DNAs, love them dearly. I would like to thank each and every one of them for saving me from drowning in the quicksand of overrunning surgeries. They are the (very) silent heroes of Primary Care, and when there are 3 or 4 in a session the joy is unbound.
    Mind you, there's a special place in Hell for those pseudo DNAs, who tease you by showing up 10 minutes late, just when you about to crack open the Pomagne in celebration of their non attendance.

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  • Cobblers

    As a locum I crack out the Babycham whenever there is a DNA. Bonus.

    OK maybe not Babycham more Orange squash but you know where I am going with it!

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  • How dare you speak in jest about the superior chocolate hobnob!

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  • We have taken the plunge and gone to 15 mins app so a DNA is a bit of a disaster as appointments seem more precious. So with some repeat offenders we are refusing to book them a routine appointment- but will offer only an urgent appt in the pool of patients we see 11-12am one prob only and no choice of GP/ANP- a compromise and at least we feel we have gained some control back......

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder