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GPs adopting 'three strikes and you're out' policy on DNAs

GPs in Northern Ireland are adopting a ‘three strikes and you’re out’ policy to deal with the overwhelming number of patients who fail to attend scheduled appointments.

Dr Tom Black, chair of the Northern Ireland GPC, said that many GPs in the region have introduced the practice as a deterrent to the growing numbers of patients – especially young people in their late teens and early 20s – who do not turn up to booked consultations.

Dr Black told the Belfast Telegraph: ‘If you miss three appointments in a calendar year, you will be asked to leave the practice and avail of services elsewhere. This is what is available to us and generally speaking it is what GPs are using.’

Statistics released by Northern Ireland’s Health and Social Care Board (HSCB) this week suggest that nearly 10,000 DNAs are clocked up every week by GP practices across the region.

More than 5,000 people fail to attend a booked GP appointment, while nearly 4,500 do not attend a scheduled appointment with a practice nurse.

The news has led to calls in the Northern Ireland Assembly to introduce stricter consequences for those who repeatedly miss appointments.

The latest DNA figures were collated via a survey carried out in NI GP surgeries last year and were unveiled by HSCB at the launch of the ‘Choose Well’ campaign, which aims to make patients think carefully about how to use health and social care services if they become ill this winter.

Readers' comments (6)

  • Aren't we supposed to write to the patient warning them first -- or else get fingered by the NHS ombudsman? Or does this only apply in England?

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  • Our surgery wanted to reduce DNA's and started putting up posters with number of DNA's the previous month pleading to avoid DNA's. This led to more DNA's so we decided that it didn't work.
    We conducted a patient survey regarding the same and a vast majority supported stricter DNA policy and removal from same I'd persistent DNA's. Our PPG discussed same and came up with this -3 DNA's and they get first warning, one more DNA and they get second warning and if they do it again they get the marching orders.
    We review these for mental illness/ memory problems and personal circumstances before asking them to leave.
    We also send tappt reminders via smell and allow cancellation via sms .
    Our DNA's have decreased by 34% over the last 5 years since we started same.
    Incidentally we had 4 complaints from patients removed via this over the the last 5 years.
    All were politely but firmly rebutted back written evidence of letters.
    I don't think NHSE can complain we we have done a survey and involved PPG with the same.

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  • Corrections on post@7.30 PM
    Damm the autocorrect on iPad - it should read we send appt reminders via Sms - and a few other minor corrections

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  • I've always regarded DNAs as an opportunity to catch up on time in a really busy surgery!
    Let's face it- there are more serious issues out there that warrant patient removal such as aggression and violence, but not DNAs

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  • We have had to take the drastic measure of only having on the day appointments, with very few pre-bookables, our DNA rate has freed up a minimum of 5 hours of appointments per month for about 6 months.

    A big push on getting mobile numbers for SMS reminders has also helped, but of course the Department of Health has decided to stop funding SMS messaging - what a very smart move that is going to be.

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  • Simple, miss one appointment … don't allow their next appointment to be pre booked … allow them to pre book for the following appointment, if they miss that, remove them.

    There are so many issues about patients not being able to get appointments but 300 DNAs per month per surgery up and down the country, something really does need to be done. Patients need to take some blame for the lack of appointments, it is often not the GP's fault.

    GP's are being bashed due to the lack of appointments but this government will not instigate action for the abusers of the NHS.

    We could all of course do what Jeremy Hunt claims he does … take our kids to A&E because it is quicker!

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