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Data lowdown: the DNA of DNAs

There are 15.4 million general practice appointments missed each year, costing the health service an estimated £216m annually, NHS England has claimed.

Analysis of NHS Digital data by NHS England found that 5% of all general practice appointments were not attended in the past year – with each slot costing an average of £30.

NHS England said GP appointments are going to waste every year because patients who fail to attend are not giving staff sufficient notice, meaning they can’t make the appointments available to other patients.

It claimed the total number of hours represented by missed appointments is the equivalent of more than 600 GPs working full time for a year.

NHS England acting director of primary care Dr Nikki Kanani said: ‘Our message is clear: if you cannot make it to your appointment or no longer need a consultation, please let your GP practice know in advance so the appointment can be filled by another patient.’

Pulse’s analysis of the data shows patients are more likely to miss their appointment the further in advance they have to book. Meanwhile, patients are less likely to miss their consultation if it is a home visit or takes place over the telephone.

However, video and online consultations have similar DNA levels to face-to-face appointments (see charts, below).


The analysis also reveals regional differences. Practices in London experience more DNAs than any other region of the country, with 7% of appointments not attended, compared with 5% in the North, Midlands and East, and 4% in the South East and South West.

GP leaders said patients need to take responsibility for the way they use GP resources.

BMA GP Committee chair Dr Richard Vautrey said: ‘With the NHS finances under historic strain, it’s vital that we don’t waste the resources we have.’

RCGP chair Professor Helen Stokes-Lampard said the figures highlighted a ‘frustrating waste of resources’, not just for GPs and their teams but for patients struggling to get an appointment.

She said: ‘There may be many reasons why a patient might miss an appointment, and in some cases it can be an indication that something serious is going on for that individual – but we would urge patients to let us know if they can’t attend as soon as possible, so that we can offer that time to someone else who really needs it.

‘To this end, practices are using electronic methods, such as SMS reminders, to encourage patients to keep their appointments, or cancel them in a timely manner.’

However, UK conference of LMCs deputy chair Dr Katie Bramall-Stainer suggested DNAs can be useful for practices.

The Hertfordshire GP said: ‘Given we are all working above capacity, a DNA may mean you swiftly move onto the next patient and maybe catch up on your late-running surgery.’

However, she added: ‘Ultimately, it will be a false economy as that DNA may require follow-up.’

Dr Bramall-Stainer said the fact that digital consultations have a similar DNA rate to face-to-face appointments raised ‘many more unanswered questions regarding the supposed efficiency of this means of consultation’.

Meanwhile, a new study in Scotland has highlighted the risk to patients who miss appointments.

The research, published in BMC Medicine last month, examined the effect of missed primary healthcare appointments on all-cause mortality in those with long-term mental and physical health conditions.

It analysed 11.5 million appointments and found patients with a greater number of long-term conditions have an increased risk of non-attendance and are at greater risk of death from all causes. Those with mental health conditions are particularly affected, the study said.

Professor Stokes-Lampard said: ‘This study highlights why it’s important to show compassion if people fail to attend, rather than punish them. For some, they forget, but others might not turn up because of their health issue.’

She said practices needed help to reduce waiting times for appointments and called for a guarantee that general practice would receive a ‘significant share’ of the funding earmarked for primary and community care in the NHS long-term plan.