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Almost half of patients who miss first hospital appointment are sent back to GP

Exclusive NHS trusts are discharging just under half of patients who do not attend their first appointment back to their GP, with some enforcing this approach as a blanket policy, a Pulse investigation has revealed. 

This is despite contractual requirements introduced by NHS England three years ago designed to stop work being pushed onto GPs, which state trusts must not automatically discharge patients who did not attend (DNA).

GP leaders said it is ‘unacceptable’ that trusts are creating extra work for GPs by not following up DNA patients themselves and warned this ‘takes up valuable time in which [GPs] could be offering appointments to other people’. 

In 2018, 45% of patients who missed their first secondary care appointment were discharged (around 553,000 out of 1.2m), according to data obtained by Pulse from 84 NHS trusts in England through freedom of information (FOI) requests.

This marks virtually no change since 2015 when 47% of DNA patients were discharged upon first appointment (around 538,000 out of 1.1m), according to Pulse’s data.


Meanwhile, some trusts have policies in place that directly breach contract requirements.

At Hillingdon Hospitals NHS Foundation Trust, it has a policy in places that states ‘any patient who does not attend their agreed routine appointment (new or follow-up) will be discharged back to the care of their GP’.

Homerton University Hospital NHS Foundation Trust says ‘the default position will be to discharge patients who do not attend their first appointment’. 

GPs have said the mounting number of DNA patients discharged back to them is creating problems for general practice across the UK.

Dr Nicholas Grundy, chair of grassroots campaign group GP Survival, said: ‘The discharging after a single DNA is infuriating and happens at least a few times a week.

‘There’s a risk for patients if they are discharged without being seen; I can understand trusts doing this if they miss multiple appointments, but not one.’ 

Renfrewshire GP Dr Henry Stafford said: ‘Secondary care discharging patients who DNA is a significant issue for us in terms of time spent chasing and rearranging appointments.

‘In the past, they were often offered three appointments, now they are usually discharged after a single DNA. I would estimate about half of those patients tell us they either didn’t receive an appointment letter, had an opt-in number to call that no one answered, or even received the letter after the date of the appointment.’ 

BMA GP Committee executive team workload lead Dr Farah Jameel said the approach was ‘unacceptable’.

She said: ‘While we recognise that the whole NHS is under intense pressure, it is not appropriate for hospital management to pass their responsibilities to GPs.

‘The BMA’s GP Committee has been clear that this is unacceptable and flies in the face of the hospital contract and, more broadly, a collaborative approach to working.’

She added: ‘Missed appointments – for whatever reason – are frustrating for all doctors, but it’s not in a patients’ best interests to be shuttled between hospital and GP when appointments are missed.

An NHS England spokesperson said: ‘Good communication and co-operation between primary and secondary care is a vital part of delivering high-quality care.

‘Where there are remaining concerns, local GPs should ensure their CCG – whose governing body they elect – takes appropriate action in line with the national contract.’ 

Pulse’s investigation also revealed the number of discharge summaries being sent by NHS trusts in England to GPs later than the required 24 hours has risen by 12% in the past three years, despite preventative measures being brought in.