Did Not Attend (DNA) Policy

 

Version	Edited by	Date issued	Next review date
4	Janet Butcher	12/03/2026	12/03/2027

 

Position	Named individual
Safeguarding Lead	Dr Naseem Saheecha
Practice Manager	Janet Butcher

 

Overview for all patient

• When a patient fails to attend an appointment or fails to notify this Practice 10-minutes after their scheduled appointment of the need to cancel or change the appointment, it is referred to as a Did Not Attend (DNA).

·     When a child fails to attend an appointment, this is referred to as ‘was not brought’ (WNB), and such occurrences are to be discussed with the Safeguarding Lead.

·      All failed appointments including telephone calls and home visits are to be recorded on the clinical system using the appropriate SNOMED CT ID.

 

·      Managing DNAs involves clinical and non-clinical staff and a coordinated approach is essential if preventative measures are to be effective.

 

·       If a patient accumulates three DNAs in a 12-month period, then a letter is sent to the patient. 

·       A discussion will take place to determine whether the patient is to be removed from the practice list if DNAs or WNBs persist.

 

 

 

Table of contents

1     Introduction   3

1.1       Guidance statement 3

1.2       Status  3

2     Policy  3

2.1       Overview   3

2.2       Recording DNAs  3

2.3       Preventative measures  3

2.4       Managing DNAs (face-to-face appointment) 4

2.5       Managing a failed home-visit encounter  4

2.6       Managing failed telephone encounters  4

2.7       Children who fail to attend   4

2.8       Actions needed for a Was Not Brought 5

Annex A – First letter to patient 6

Annex B – Removal of patient 7

Annex C – Letter regarding child who was not brought 8

 

1.1      Guidance statement

The purpose of this document is to provide guidance regarding the management of patients who fail to attend their appointments. This document sets out the procedures for monitoring and recording missed appointments, and the necessary actions required to effectively manage missed appointments.

1.2      Status

In accordance with the Equality Act 2010, we have considered how provisions within this policy might impact on different groups and individuals. This document and any procedures contained within it are non-contractual, which means they may be modified or withdrawn at any time. They apply to all employees and contractors working for the Practice.

2.1      Overview

When a patient fails to attend an appointment or fails to notify this Practice 10-minutes after their scheduled appointment of the need to cancel or change the appointment, it is referred to as a Did Not Attend (DNA) or Was Not Brought (WNB).

2.2      Recording DNAs

All DNAs are recorded on the clinical system in the individual’s healthcare record using the relevant SNOMED CT ID. DNA statistics are also displayed in the waiting area.

The following morning, Administrators will review any failed appointments and code all DNAs and WNBs from the previous day into the patients’ medical records.

A nominated Administrator will be responsible for generating a monthly DNA report from the clinical system and ensuring that the appropriate DNA letters are sent to the relevant patients.

2.3      Preventative measures

In order to reduce the number of DNAs, the Practice offers:

·         Easy cancellation: Rapid access is provided for patients who wish to contact the Practice to cancel an appointment, such as a dedicated option to Check and Cancel your appointment via telephone, and online cancellation functionality via our website.

·         Appointment reminders: Patients are sent a text message to remind them about a forthcoming appointment. The reminder includes an explanation of how to cancel the appointment if it is no longer wanted.

·         Patient recording: Patients are offered their own appointment card/slip for their next appointment if booked face-to-face at reception. 

·         Patient engagement: Discuss the issue with the Patient Participation Group (PPG) to highlight the numbers and plans for improving the DNA rates.

·         Patient information leaflet: This will detail the policy for dealing with patients who fail to attend their appointments

2.4      Managing DNAs (face-to-face appointment)

If a patient fails to attend their appointment without notice, this will be recorded as: Did not attend – SCTID: 281399006.

Should the patient fail to attend three appointments within the same 12-month period, a letter explaining the DNA will be sent to the patient using the template at Annex A.

Prior to writing to the patient using the template at Annex B, the GP Partners will assess whether removing the patient from the Practice’s list would be detrimental to the patient’s health or wellbeing and cause significant harm. Should the decision be made to remove the patient from the list, the Practice will consider this BMA guidance.

Letters sent to patients are only valid for a 12-month period.

2.5      Managing a failed home visit encounter

A failed visit is when there is no access to or contact with the patient at a planned or agreed visit. For further detailed information, refer to the Practice’s Home Visit Policy.

2.6      Managing failed telephone encounters

Failed telephone consultation encounters must be managed appropriately to ensure patient safety is not compromised.

Clinicians will attempt to call the patient twice. If there is no response after the second attempt, the appointment should be recorded as “Failed encounter – no answer when rang back” (SCTID: 185337004).

These are treated in the same way as face-to-face appointments, and a letter will be issued after three DNAs.

2.7      Children who fail to attend

 

The BJGP explains that while all missed appointments have traditionally been classified as a DNA, this group needs to be classified as Was Not Brought (WNB) as it is not a child’s responsibility to attend the appointment; it is the responsibility of their parents or carers to take them. Awareness must be given to this and the consideration that this could be termed as medical neglect. The Nottingham Safeguarding Children Board has developed a video to assist with understanding the differences between medical neglect and a simple DNA.

2.8      Actions needed for a Was Not Brought

 

Any incidences of WNB are to be recorded on the clinical system as “Child not brought to appointment”, SCTID: 901441000000108 and the following actions taken:

 

     a.  For the first missed appointment:

·         This Practice will send a further invitation to the patient

·         A letter will be sent to the parent or carer to ascertain the reasons behind the non-attendance.

·         Any response from the parent or guardian will also be noted in the patient’s clinical record, including if there is a valid reason not to attend or to vaccinate 
A template letter for a child who Was Not Brought is at Annex C

b.    For the second missed appointment:

·         The responsible clinician will contact the parent or guardian (either face to face or via telephone) to discuss the reasons and the importance of the appointment or vaccination
The contents of the Was Not Brought letter should be discussed, reiterating that this could be considered as a safeguarding concern

·         Additionally, in cases of missed vaccinations, the contents of the WHO leaflet should be reiterated, explaining the importance of childhood immunisations

·         A second letter should be sent to the parents or guardian
Any response from the parent or guardian given face to face, by telephone or by letter will also be noted in the child’s clinical record

 

c.     For the third missed appointment:

 

·         When a child remains uncontactable and/or unvaccinated after a third contact, this Practice will mark the patient record as either unable to contact or unvaccinated
The clinician noting that the child remains unseen or unvaccinated despite all attempts to recall the patient is to discuss their concerns with the safeguarding lead
A further letter is to be forwarded to the parent or guardian advising them that, due to the persistent failure to bring their child, this has been referred to the safeguarding lead
Should any clinician have significant concerns, they are to initiate a child protection referral using the contact numbers as below and as detailed within the Practice’s Safeguarding Handbook

 

All missed appointments for children should be flagged with the safeguarding lead

Annex A – First letter to patient

Note: The suggested wording below can be used in letters and/or emails. It must be edited to reflect the Practice’s specific circumstances

Our records show that you had an appointment booked with [insert clinician’s name] on [insert day and date] but failed to attend this appointment. If you believe this to be incorrect, please contact us to discuss.

Appointments at The Saheecha’s Practices are at a premium and this missed appointment could have been used by another patient if you had provided the Practice with adequate notice that the appointment was no longer required.

During this last month, [insert number] appointments were recorded as “Did Not Attend” (DNA) which represents [add percentage] of appointments at The Saheecha’s Practices. Please be advised that this Practice has a DNA policy which, for patients who repeatedly fail to attend, may result in them being removed from the Practice’s list.

If you need to cancel or change an appointment, you can:

·         Call the Practice on 01708 343991 for The Health Centre site or 01708 343300 for Heaton site and select the Check and Cancel option.

·         Cancel your appointment via our website: www.thesaheechaspractices.co.uk

 

Please help us to maximise appointment availability in the future. Your cooperation is very much appreciated.

 

Annex B –Removal of patient

Note: The suggested wording below can be used in letters and/or emails. It must be edited to reflect the Practice’s specific circumstances

Our records show that you had an appointment booked with [insert clinician’s name] on [insert day and date] but failed to attend this appointment. If you believe this to be incorrect, please contact us to discuss. 

We previously wrote to you on [insert day and date] regarding the appointments you missed on [insert day and date] and [insert day and date]. You have now missed many appointments within a 12-month period without justification.

Having discussed this with the GP Partners, we have decided that we are removing you from our Practice’s list. We notified NHS England on [insert date] of our decision and you will be removed on the eighth day following notification.

You are advised to register with another practice in the local area as soon as possible. A list of primary care Practices can be found at www.nhs.uk by entering your postcode.

The decision to remove you from the list was not taken lightly but it is imperative that we provide an efficient service for all of our listed patients and we are unable to do so if a patient repeatedly fails to attend scheduled appointments.

The Practice team wishes you well for the future.

 

Annex C – Letter regarding child who was not brought

Note: The suggested wording below can be used in letters and/or emails. It must be edited to reflect the Practice’s specific circumstances

Our records show that your child had an appointment booked with [insert clinician’s name] on [insert day and date] but failed to attend this appointment. If you believe this to be incorrect, please contact us to discuss.  

Appointments at The Saheecha’s Practices are at a premium and this missed appointment could have been used by another patient if you had provided the Practice with adequate notice that the appointment was no longer required. 

[If the appointment was a missed vaccination insert the following:

Vaccination is the most important thing we can do to protect ourselves and our children against ill health. They prevent up to three million deaths worldwide every year. Since vaccines were introduced in the UK, diseases like smallpox, polio and tetanus that used to kill or disable millions of people have either been eradicated or are seen very rarely. Other diseases like measles and diphtheria have been reduced by up to 99.9% since vaccines against them were introduced.

A child who lacks capacity needs to be brought to their clinical appointment by their parent or the person with clinical responsibility. Failure to bring a child to a medical appointment will always be classified as a “Was not brought” with a note being placed within the patient’s medical record.

Please be advised that, should there be continued failures to bring a child to their medical appointment, we would consider this as potential neglect towards that child and, as a result, this Practice would be obliged to advise the local safeguarding team of any concern that we may have.

If you need to cancel or change any appointment, you can:

If you need to cancel or change an appointment, you can:

·       Call the Practice on 01708 343991 for The Health Centre site or 01708 343300 for Heaton site and select the Check and Cancel option.

·       Cancel your appointment via our website: www.thesaheechaspractices.co.uk

 

Please help us to maximise appointment availability in the future. Your cooperation is very much appreciated.