HSMC DNA (Did Not Attend) Policy
1. Purpose
The purpose of this policy is to reduce the number of missed appointments, ensuring that clinical time is used effectively for all patients. Every missed appointment is a wasted resource that could have been offered to another patient in need.
2. Patient Responsibilities
To support the practice, patients are expected to:
· Cancel in a timely manner: Provide at least 24 hours' notice if an appointment is no longer required.
· Keep contact details updated: Ensure the practice has a current mobile number for SMS reminders.
3. The DNA Process
We utilize an automated system to support attendance:
1. Confirmation: An SMS is sent at the time of booking.
2. Reminder: An SMS is sent 24 hours prior to the appointment.
Clinical Governance Pathway
If a patient fails to attend without prior cancellation, the following steps are taken:
| Occurence
|
Action Taken | Content |
| 1st DNA | Warning SMS 1 | Notifies the patient of the missed slot and explains the impact on the NHS. |
| 2nd DNA | Warning SMS 2 | A firmer reminder noting this is the second occurrence within 12 months. |
| 3rd DNA | MDT Review | The case is flagged for a Multi-Disciplinary Team (MDT) review regarding potential removal. |
4. Exceptions & Safeguarding
The practice recognizes that some patients face barriers to attendance. Removal from the list will not be considered for the following groups without exceptional clinical justification:
· Minors: Patients under the age of 16.
· Lack of Capacity: Patients with a recorded lack of capacity or significant cognitive impairment.
· Vulnerable Adults: Patients on the Safeguarding Register or those with known severe mental health crises.
· Clinical Discretion: Any case where a GP believes removal would pose a significant risk to the patient's well-being.
5. MDT Review and Removal
Before any patient is removed, an MDT Review (comprising at least one GP and the Practice Manager) will take place. They will assess:
· The reasons for the DNAs.
· The patient’s medical history and vulnerability status.
· Whether any "reasonable adjustments" (e.g., easier-to-read reminders) could prevent future DNAs.
5.1 MDT Checklist: Reasonable Adjustments & Vulnerability Review
Patient Name: NHS Number: Date of Review:
Before proceeding with a removal for repeated DNAs, the MDT must confirm that the following factors have been considered and addressed:
1. Communication Barriers
· [ ] SMS Delivery: Has the patient opted out of SMS, or is the mobile number on file incorrect/disconnected?
· [ ] Language: Is the patient’s first language something other than English? Has a translated version of the policy or an interpreter been offered?
· [ ] Accessible Information: Does the patient have a visual impairment, learning disability, or low literacy that makes standard SMS/letters ineffective? (e.g., Do they need large print or "Easy Read" formats?)
2. Clinical & Social Factors
· [ ] Mental Health: Is there a known diagnosis that may impair the patient’s ability to manage appointments or leave the house?
· [ ] Cognitive Impairment: Are there early signs of dementia or memory loss not yet formally coded as "Lack of Capacity"?
· [ ] Substance Misuse: Is the patient currently engaging with recovery services where attendance stability is a known issue?
· [ ] Carer Involvement: Does the patient rely on a carer/third party to attend? If so, have we attempted to contact the carer/third party regarding the missed appointments?
3. Final MDT Determination
· [ ] Decision: Proceed with Removal / Retain with Support Plan / Issue Final Warning.
· [ ] Justification: ______________________________________________________
· [ ] Sign-off: (GP Lead & Practice Manager)
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