Did Not Attend (DNA) Policy

 

 

Table of contents

1      Introduction

1.1       Policy statement

1.2       Status

 

2      Policy

2.1       Overview

2.2       Recording DNAs

2.3       Preventative measures

2.4       Managing DNAs (face to face appointment)

2.5       Managing a failed home-visit encounter

2.6       Managing failed telephone encounters

2.7       Children who fail to attend

2.8       Actions needed for a ‘Was Not Brought’

 

 

1       Introduction

1.1      Policy statement

 

The purpose of this document is to provide guidance regarding the management of patients who failed to attend their appointments at Windrush Surgery. It is essential to make the best use of the clinicians’ availability to ensure that all patients have access to appointments within an acceptable time frame.

 

This document sets out the procedures for monitoring and recording and the required actions to be taken to effectively manage missed appointments at this practice. Within general practice, failure to attend appointments is commonplace. It is therefore essential that an efficient management system is in place.

 

1.2      Status

 

The practice aims to design and implement policies and procedures that meet the diverse needs of our service and workforce, ensuring that none are placed at a disadvantage over others, in accordance with the Equality Act 2010. Consideration has been given to the impact this policy might have regarding the individual protected characteristics of those to whom it applies.

 

This document and any procedures contained within it are non-contractual and may be modified or withdrawn at any time. For the avoidance of doubt, it does not form part of a contract of employment. Furthermore, this document applies to all employees of the practice and other individuals performing functions in relation to the practice such as agency workers, locums and contractors.

2       Policy

2.1      Overview

 

When a patient fails to attend an appointment or fails to notify the practice 24 hours prior to the 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 to be recorded on the clinical system in the individual’s healthcare record using the relevant Did Not Attend, SNOMED code. This practice will review DNA statistics on a regular basis, presenting this information at the relevant internal meetings. DNA statistical information is displayed in the waiting area using the practice’s DNA poster and or the waiting room TV. In addition to recording DNAs upon the clinical system, the practice also records all DNAs on their DNA Logging Toolkit.

2.3      Preventative measures

 

In order to reduce the number of DNAs, the practice will offer:

 

• Easy cancellation: Rapid access is provided for patients who wish to contact the practice to cancel an appointment, such as a dedicated phone service, a text message service and online cancellation functionality.

 

• 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 asked to write their own appointment card for their next appointment rather than having this done for them. This encourages recall, thereby reducing subsequent DNAs.

• Read back: The administrative team will ask the patient to repeat the details of the appointment to them to check that they have remembered and recorded it correctly.

• 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)

 

Should a patient fail to attend their appointment without notice, this will be recorded as: Did not attend – SNOMEDCTID 281399006.

Should a patient advise that they need to cancel an appointment, although less than 24 hours’ notice is given, this will be recorded as: Appointment cancelled by patient – SNOMEDCTID – 185332005

It should be noted that, while unacceptable in most cases, there may be extenuating circumstances as to why the patient failed to attend their appointment. Therefore, prior to any letter being sent to a patient, it would be reasonable to discuss this with their clinician.

Should there not be any mitigating reasons, then a letter explaining the DNA will be sent to the patient. If the patient fails to attend a second appointment within a 12-month period, and should there be no reasonable mitigating circumstances, a further letter will be sent to the patient.

Should the patient then fail to attend a third appointment within the same 12-month period, a decision will be made by the management team as to whether the patient is to be removed from the practice’s list.

Prior to writing to the patient, the senior GP 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.

2.6      Managing failed telephone encounters

 

Telephone consultation failed encounters must also be managed appropriately to ensure patient safety is not compromised.

If a patient fails to answer a pre-booked telephone consultation, it is the responsibility of the clinician initiating the call to Read code this as a “Failed encounter – no answer when rang back” using either Read code 9N4C or SNOMED CT code 185337004.

The clinician should task a member of the reception or administrative team to contact the patient and have the appointment rearranged. For accurate record keeping, the clinician must document in the record that they have instructed the reception or administrative team to contact the patient to rearrange the appointment.

The receptionist or administrator must also document that they have telephoned the patient to rearrange their appointment using SNOMED CT code 24671000000101 – “Telephone call to a patient”. If the patient fails to answer the call from the receptionist or administrator, this must also be recorded as a “Failed encounter – no answer when rang back” using Read code 9N4C or SNOMED CT code 185337004.

 

The patient must then be sent a message using the practice messaging system asking them to contact the practice. This must also be recorded in the patient’s healthcare record.

When the patient contacts the practice to rearrange, the receptionist or administrator is to ask why the patient failed to answer the pre-booked call. There are many feasible reasons for doing so, see examples below (this list is not exhaustive):

• Lost signal
• Was on another call
• Phone went straight to voice mail
• Caller ID was blocked

By doing so, this practice can determine the root cause of such failed encounters and take appropriate action, i.e., advise all patients that the call will be coming from a withheld number, thereby preventing future failed encounters.

If a patient has requested a call back from a clinician and they fail to answer, the same principle applies, although the clinician should, at the next available opportunity within that same session, make a second attempt to call the patient.

At the end of the session, the clinician should make a third attempt to contact the patient. Should the patient fail to answer the call for the third time, the clinician is to Read code this as a “Failed encounter – no answer when rang back” using either Read code 9N4C or SNOMED CT code 185337004.

The clinician should then task the reception or administrative teams accordingly to contact the patient. When contact with the patient is made, they must be offered an appointment based on clinical need. Should a receptionist or administrator have any doubt as to the type of appointment needed (routine, urgent, same day etc.), they should seek advice from a clinician.

2.7      Children who fail to attend

 

The British Journal of General Practice article, explains that while all missed appointments have traditionally been classified as a DNA, this group needs to be classified as Was Not Brought 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.

 

For further information, The Nottingham Safeguarding Children Board has developed a video to assist with understanding the differences between medical neglect and a simple DNA. Further definitions of neglect and medical neglect are available from Safeguarding Wales.

2.8      Actions needed for a ‘Was Not Brought’

 

Although it is a subtle difference, coding the non-attendance of children as ‘Child not brought to appointment’ using Read code 9Nz1 or SNOMED CT 901441000000108 may be considered to enable more accurate safeguarding auditing in addition to emphasising the potential failure by those responsible for the child’s welfare.

 

1. Actions following 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. If appropriate, a copy of the WHO leaflet If you choose not to vaccinate your child, understand the risks and responsibilities is to also be forwarded

 

• 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

 

 

1. Actions following 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

 

1. Actions following 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 detailed within the practice’s Safeguarding Policy.

 

Any non-attendance by a child to their medical appointment will trigger a letter that needs to 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. All missed appointments should be flagged with the safeguarding lead.