As the NHS published its Long Term Plan Kay Silversides looks behind the headlines on DNAs, in our latest article on ways to reduce stresses on our health service
Recent media reports have highlighted how much missed GP appointments cost the NHS – the princely sum of £216m a year, which could pay for 2,325 full-time GPs.
The price paid for DNAs (‘do not attends’) is quite an eye-opener and clearly of concern. But this also raises a lot of questions, including why does this happen? And exactly who are the patients who are not turning up?
We know from our own research on behalf of Clinical Commissioning Groups (CCGs) that the reasons for DNAs are varied.
Patients most likely to miss appointments on a serial basis have high levels of social and health vulnerability
One key cause is the difficulty in cancelling appointments, particularly if you are relying on getting through on the phone to your GP surgery.
We hear frequently about the problems people face getting through to their surgery to make an appointment in the first place – who wants to go through that again to cancel?
Many areas have already implemented text options to make it easier to cancel an appointment. And the NHS Long Term Plan includes a raft of digital initiatives to make interacting with health services as convenient as online grocery shopping. With any luck, this will go some way to resolving this issue for the majority.
However, a slightly knottier problem is what to do about the repeat or serial DNA-ers. A study led by the University of Glasgow and published in the Lancet identified that non-attendance rates in primary care are partly driven by a significant number of patients missing multiple appointments.
Nearly 20% of patients did not attend more than two appointments in the three-year study period.
Crucially, this research also found that the patients who are most likely to be missing appointments on a serial basis have high levels of social and health vulnerability, including long term mental health conditions . So, those that need healthcare the most are the most likely not to attend.
Clearly, this issue goes beyond the face value cost to the NHS and plays a role in perpetuating health inequalities.
The Long Term Plan talks about the approach to reducing health inequalities, including the need for local health systems to have a detailed understanding of the local population. This is no easy task and must delve deeper than an overview of deprivation stats.
As the Glasgow study also showed, socioeconomically deprived patients were also more likely to miss multiple appointments if they were registered in GP practices located in affluent urban areas, so to some extent blanket approaches to addressing health inequalities in typically deprived locations may not be enough.
Although addressing the issue of serial DNAs is only one issue amongst many in a local population, the renewed emphasis on collaboration and integration provides a real opportunity for partners to work together to harness the power of this data to target and engage with a potentially very vulnerable, hidden, local population.
Kay Silversides is a research manager at Qa Research. You can contact her on firstname.lastname@example.org or 01904 632 039