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How can practices reduce DNAs?

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The cancellation or non-attendance of appointments at short notice remains a major challenge facing the NHS today.

Depending on the situation, appointments that become free cannot always be filled. When this happens, valuable clinical capacity can go to waste, waiting times for other patients can increase and treatments may be delayed.

The impact in numbers

The NHS estimates 15 million appointments in general practice are not used each year. From the 307 million sessions scheduled annually, around 1 in 20 are missed. That’s over 15 million missed slots with a cost to the NHS of more than 216 million pounds. The knock-on effect for practices adds up to losses in efficiency, financial income and time.

With demand for appointments at an all time high and limited clinical resource across the health system, protecting valuable clinical and practice time is essential.

Exploring the causes of DNAs

There are a myriad of reasons why DNAs can happen. According to one study, the most common causes include forgetfulness, cancellation difficulties, being too ill, work/family issues, inconvenience and transportation. A long list for sure that only begins to scratch the surface of this complex issue.

Many of these causes can be difficult to anticipate and plan for by their very nature. Unforeseen circumstances can and do arise. So what’s the answer? What can healthcare providers do to mitigate these scenarios? Thankfully, there are some tools at a practice’s disposal to help proactively guard against potential DNAs.

1. Making it as easy as possible to cancel appointments online

The humble GP practice website is one of the most important. Indeed, NHS England’s guide on highly usable and accessible websites provides a number of best-practice recommendations on how to ensure patients can easily book, cancel or amend appointments online.

When a patient visits your website, one of these ‘top tasks’ will usually be front of mind. Thus, ensuring your website is task-focused and prioritised around such actions is key. People scan websites, so include clear calls to action for patient tasks. You can do this by seeding common keywords people search for around appointments and structuring your website menu or main navigation around these tasks.

On an informational level, providing details about different options for cancelling or changing an appointment at your practice can also help. Indeed, one case study published by Practice Index showed how one practice generated an overall DNA reduction of 25% by improving information available on their website in relation to cancellations, alongside other enhancements.

If you’re looking to enhance your practice website to these standards quickly, Livi can help. Our websites platform is built to NHS Digital Service Manual guidelines and reflects NHS branding, look, feel and functionality. Plus, we provide all the content you need to make tasks easy for patients.

2. Using appointment reminders to their full potential

Patient reminders are used by many practices today of course. In the fight against forgetfulness, harnessing these simple forms of communication to their fullest potential is vital. Certainly, research has shown that pre-appointment contact and short message service (SMS) alerts have halved DNA rates in some areas.

These digital reminders help reduce costs vs traditional letters and may be automated to save your practice time. SMS messages also provide an additional means for patients to cancel or reschedule appointments easily. Indeed, patients have exhibited a preference for doing so via SMS.

In terms of content and messaging, different approaches can drive success. Studies report that including the cost of a potential missed appointment in a message produces a DNA rate of 8.4% compared to 11.1% in a message without this information. While other practices have found that featuring a positive tone or imagery within reminders can also deliver results, reducing non-attendance in high DNA groups such as 50-65 year-olds by almost 40%.

No matter what route your practice decides to take, our Mjog smart message platform can support. Our advanced appointment reminders enable GP practices to set up customised, editable messages per appointment type. Sent by SMS, email or telephone, reminders may be scheduled and automated based on your specific needs. This helps practices save time and also allows patients to rearrange or cancel an appointment, when they need to, quickly and simply.

3. Maximising the capabilities of digital healthcare

Finally, digital consultations remain an invaluable tool in preventing DNAs. A recent study reveals telemedicine visits are less likely to result in a missed appointment compared to in-person appointments. This is also associated with decreased disruption in patient-clinic relationships.

In addition, the convenience of digital for patients can help remove some of the common barriers to appointment attendance, such as transportation difficulties and other unforeseen life events. For example, if a patient is too busy with work or an urgent personal situation arises, digital can alleviate time pressures as well as the need for a patient to travel and be physically present. If a patient is too sick to attend, likewise digital healthcare can facilitate.

And when DNAs do arise, having digital clinical capacity on-hand at short notice can be a great way of filling any gaps that do become available. Our Livi Population offering provides PCN and GP partners with a flexible, agile solution for digital clinical capacity, delivering resource directly to a practice when and where it is needed.

Need support? Livi can help. To find out more, contact

How can Livi help you?

As a leading digital healthcare provider, Livi can deliver a range of support to ICSs, PCNs and practices. Our solutions and services include digital consultation technology, clinical capacity, smart messaging, and patient engagement and remote monitoring tools.

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