Studying and reducing DNAs to improve access

Mohammed N Hossain

doi:10.3399/bjgp14X677059

We originally had a 4-week advance booking system for appointments which we had for over 10 years but were not performing well on ‘access’ because of a high number of patients who did not attend (DNA). We often had over 100 DNAs per month so many appointments were being wasted. I noticed that another local practice which permitted advance booking only 2 days ahead scored better in the ‘access’ survey than our practice. Another local practice was piloting a same day booking system with no appointments booked in advance, from June 2013.

We calculated that we had nearly the correct number of GP and nurse appointments per 1000 patients, per week. The Local Medical Committee had advised 100 appointments per 1000 patients per week. We are an average size practice of 6400 patients.

An audit of the DNAs in April 2013 showed that 80% of DNAs had booked more that 7 days previously, so we changed to a 1-week advance booking system from 1 July 2013 with 50% of appointments bookable in advance and 50% available on the day, for GP appointments but not nurse appointments. The ‘same day’ appointments were unblocked on the day at 8 am each morning to prevent them being booked online.

A repeat audit of DNAs in October 2013 showed that 75% of patients who DNA had booked more than 3 days ahead so we have just changed to a similar 3-day booking system from Monday 9 December 2013. This has reduced our DNAs and reduced stress within the practice. Other practices in the UK may wish to consider these ideas. I have concluded that a 2–3 day advance booking system is the right one for our practice and will probably be optimal for most practices.