Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Intended for Healthcare Professionals
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
  • Subscribe BJGP on YouTube
British Journal of General Practice
Intended for Healthcare Professionals

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
Life & Times

In defence of the DNAs

Jim Pink and Elizabeth Ryan Harper
British Journal of General Practice 2019; 69 (680): 134. DOI: https://doi.org/10.3399/bjgp19X701549
Jim Pink
Llanishen Court Surgery, Cardiff. Email:
Roles: GP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: james.pink@wales.nhs.uk
Elizabeth Ryan Harper
Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant. Email:
Roles: Foundation Year 1 Doctor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: elizabeth.ryanharper@wales.nhs.uk
  • Article
  • Info
  • eLetters
  • PDF
Loading

Another day, another negative story about the NHS, broadcast on breakfast radio, at just the correct time to put my back up before even stepping into the surgery. Yesterday was about unacceptable waiting times in A&E, the day before about how we are earning too much money, and today it’s all about the patients who failed to show up for their appointments — the much maligned DNAs.

It seems that someone who isn’t busy seeing patients has found the time to count the number of appointments ‘wasted’ because of patients not turning up. The quoted figures came from West Fife where there were 252 DNAs in one week.1 The report in question focused on the costs of these missed and cancelled appointments, and implored the public to attend the appointments they had made in order to prevent increased costs to the NHS. Other studies suggest that DNAs account for 10 million lost appointments a year.2 Such figures are bound to raise eyebrows among managerial types. The drive for increased efficiency within the NHS is laudable, but we mustn’t forget that the NHS is one of the most cost-effective healthcare systems in the world.3 We can only squeeze the sponge so much.

FROM THE PATIENT’S PERSPECTIVE

Clearly, on paper, DNAs are a very bad thing for the NHS. Demand for appointments is overwhelming and patients not turning up leads to others having to wait longer. The frustration is understandable. As a GP partner, I know about distributive justice in the provision of healthcare services. But I also think the fuss about DNAs is missing two important points.

First, do we fully understand why patients don’t attend? Are these patients forgetful? Are they disorganised? Do they have a physical or mental impairment that prevents them from understanding appointment details? Has the problem gone away?

Has there been a breakdown in transport provision? Are they simply inconsiderate? Are they just scared? Perhaps there is a combination of the above.

For a recent minor issue requiring an outpatient appointment, I received two appointments with different specialists on different days for the same problem, both of which required confirmation via telephone during office hours. Having confirmed the correct appointment and cancelled the incorrect one, I still received an automated telephone message asking me to confirm the appointment that I had already cancelled. I am an NHS doctor, with intact faculties, but this is not the case for all of our patients. I’m not surprised some people either turn up to the wrong clinic, or not at all.

THE SILVER LINING

What can we do to help patients who struggle to keep appointments? The increasing trend for standardised letters from hospital stating that because a patient has missed their appointment they will need a re-referral from their GP is punitive to both the patient and primary care. It assumes that the only patients who don’t turn up are inconsiderate and completely ignores the multitude of other reasons why they may not have attended that day, while adding unnecessary additional workload for the GP.

Second, I don’t know of any doctor who hasn’t on at least one guilty occasion been delighted when a patient hasn’t turned up. This is because, throughout the NHS, demand outstrips supply, so clinicians constantly feel they have insufficient time to see patients, manage the clinical admin, deal with the bureaucracy, and develop services. Just as many hospitals are running on bed occupancy rates of greater than 100%, so too are many clinics being overbooked, or routinely running over time (as 10-minute appointments just really aren’t long enough). When faced with an overbooked, over-running clinic, a DNA can be a pressure valve: an opportunity to check an email or blood result, write a letter, chat to a colleague, look something up, visit the bathroom, sip a cup of tea, or, more likely, catch up on lost time. These 10-minute unscheduled mini-breaks may well be protective against burnout.

Recently, I was sitting at the dinner table with my two young children, and we all had a pleasant surprise when the children’s mother walked in: ‘Hello, darling. You’re not normally home in time for dinner.’‘No — I got away on time for once, as I had two DNAs!’

The NHS is a highly efficient healthcare system, and it is imperative that we keep it this way, but we mustn’t forget the dangers of improving efficiency. A little slack in the system is good for those who work in the NHS, and allows them to recharge their emotional and cognitive batteries once in a while. We are then able to ride out the bad days better. Aiming towards 100% efficiency in an already efficient system is only a good idea on paper. If we are able to reduce DNA rates to nil, we had better start thinking of alternative ways to decrease clinician workload, as currently the patients who don’t attend without cancelling may just be doing their doctor a favour, despite what the powers that be may claim.

  • © British Journal of General Practice 2019

REFERENCES

  1. 1.↵
    (Feb, 2018) In just one week, 252 people failed to show up for a GP appointment in West Fife. Dunfermline Press 13:http://www.dunfermlinepress.com/news/15989277.In_just_one_week__252_people_failed_to_show_up_for_a_GP_appointment_in_West_Fife/ (accessed 22 Jan 2019).
  2. 2.↵
    1. Slawson L
    (Jan, 2018) Patients missing their appointments cost the NHS £1bn last year. Guardian 2:https://www.theguardian.com/society/2018/jan/02/patients-missing-their-appointments-cost-the-nhs-1bn-last-year (accessed 22 Jan 2019).
  3. 3.↵
    1. Davis K,
    2. Stremikis K,
    3. Squires D,
    4. Schoen C
    (2014) Mirror, mirror on the wall, 2014 update: how the US health care system compares internationally. Commonwealth Fund. http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror (accessed 22 Jan 2019).
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 69 (680)
British Journal of General Practice
Vol. 69, Issue 680
March 2019
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
In defence of the DNAs
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
In defence of the DNAs
Jim Pink, Elizabeth Ryan Harper
British Journal of General Practice 2019; 69 (680): 134. DOI: 10.3399/bjgp19X701549

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
In defence of the DNAs
Jim Pink, Elizabeth Ryan Harper
British Journal of General Practice 2019; 69 (680): 134. DOI: 10.3399/bjgp19X701549
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • FROM THE PATIENT’S PERSPECTIVE
    • THE SILVER LINING
    • REFERENCES
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Books: The Only Book I’ll Ever Write: When The Doctor Becomes The Patient
  • Being philosophical when it’s complicated
  • Sleepwalking into a two-tiered healthcare system
Show more Life & Times

Related Articles

Cited By...

Intended for Healthcare Professionals

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2023 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242