Shedding light on the mystery of DNAs

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"Did Not Attends" waste GP time and deny access to patients who do need to see the doctor. But evidence shows a way to cut them in half, without technology and without trying to change behaviour

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Shedding light on the mystery of DNAs in general practice Harry Longman April 2013:

Shedding light on the mystery of DNAs in general practice Harry Longman April 2013

Another 10 minutes wasted. Why does it matter?:

Another 10 minutes wasted. Why does it matter? That so-and-so will go round the loop and see me again They were turning patients away on reception, who did need to see me J ust another £200 million problem for the NHS

Spot the relationship between GP DNAs and how many days the patient waits between the booking and the appointment.:

Spot the relationship between GP DNAs and how many days the patient waits between the booking and the appointment. Same day DNA rate is 1.4%. Within a single day it jumps to 3% The rate rises steadily to between 4 and 5%

For other clinicians in practices, ie not the GPs, the same relationship applies but DNA rates are higher overall.:

For other clinicians in practices, ie not the GPs, the same relationship applies but DNA rates are higher overall. Same day DNA rate is 1.3%. Within a single day it jumps over 3% The rate rises steadily to between 6 and 7%

What hasn’t worked (much) in the effort to reduce DNAs?:

What hasn’t worked (much) in the effort to reduce DNAs? Reports of 20% reduction with text messaging? If this worked they would stop having to do it wouldn’t they?

The obvious solution: if all appointments were offered on the same day, DNAs would drop.:

The obvious solution: if all appointments were offered on the same day, DNAs would drop. As many as possible just here – problem solved

Average days wait at this Salford practice dropped from three to under one, 90% seen the same day. A few patients choose to wait a day or two.:

Average days wait at this Salford practice dropped from three to under one, 90% seen the same day. A few patients choose to wait a day or two. Intervention, new system launched in week 41

Reduction in DNAs is not the aim, but merely a by product of a fundamental change to the access model.:

Reduction in DNAs is not the aim, but merely a by product of a fundamental change to the access model. Reception takes call GP phones patient Problem solved Come and see GP Admin question Come and see nurse 10% 20% 10% 30% 60% 70%

As predicted, DNAs for GP appointments have dropped over 50%. Similar outcomes are seen repeatably with other practices.:

As predicted, DNAs for GP appointments have dropped over 50%. Similar outcomes are seen repeatably with other practices. Reminder, intervention here at week 41

Now, are DNAs a people problem or a system problem?:

Now, are DNAs a people problem or a system problem? How many years are we going to try changing behaviour? Or just change the practice system in four weeks.

Here’s a one word solution to the mystery of DNA:

Here’s a one word solution to the mystery of DNA

Note on method:

Note on method Data was collected from 39 practices Periods are from January 2011 to March 2013. Total count of appointments analysed: n = 837,208 Method: Select face to face appointments and count by number of days between booking and appointment. DNA rate = (count of DNAs)/(count of DNAs plus finished) Summary Role Status Count GP Did Not Attend 11015 Finished 438841 Other Did Not Attend 18094 Finished 369258 h arry.longman@patient-access.org.uk www.patient-access.org.uk

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