Better interventions could cut missed appointments by third

A study carried out by behavioural scientists suggested three possible interventions which could be put in place quickly and at no cost to the NHS to cut the number of “Did Not Attends”.

Changes the team suggested were informed by social influence theory, and were tested in NHS Bedfordshire’s GP surgeries. The proposed interventions to cut the number of DNAs were:

• Patients calling for an appointment should be asked to repeat back the time and date of their appointment before the call ends.
• When booking follow-up appointments, patients should write down the time and date on an appointment reminder card rather than healthcare or reception staff doing it for them.
• Replacing common signs that communicate the number of patients who did not attend appointments in previous months with signs that conveyed the much larger number of patients who do turn up.

Interventions one and two were made in the hope that they would increase the participation of patients to cut down on DNAs, or at least increase the likelihood that those who could not make their appointment would contact the surgery to cancel.

Often, GPs cite DNAs as a cause of increased waiting times and a rise in costs - DNAs cost the health service an estimated £700 million each year, with nearly six million appointments left unattended.

According to research, the number of patients attending Accident & Emergency can increase unnecessarily and inappropriately because of DNAs.

The paper’s lead author, Steve Martin, is also the BDO Alliance’s behavioural change lead.

He said: “While some DNAs are a result of transport issues or patients experiencing difficulty in getting through to cancel an appointment, a simple fact, backed up by surveys of patients themselves, is that one of the more common reasons why patients DNA is that they simply forget.”

DNAs decreased by 3.5 per cent thanks to the first intervention, while intervention two helped cause an 18 per cent decline in DNAs.

The expert and his team argue that showing patients DNA numbers in surgery waiting rooms may cause a rise, rather than a fall, in the number of DNAs.

“Research has consistently shown that drawing attention to the regrettable frequency of unwanted behaviours can have the effect of normalising those behaviours resulting in an increase in their occurrence,” Martin said.

Swapping the signs with posters showing the larger number of people who went to their appointments, along with the other two interventions, meant there was a 31.7 per cent fall in the number of DNAs, in comparison to the average during the previous year.