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Top 10 rules for missed appointments

The MDU's Dr Jacqui Phillips provides 10 ground rules on how to manage 'did not attend' patients.

Patients in the UK miss around 10 million GP and five million practice nurse appointments each year, disrupting surgeries and wasting NHS resources.

Top 10 rules on how to deal with the 'did not attend' (DNA) patient


Competent adults are responsible for attending appointments, but while GPs cannot be expected to chase up every DNA, they do have some responsibility in certain cases.


The MDU advises practices to ensure they have a clear, consistent protocol for booking appointments and identifying and dealing with missed appointments - and that all clinical, reception and administrative staff are aware of it.


You are advised to tell all patients - perhaps via your practice leaflet and website - how the appointment system operates and the potential consequences of missing appointments.


When a patient repeatedly misses appointments, consider exploring whether there is an underlying health or social problem.


If a patient, who may be acutely unwell, fails to attend an emergency appointment, it is important that the practice can demonstrate reasonable steps were taken to investigate the circumstances and need for care.


Practices need clear procedures for following up patients' failure to attend screening appointments, even if reminders have been sent. Ensure patients get adequate information to decide whether to participate.


A patient failing to attend a chronic disease review can present a dilemma, particularly if they require repeat prescriptions.


The MDU advises practices to have a system for dealing with patients not attending hospital appointments. GPs must consider the severity of the patient's condition and relevant information about their circumstances.


If a well-informed patient decides not to attend a hospital appointment, it is unlikely that their GP would be criticised.


If a patient who misses an appointment is harmed and sues you, a successful defence would require you to demonstrate that your actions had not fallen short of those a 'reasonable' clinician would take and that they are supported by a responsible body of GPs.

Always make sure you inform patients in ways they can understand about why it is important to attend appointments. The information should include other options for treatment and investigation so that patients can make a decision about whether to attend.

Keep clear records of steps taken to investigate incidents of non-attendance and attempts made to inform patients of the need to attend.

  • Dr Phillips is a medico-legal adviser at the Medical Defence Union www.the-mdu.com
Photo: SPL

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