Background

Non-attendance for GP and nurse appointments has increasingly become a serious problem. This situation is not only a huge waste of resources for Doctors and Practice Nurses but also means that many patients have been declined appointments when, in fact, they could have been seen by the medical staff. It also means that waiting times for routine appointments may be longer than we would want, which causes understandable frustration for patients.

The Patient's Representative Group, as well as the doctors have been most concerned about this problem and have provided posters in the surgery to highlight the issue and request patient's cooperation.

The Practice has also instigated a text-based system that reminds a patient of their appointment at the point of booking and again on the day before the appointment. Sadly these measures have not prevented the problem from growing. It is against this background that the Practice and the Patient's Representative Group have agreed the following Protocol to deal with the problem.

Monthly Review of Non-attendance

The Practice will review on a monthly basis all cases of non-attendance where the patient both failed to turn up at the surgery and failed to notify the Practice in advance.

The patients in this category will receive an initial standard letter warning them that this behaviour is not acceptable and that it may lead them to being removed from the Practice List if repeated.

Repeated Non-attendance

If a patient having been cautioned by a first letter becomes a non-attendee again within 12 months of the initial non-attendance then they will receive a FINAL WARNING letter that will inform them that if they fail to attend an appointment again without prior notice, their registration status at the practice will automatically be reviewed and their removal from the practice list will be considered a serious option.

Review of Registration

If a patient fails to attend an appointment, without prior notice 3 times within a space of 12 months, and has received a FINAL WARNING letter to that effect from the practice, the GP Partners and the Practice Manager will review this patient’s registration status in accordance with this policy. The patient will be invited to the practice to provide any mitigation that can be taken into account as part of the review.

There are two possible outcomes:

• The review will result in the automatic removal of the patient from the Patient List if the practice feels the repeated DNA's are unjustified and despite written warnings the patient has provided no satisfactory explanation for, or has shown no willingness or inclination to improve their attendance at pre-booked appointments. In that case the patient will be formally written to with the outcome of their registration review within 7 days of the removal being decided and rationale that led to the decision. Like any communication pertained to the patient, this letter will be saved in the patients clinical notes. From the removal date onwards the patient will no longer be able to receive primary medical services from The Practice and will have to register with another local practice.
• If the GP Partners and the Practice Manager consider that the health, condition or life circumstances of the patient have contributed to their non-attendance, and/ or the mitigating circumstances mean that the patient should not be removed at that time, the patient will remain on the list. The patient will again be formally written to with the outcome of the registration review within 7 days of the review meeting. They will be informed that on this occasion the practice has decided to maintain their registration, but as repeated DNAs are a serious problem for the practice, their attendance will continue to be closely monitored. Again this letter will be saved in the patients clinical notes. If the pattern of non-attendance persists, a further review of their registration will be carried out and removal from the list will be in accordance with this policy.