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How nudging techniques could help to decrease the number of DNAs

By Katherine Baterip, Customer Relationship Executive

Patients that do not attend their booked appointments, otherwise known as DNAs (did not attends) in the NHS are creating even more stress within an NHS system that the media is already portraying as overworked, underfunded and understaffed.

Information collected by five CCGs across Mid and South Essex showed that across 44 practices each month in Basildon and Brentwood, around 450 hours of GP appointment times are wasted, totalling around 12,000 appointments and the equivalent to 3.5% of the total number of appointments available. Across England, these figures are expected to be even higher, with 10 million appointments suspected to be missed annually.

A potential knock-on effect could be that a patient who is unable to obtain a GP appointment may choose to go to A&E, putting further pressure on hospitals. If GP appointments are then missed on top of this, even more NHS time and money is wasted. To avoid this, practices should have clear policies in place to tackle the issue.

What can be done to help resolve this?

Some practices are sending text and email reminders, as well as calling patients with the option to cancel the appointment, whereas others are even warning patients who repeatedly miss their appointments that they could be taken off the surgery books. Whilst a variety of practices have also found publishing the number of DNAs and total number of hours wasted helpful.

There isn’t just one solution, it will be trial and error and each area will find different things that will work more for them compared to others. Perhaps there is something simpler that you can try?

The concept nudge theory 1

Nudge theory is a concept which proposes positive reinforcement and indirect suggestions to try and influence the decision making of groups and individuals.

Previously, there have been discussions about transitioning nudging techniques from the commercial world into GP Practices, and this would help to build personal relationships and ‘nudge’ patients towards making the right decisions about their health.

So how can this be applied to DNAs? 2

The purpose of a GP practice is for patients to leave feeling better than they would have had they not visited. Nudging techniques can help with this, and can be applied to General Practice in several ways. For example; greeting patients upon arrival instead of leaving them to log in via a computer, playing music in the waiting room and having reading material available are all factors that would make them feel more at ease. This will create a better experience for patients, and having the human contact upon arrival will give the chance to build further personal relationships, which in turn make them feel more welcome, and can only be seen as positive steps to ensuring patients turn up for their appointments.

This is not only something for Practice Managers to think about, as any staff within the practice involved with the appointments process can contribute. You could try to communicate with them in a way that isn’t pressurising, but in fact encourages them to attend their appointments. Instead of warning patients there could be fines for missed appointments, trying using less aggressive language and inform them how much each missed appointment can cost the NHS. The idea is to leave the choice with the patients in regards to whether or not they arrive by gently nudging them in the right direction of choosing to attend. This in theory will lead to more patients repeatedly keeping to their appointments all without needing extra time, extra funding, or extra staff.

Katherine Baterip is MIABs Customer Relationship Executive, and works alongside healthcare professionals in order to explore the topics that matter the most to them, to find out how MIAB can help.