It is estimated that missed appointments or ‘Did Not Attends’(DNAs) cost the NHS £1 billion every year(i). Whilst this figure is alarming, there is another unspoken cost - that of the widening gap in health inequalities.   

Every DNA is a missed opportunity - both for the NHS and for the patient. There is a ripple effect as staff invest time into rebooking appointments and juggling schedules whilst the patient’s health deteriorates - patient engagement platform ‘Dr Doctor’ found that people who DNA are 40% more likely to present in A&E within 7 days(ii). Clearly, missing appointments can lead to longer term problems: treatable illnesses become more critical, increasing pressure on services. 

Research indicates that repeatedly missing appointments is associated with greatly increased mortality risk. This risk is most prominent among patients with mental health conditions. One study claims that approximately 5% of patients with known mental and physical morbidities, who miss two appointments per year, die within 12 months(iii).

What can we do about it? ‘Simple’ fixes could have unintended consequences

So, what can be done to prevent DNAs? Nationally, the rate of DNAs is highest amongst patients with characteristics associated with health inequalities such as deprivation, ethnicity, disability and mental health conditions. Former Chancellor Rishi Sunak’s recent proposal to introduce a temporary £10 fine for patients who miss NHS appointments came under criticism for its potential to exacerbate health inequalities without addressing the problem. If someone is already struggling to afford transport to their appointment, is fining them fair?  

For many it is not simply 'forgetting' or being 'disorganised', it is facing language or literacy barriers, enduring mental health conditions or living difficult lives which makes accessing healthcare systems extremely challenging.

Therefore, targeted and carefully considered solutions would likely be more appropriate and effective. Thanks to NHS Charities Together, Dorset ICS has received funding to develop a better understanding of who is most likely to DNA and what leads to missing appointments. Over the next few weeks, I will be exploring some of these barriers and speaking to healthcare professionals with valuable insights into factors that affect health equity. If anyone would like to find out more, has any contacts, insights, or general questions about the project, please email me at rosie.osborne@dorsetcouncil.gov.uk. 

(i) NHS 2019 Outpatients Project: 2019 Outpatients project – Results published — NHS Benchmarking Network

(ii) DrDoctor: DNA vs last minute cancellation - should there be a standard metric? (drdoctor.co.uk)

(iii) ‘Missingness’ in health care: Associations between hospital utilization and missed appointments in general practice. A retrospective cohort study ‘Missingness’ in health care: Associations between hospital utilization and missed appointments in general practice. A retrospective cohort study | PLOS ONE