Late arrivals

All of our practices are based in busy London areas, where patients rely on public transport and little parking is available. Try to be understanding if patients are late - they may have made every effort to get to their appointment on time. Most people who make an appointment genuinely need to see a clinician and rebooking is not always an option.

If the patient arrives less than 10 mins late, we must try and accommodate them. Even if the next patient has been called, ask the patient politely to wait.

There may be a delay between when the patient arrives at reception and when a receptionist speaks to them. If the patient arrives less than 10 minutes late, but they’re waiting to speak to a receptionist, we should accommodate them.

What to do if a patient arrives more than 10 minutes late

1. Reception informs the patient that since they are more than 10 minutes late they may not be seen, and to please wait for the clinician’s decision
2. Reception notifies the clinician that the patient has arrived & adds a note on the clinic list that the patient arrived late
3. Clinician decides if it’s urgent that the patient is seen that day, and if they are able to see the patient either then or later in the day (if they have spare slots and/or no one else waiting to be seen) and tells reception
4. Reception informs the patient of the clinician’s decision

Especially if the patient cannot be accommodated, please be as empathetic as possible! Mark the on the appointment book as ‘Patient DNA’ (D)

Did not attend (DNA)

We try to be understanding and give patients the benefit of the doubt if they DNA. Careful consideration must be given before a patient is removed from the practice list, however, we will remove patients that continually miss their appointments without good reason. More than 15 million appointments are wasted each year because patients do not turn up or fail to warn surgeries that they will not be attending.

Face-to-face appointments

1. If a patient DNAs, mark this on the appointment book as ‘Patient DNA’ (D)
2. Check the patient did not make any attempts to cancel → if not, send Accurx text: ‘DNA policy text template’ or ‘Child not brought DNA’ as applicable
3. Check the DNA history → if this is the third DNA in 12 months, notify the Reception Lead

Phone appointments

1. If a patient fails to answer, make a second attempt to call the patient at the next available opportunity within the same session
2. If the patient fails to answer again, make a third attempt to contact the patient at the end of the session
3. If a patient fails to answer the third attempt, right click on the slot → go to ‘Change slot status’ and select ‘Telephoned but no answer’ or press ‘H’
4. Check the patient did not make any attempts to cancel → if not, send Accurx text: ‘DNA policy text template’

• Once finished, press ‘T’ for Call ended

Warnings & removals

1. Check clinic list at the end of the day for any appointments marked as patient DNA
2. Check if an Accurx text has already been sent → if not, send Accurx text: ‘DNA policy text template’ or ‘Child not brought DNA’ as applicable
3. If this is the patient’s third or fourth DNA, notify Julie
• After the third DNA in 12 months a letter will be sent to the patient warning them of our removal policy.
• After the fourth DNA we’ll review whether to remove the patient from the practice list.

See ⚠️Patient Warnings & Removals for more information.

Safeguarding: Vulnerable Patients & Was Not Brought (WNB)

All patients are potentially at risk of safeguarding issues, but some groups of patients are particularly vulnerable, and a DNA/WNB by one of these patients may be a sign of a serious concern.

Was not brought (WNB)

If a patient is reliant on someone else to make, rearrange or take them to appointments, recording was not brought is more accurate than DNA if they miss an appointment.

Patterns and contexts of DNA / WNB are very important!

In most cases, a one-off DNA/WNB would not be a concern; we all forget things from time to time and mistakes happen.

However, vulnerable patients not attending/not being brought to health appointments can be a sign of neglect or other abuse (e.g., a DNA by a known victim of domestic abuse may be an indicator of an escalation of abuse or coercive control being exerted by their partner).

Also, a pattern of multiple DNAs/WNBs could become a serious personal and/or public health issue (e.g., DNAs by a schizophrenic patient requiring antipsychotic depot injections can lead to patient relapse due to lack of timely administration).

So, if a vulnerable patient DNAs or WNB → explore further (in case of a potential underlying safeguarding issue that needs addressing).

What to do if a child or vulnerable adult DNA / WNB

1. Follow the steps above to record DNA from a face-to-face or phone appointment.
2. Reception should notify the Reception Lead or Safeguarding Lead at their site if any patient with known safeguarding concerns DNA / WNB, or if they have any concerns for a patient that DNA / WNB who may not already have a recorded safeguarding concern.
3. Clinicians should examine the patient’s record and any family members for risk factors, assess if any further action is required and act accordingly (if in doubt, notify the site Safeguarding Lead and/or Care Coordinator, if appropriate).

See our 🦺Child Safeguarding and 🦺Adult Safeguarding pages for more information on risk factors, assessing risk and how to act.