(Time to read: 4 minutes)

£162 million apparently. The financial cost of DNAs – accounting for an average of £108 for every single missed appointment.

Getting to grips with DNAs can be the difference between your GP practice flatlining and being given a clean bill of health. Overcoming high DNA rates can help reduce costs and mismatch between demand and capacity. “It can also save your sanity!” gasped one of the GP partners at the last place I helped out at.

DNAs – An unlikely suspect 

So, who’s the main culprit when it comes to DNAs? The just-turned 20s? Those in the thick of raising a young family? Surprisingly, at this practice in particular, it was the 50-65 year-olds who were the most common culprits.

Sat in a cold team meeting room at 7pm on a Tuesday night, the practice manager, admin coordinator, two of the GPs and the practice nurse huddled around sheets of figures. The practice’s apprentice had also helped me to tally up just over 300 patient surveys and feedback from a lunchtime meeting with admin staff. Armed with marker pens and a box of Krispy Kremes for company, we pored over the results.

Discovering that this was the biggest problem group in terms of DNA rates helped us straight away. It allowed us to really consider the lifestyle of the age group in question, including their habits, aspirations and preferred communication methods. In marketing, we call them ‘customer personas’, but drawing these up so we had a physical representation allowed us to use them in training with the rest of the practice team.

It also allowed us to design a specific communications campaign that spoke the language of this demographic. One of my favourite parts was creating a poster featuring a young working gran with her super-cute granddaughter, which said: “You wouldn’t forget to pick Ella up from nursery, so please don’t forget to cancel your appointment if you don’t need it anymore.”

A drip-drip approach

Everyone commented on the sweet-looking, little girl for weeks! It certainly got people of all ages talking in the waiting room, but it wasn’t the only thing we set in motion:

• We added two new holding messages to the phone system. The first was from one of the most popular GPs at the surgery, reminding patients how easy it was to cancel an appointment, in a light, friendly manner. The second was from one of the Patient Reference Group (PRG) members and it gave a short, passionate plea for everyone to support the practice and ensure there were enough appointments to go around for the community. It probably wouldn’t work at every practice, but this lady in particular was a much-loved character in the local community so was a great peer-to-peer example to use.
• We rephrased the wording on the text confirmations, reminders, waiting room posters and leaflets, and website content to sound more positive. Instead of stressing how many people had missed appointments in a month, we used the power of social norms to say how many people had kept their appointments instead. Wording was accompanied with fun pictures of various staff members smiling with their thumbs up – again, another talking point and one designed to foster greater trust.
• We provided more information about how and why the practice worked the way it did when it came to appointments. The patient surveys uncovered a staggering level of frustration among patients who did not know their options for cancelling appointments. This in itself was a light-bulb moment for the team, who set to work improving the information published around the practice and on the website, on how to cancel unwanted appointments easily.
• Staff were invited to a communications session with a difference in practice learning time. This wasn’t just to adopt a consistent approach for encouraging read-backs in conversation or better signposting. We made the experience fun by inviting members of the PRG too for a quick exercise that challenged the team about human behaviour. This helped everyone to clearly understand the evidence behind DNAs but also it encouraged experimenting with other ideas in the practice. Staff are now really enthused about trying new things.

Want to boost your DNA-busting efforts?

The practice in question had one of the worst DNA rates in their area, but just six months on, they’ve managed to:

• Reduce DNAs in the target group by almost 40%
• Reduce DNAs overall at the practice by 25%

I can’t wait to see how they fare in the next few months but the signs are really encouraging. If you’re still struggling with DNAs at your practice, I have a few suggestions:

• Do your research before you change anything!
• Involve the whole team and your PRG.
• Once you have the stats, speak to one or two local community groups who might be able to provide a more rounded picture.
• No one size fits all – there are great examples across the country of successful DNA campaigns. Check out NHS Leeds West or more recently, and one of my favourites, DNA Man from here in Sheffield – a sight for your eyes and your stats!

About Kara Dudley

Front-line friend to primary care. Champion of common sense and ‘reyt’ simple words. Kara is a healthcare marketing specialist living and working in Yorkshire.

https://yorkshiremedicalmarketing.com/