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Patient no-shows, or ‘Did Not Attend’ (DNA) rates, have long been a challenge for the NHS, but the issue has worsened since the pandemic. 

Despite the UK having one of the lowest DNA rates in the world, the eight million missed hospital appointments last year have placed significant strain on both the NHS and its clinical staff.

Missed appointments can also impact patient health outcomes, disrupt treatment plans and delay care for others who could have used the time slot.

To improve the efficiency and sustainability of the NHS, it’s essential to understand the true cost of missed NHS appointments. and the causes, consequences, and potential solutions to solve this problem. 

The financial impact

First off, let’s look at the financial implications of missed hospital appointments, and how they affect the NHS as a whole.  

It’s been estimated that each missed hospital appointment costs the NHS £165 in terms of wasted clinical time and extra admin – that’s around £1.2Bn each year. This is an additional financial pressure on an already overstretched health service.  

The NHS, which operates under a fixed budget, must make sure that its resources are allocated as efficiently as possible. So wasting such a significant portion of its budget on unused appointment slots hinders its ability to provide timely care to patients, reduce the waiting list, and invest in new technologies and treatments.

The impact of missed appointments on patient care

Sadly, the cost of missed appointments goes far beyond the financial. 

When patients miss their appointments, it disrupts their treatment plans and can delay their care. For individuals with chronic conditions, these missed appointments can lead to worsening symptoms, disease progression, and, ultimately, more intensive and costly treatments later on. 

Let’s take a look at a patient with diabetes as an example. Studies have shown that missed diabetic appointments can result in poorer glycaemic control, more complications, more frequent hospital admissions and increased all-cause morbidity. 

Missed appointments are also particularly disruptive to services like oncology. When a patient fails to attend a scheduled cancer treatment session, it can delay their care and may even impact their chances of recovery. 

What’s more, rescheduling patient appointments creates an additional administrative burden on NHS staff, and can contribute to longer waiting times for other patients. 

Causes of missed appointments

Understanding why patients miss appointments is crucial to addressing the problem of DNAs. Several factors contribute to high DNA rates, including;

    • Transport and accessibility issues: Many patients, particularly those who are elderly or live in rural areas, can struggle to attend appointments due to a lack of reliable public transport. This is a significant barrier, especially for those who don’t have a car or cannot afford taxis.
    • Social deprivation: While NHS care is free at the point of delivery, the cost of getting to the hospital (and parking there) is not. For some patients, particularly those on low incomes or benefits, the expense of travelling to and from appointments can be prohibitive. And they may not be able to afford to take time off work – or the cost of childcare while they attend their appointment.
    • Poor communication: In some cases, appointments are missed due to poor communication between the NHS and their patients. If appointment letters are delayed or unclear, patients may not realise when their appointment is scheduled for, leading to DNAs.
    • Forgetfulness: At Deep Medical, we believe that missed appointments are more than just a matter of forgetfulness. While reminders help, they aren’t always effective – patients with visual impairments or language barriers, for example, may need extra support to keep track of their appointments. But the fact remains that some patients may need additional support to remember their appointments.

The broader implications

Missed appointments create a ripple effect that extends far beyond the here and now, with serious long-term consequences for the NHS.

One of the most pressing issues is the worsening of already critical waiting times. With over seven million people on NHS waiting lists – many of us know someone waiting for NHS treatment – every missed appointment wastes valuable clinical time that could have been used to reduce these wait times and improve patient access to care.

Missed appointments also take a toll on staff morale. Doctors, nurses, and healthcare professionals already work under immense pressure, and the frustration of preparing for patients who don’t show up only adds to burnout and dissatisfaction, ultimately affecting the quality of care and further straining the healthcare system.

Potential solutions

Let’s take a look at some of the ways that the NHS is working to reduce missed appointments. 

  • Multichannel reminders: Many hospitals now send multichannel (voice or text) message reminders to patients in the days leading up to their appointments. These reminders have been shown to reduce DNA rates, as they help patients remember their appointments and allow them to cancel or reschedule if necessary, particularly if the reminders are ‘two way’ and allow the patient to reply.
  • Flexible appointment scheduling: Offering more flexible appointment times, such as evening or weekend slots, can help patients with work or family commitments attend their appointments. This is particularly important for working age adults who may struggle to take time off during regular working hours, or parents who need to fit appointments around the school run and other caring commitments.
  • Telemedicine / healthcare at home: The rise of telemedicine has created new opportunities for reducing missed appointments. By offering virtual consultations, the NHS can provide more convenient options for patients, especially those with mobility issues or those living in remote areas.
  • Using AI to predict DNA: At Deep Medical, we use AI to predict which patients may miss their clinical appointments, without accessing their medical records. Our ‘DM Schedules’ dynamically manages clinic capacity, aligning the clinical workforce with patient demand. Clinical staff can identify likely no-shows or cancellations up to three weeks in advance, allowing them to confirm attendance or fill slots from the waiting list, optimising clinic time and reducing the waiting list.

Conclusion

Missed NHS appointments represent a significant challenge for the NHS both in terms of financial planning and negative patient outcomes. 

By addressing the underlying causes, such as transport issues and communication challenges, the NHS can reduce the number of missed appointments, improve efficiency, and ultimately provide better care for patients. 

With waiting lists at record highs and healthcare resources stretched thin, tackling the issue of DNAs has never been more urgent.