Did Not Attend (DNA) Policy

Due to high levels of patients not attending appointments, we have reviewed our Did Not Attend (DNA) policy.

Any patient who fails to attend for their own or their child’s appointment without informing the practice incurs a burden to the practice and to other patients in terms of lost appointments. Many appointments every day are missed without being cancelled. Every missed appointment is an appointment that could have been given to another patient who needed it.

Please help us to help you by always cancelling an appointment you are unable to attend or no longer need, well in advance, so that it may be offered to someone else.

Due to high levels of patients not attending appointments, we have reviewed our practice policy. Patients who fail to attend appointments and do not contact the surgery in advance will be managed according to the practice DNA policy as set out below:

Any patient who misses their appointment without cancelling in advance will be sent a standard text reminder notifying them of the missed appointment and a reminder of our policy if they continue to miss appointments.
If a patient fails to attend 2 appointments within the last 12 months, their case will be discussed at a practice meeting. An informal warning letter may be sent to the patient, advising them that a further missed appointment could risk removal from the practice.
If the patient fails to attend a third appointment within 12 months of a warning letter, the matter will be discussed at a practice meeting, and a majority agreement will be reached as to whether the patient will be removed from the practice list. The patient will be informed of the outcome of this meeting with a formal letter.
Warning letters are valid for a period of 12 months. Removal based on warnings greater than 12 months old will be invalid – in this case a further formal warning and period of grace will be required.
For parents, please note that the policy above will also apply to children who are not brought to their appointments. Missed appointments will trigger a discussion in a practice meeting and review with our safeguarding lead. Failing to bring children to their appointments can be a sign of other problems that would need further action.

Patient removal policy

The surgery operates on a policy of mutual respect between patients and staff. We aim to build long term relationships with our patients. However, there may be circumstances when it would be considered reasonable, or in the best interests of the Practice or the patient, to remove patients from our list. The purpose of this policy is therefore to define the practice guidelines for patient removal ensuring that all cases are dealt with fairly.

Below are examples that will trigger the removal process and the resulting action by the practice.

Physical abuse, violence, or threats of the same, including any damage to practice premises

Will be immediately reported to the Police and the person will be immediately removed from the list and referred to the scheme for violent patients.

Crime and deception

Where a patient fraudulently obtains drugs for non-medical reasons, deliberately lies in order to obtain a service or benefit by deception, steals from the practice or attempts to use the doctor to conceal or aid any criminal activity, they will be immediately removed from the list

Verbal abuse of a member of staff

Normally one written warning will be issued with any further incident resulting in removal from the list, but the practice reserves the right to remove someone instantly depending on the severity and nature of the incident.

Persistent failure to attend appointments

Once an appointment is made, patients are expected to keep it or inform us in good time that they need to cancel or change it. Failure to do so for three appointments within one year at the surgery will trigger a warning letter. Further failure to attend will result in removal from the list.

Persistent, unreasonable demands

Examples might include pressurising clinicians to prescribe a certain medication that they deem inappropriate or demanding urgent appointments for minor problems. Persistent instances will result in the patient being issued with a warning. A further incident will result in removal.

Persistent abuse of services

If the practice is aware that a patient, or relative, persistently ignores requests to follow procedures set down to ensure safe clinical care for them and other patients, two warnings in writing will be given. On a third occasion, the removal of that patient will be made.

Irretrievable breakdown of the doctor-patient relationship

Occasionally a patient’s behaviour falls outside that which is normally considered reasonable and leads to an irretrievable breakdown of the essential doctor-patient relationship. In some cases, this can be overcome by changing GPs within the practice but in others this will not be appropriate and following written explanation the patient will be removed from the practice list. Examples include sexual advances towards a clinician, making an unfounded allegation against a GP or the practice, or falling out with several clinicians within the practice and insisting on seeing only one.

Distance

If a patient moves outside of the practice boundary, they are automatically deemed to have left the practice and will be removed from the list by the Health Authority.