Reducing Missed Appointments: How Better Communication Cuts DNAs in the NHS
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While DNAs are often framed as a patient behaviour problem, NHS guidance increasingly makes it clear that communication plays a central role. How appointments are communicated, how reminders are delivered, and how easy it is for patients to respond all have a direct impact on attendance rates.
This article looks at why DNAs happen, what NHS England recommends to reduce them, and how better communication practices can make a measurable difference.
The True Cost of DNAs
Missed appointments place pressure on every part of the system.
From a financial perspective, outpatient appointments that are booked but not attended cost the NHS hundreds of millions of pounds each year. Clinicians, rooms, and equipment are still allocated, even when no patient arrives.
Operationally, DNAs disrupt clinic flow. Empty slots cannot always be filled at short notice, particularly for specialist services. This contributes to longer waiting lists and inefficient use of staff time.
For patients, the impact is personal. Missed appointments can delay diagnosis or treatment, particularly for those already waiting months to be seen. In some cases, a missed appointment leads to a return to the back of the queue.
The scale of the issue is well documented by NHS England, which continues to highlight DNAs as a key barrier to improving outpatient efficiency.
Why Patients Miss Appointments
DNAs are rarely about apathy. In many cases, they are the result of friction in the system.
Common reasons include:
- Appointments communicated too far in advance, then forgotten
- Letters arriving late or not at all
- Messages sent to outdated contact details
- Patients unsure how to cancel or rebook
- Work, caring responsibilities, or transport issues
A single reminder, sent once, assumes too much. It assumes the message is seen, understood, remembered, and acted upon. For many patients, that assumption does not hold.
Why Single Reminder Approaches Fall Short
Historically, many services relied on a single letter or one reminder text. NHS England guidance now recognises that this approach is often ineffective.
One-off communications fail to account for:
- Competing priorities in people’s lives
- Digital overload, particularly with email
- Accessibility needs
- Anxiety or uncertainty about appointments
When communication breaks down, the appointment is still booked, but the patient does not attend. The system absorbs the cost.
What NHS England Recommends
NHS England’s guidance on reducing DNAs in outpatient services is clear. Services should move away from one-touch communication and adopt structured reminder and recall processes.
Key principles include:
- Using reminders at appropriate intervals
- Reinforcing messages rather than relying on a single contact
- Making it easy for patients to confirm, cancel, or rebook
- Recognising that different patients respond to different communication methods
The guidance also highlights the importance of reducing friction. If cancelling or rebooking is difficult, patients are more likely to default to non-attendance.
Source: NHS England
The Role of Repeat and Reinforced Communication
Evidence consistently shows that reminder systems improve attendance. Reviews of healthcare reminder interventions demonstrate that patients are significantly more likely to attend when they receive timely prompts, particularly close to the appointment date.
The effectiveness is not just in the reminder itself, but in the structure of communication:
- Initial notification
- Follow-up reminder
- Final prompt near the appointment
- Clear options to respond
This approach mirrors how people manage other important commitments in their lives, from travel to financial deadlines.
How Better Communication Supports Outpatient Efficiency
When communication improves, the benefits ripple through the system.
Clinics experience:
- Fewer empty slots
- Better use of clinical time
- More predictable session flow
Administrative teams spend less time manually chasing patients and rebooking missed appointments. Patients experience fewer delays and greater clarity.
Importantly, reducing DNAs does not require more capacity. It allows existing capacity to be used more effectively.
Communication as an Operational Lever
Reducing DNAs is often approached as a behavioural challenge. NHS guidance increasingly frames it as an operational design issue.
Clear, repeated, and accessible communication removes barriers that lead to non-attendance. It supports patients to engage with services in a way that fits their lives, rather than expecting the opposite.
This is where modern communication approaches align closely with NHS digital transformation goals. Better communication is not a digital nice-to-have. It is a practical lever for improving performance and patient experience.
Looking Ahead
DNAs will never be eliminated entirely, but they can be reduced.
NHS England guidance shows that services which invest in better reminder and recall processes see meaningful improvements. The common factor is not technology alone, but how communication is structured and delivered.
For NHS organisations under pressure to improve access and reduce waiting times, reviewing communication practices is one of the fastest and most effective places to start.
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