Rising Did Not Attend (DNA) Appointments | A Growing Challenge in the Urgent Care Landscape

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At a time when the NHS waiting list is already at an all-time high, the rising rates of DNA (Did Not Attend) appointments pose a significant risk to recovery across the healthcare landscape.

Since the onset of COVID-19, 12.6 million of 211 million appointments made were marked as DNA (5.9%). These appointments, which already encroach on valuable clinical time, represent vital resources that many Trusts and Systems cannot afford to expend – with severe negative impacts on NHS wait times, provider costs, and training clinical capacity.

As the NHS works full steam ahead towards the recovery of services and protection of the patients reliant upon them, it is important to explore how DNA Outpatient Activity has changed since the onset of the pandemic and what critical steps are needed to tackle the growing challenge. At a time when NHS and care providers are already struggling at near-maximum capacity, teams on the ground must be given the tools, technology, and data-driven understanding of their local situation needed to deeply examine and restructure their services for the post-COVID onset climate.

As many organisations have limited access to the ground-level data and insights needed for visibility of the core pathways and key targets for improvement, technology and approaches that integrate such data alongside system and national insights, data validation, and predictive outlooks, are critical to supporting ongoing provider recovery strategies. Through work with our partners in identifying and tackling the current and upcoming challenges facing our healthcare system today, analytics generated through RwHealth’s Data Science Platform have identified several early insights around DNA Outpatient Activity – curated to support the NHS and care providers as they refocus their efforts on provider recovery and improvement strategies.

DNA Patterns | Understanding Nationwide and Age-based Variation Across the Population

Under the changing COVID landscape and lasting impacts of halting all non-urgent care by the NHS early in the pandemic, Outpatient activity – including DNA rates – saw a significant drop in an attempt to manage COVID patients in March 2020. However, with the decreasing COVID levels and the gradual return to normal services, DNA rates have since shown an overall rise, the period between April 2020 – March 2021 averaging more than 470,000 missed appointments and the period from April 2021 – February 2022 averaging more than 630,000 missed appointments.

With these rising DNA levels at a national level, tackling potential inequalities in access to healthcare in a landscape of growing strain upon services sees understanding of DNA activity between different cohorts of the population as a key factor in building greater detail around where future challenges may lie. Indeed, analysis of age group variation to date has highlighted 25-39 and 50-59 years as having had consistently high DNA rates, both before and after the onset of the pandemic, these are bands saw a Year-on-Year increase of more than 30 % from 20/21 – 21/22, with patients within 30–34 year age band ranking the highest at close to 9% of total appointments missed since the onset of the COVID-19 pandemic. 
Furthermore, insights generated from the DSP have highlighted a substantial increase in DNA rates between September 2020 – February 2021, wherein the patients may have once again opted to avoid hospitals and other public environments due to risks of COVID infection. For providers, these insights are critical in informing the NHS pre-planning measures, as well as their strategies for maximising clinical capacity where possible.

Streamlining the Pathway to Recovery | Understanding Variations Between Treatment Services

Diving deeper into the variation of DNA’s across the entire healthcare landscape, with a more keen focus on the treatment services most heavily impacted by the pandemic, is a critical component in supporting recovery planning as providers work towards identifying the key services within which improvement opportunities exist. Of note, the analysis identified a particular peak in missed appointments within Ophthalmology services both in 20/21 and 21/22, averaging more than 41,000 and 57,000 missed appointments, respectively.

Further exploration of Year-on-Year trends across the ‘Top 5’ services identified Physiotherapy services as having shown a 48.33% increase in DNA appointments, followed closely by Ophthalmology services at 36.43% since the onset of COVID-19. While this may have been impacted by the fact that these services require close face-to-face interaction and are potentially deemed as less urgent treatments by patients seeking to minimise the risk of COVID-19 exposure, a critical next step for providers will be understanding how this looks at a provider level, and what local factors may be the true driving force for these trends or deviations therein.  

Exploring DNA Activity Between CCG Providers | The Potential Impact of Telemedicine

At a healthcare provider level, focusing upon CCG’s dealing with an all-time high pressure and demand alongside steep DNA rates, it is essential to explore what DNA Outpatient activity looks like between providers, in order to better understand the factors and influencers for DNA activity and fluctuations within. In the post-COVID era, CCGs today have pushed towards increasing outpatient attendances and have seen improvement in comparison to the pre-COVID period. 

The Potential Impact of Telemedicine 

This general reduction in DNA rates could partly be due to focus upon switching to virtual modes of care and thereby seeing notable reductions in DNA rates. Indeed, this is in-line with proposals made by NHS England earlier this year, suggesting that CCGs make greater use of telemedicine as a means of providing care to a minimum of 25% of total outpatient appointments. Such changes can be seen reflected in current data, wherein more CCGs are now switching to virtual models of care, thereby seeing notable reductions in DNA rates. 

While telemedicine services have been important players in supporting healthcare providers and patients, particularly in the COVID-19 environment, it nevertheless holds the potential to increase health disparities further between different deprivation groups. Although telemedicine comes with several advantages, the risk of exacerbating health inequalities that have arisen since the onset of the pandemic makes it critical that policymakers and healthcare providers ensure any solutions utilised to reduce DNA rates do not further feed into this problem. 

Predictive insights for Future Planning

With predictions generated at a national level by the RwHealth’s Health Data Science Platform (DSP), our predictions suggest that DNA appointments could reach and even exceed pre-COVID levels by October 2022. With increasing pressures and demand for appointments, our predictive modelling can help healthcare providers in focusing their strategies for recovery and emphasise service improvement or pathway redesigns. Such planning will need to factor not only the impacts of COVID, despite its link as a key player in rising in DNA activity, other internal and external factors that will exist beyond fluctuations in infection rates require careful consideration when looking for ways to reduce the DNA’s.

To this end, the DSP’s ability to generate these deep provider level and national insights is one that has been truly instrumental in our ongoing work to support healthcare partners in light of the challenges brought about by Covid-19. Supporting planning with advanced modelling capabilities and innovative predictive technology is something that we truly believe will be a vital part of strengthening best practices for key at-risk specialties and patient groups – both as the pandemic continues and as we one day return to a world closer to normal.

We welcome you to download our complete report here for a deeper dive into key findings in DNA Outpatient Appointments.

For those of you who wish to explore the opportunities within this form of advanced data analytics further, we welcome you to try out RwHealth’s innovative Data Science Platform and uncover a depth of critical insights. To set up a free trial of the platform, please get in touch at info@realworld.health