What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

NHS England estimates 650,000 monthly outpatient appointments result in a DNA (Did Not Attended), with rates 48% higher in the most deprived areas. Whilst this is bad for the NHS because as it wastes resources, for those who miss their appointments it also delays their care.

There are complex reasons that lead to patients missing appointments that are often beyond the patients’ control. It’s therefore good to see digital tools and AI being used to predict non-attendance and provide priority scheduling for patients who are most at risk of missing an appointment.

Through conducting qualitative interviews, we want to understand how well the new approaches are working for patients. Getting this right will increase productivity and reduce waste, but will do so in a way that also promotes equity. Identified learning can then be transferred to primary care where NHSE estimate there are 7.2 million appointments missed annually at a cost of £216 million.

What does your project aim to achieve?

To date the success of measures to reduce DNAs have been based purely on how well they achieve that headline goal. I.e. whether there are fewer DNAs than before.

However, our project aims to provide a more qualitative analysis of the benefits to patient cohorts who have been better supported to attend their appointments. We want to understand:

• How automatically making care available at more convenient times has improved patient experience of the services and what impact this has had on confidence in the NHS among groups most affected by health inequalities.
• How has it affected their usage of other NHS services? E.g. has it made them less likely to attend A&E?
• How patients think things could be further improved? Are more personalised appointment slots sufficiently joined up with support with transport for example?
• What have staff learnt through this programme that could help reduce inequalities more broadly.

How will the project be delivered?

Our project will be delivered in collaboration with Deep Medical, as well as Mid and South Essex ICS and Mid and South Essex Foundation Trust who have been trialling the system.

We will carry out 25 in-depth independent interviews with patients from key PLUS groups who have been offered appointments through the system to explore their experiences. We will look to understand any benefits they may have experienced, as well as potential negative impacts.

We will also look to understand what other information people want digital systems to have about them when offering appointments, and how this information could be shared between primary, community and secondary care services. We are particularly interested in understanding how better information sharing between services at the point of referral could help further reduce DNAs. To support this we will augment the patient interviews with 5 sector facing interviews with staff working across Mid and South Essex.

How is your project going to share learning?

Tackling DNA rates in this was is at its heart a health inequalities issue, and National Voices is an organisation that specialises in working with policy makers and service planners to address these issues.

Our dissemination plan for this work would include:

• Creation of a short case-study report showing how addressing the DNA issue has improved patient experience and outcomes. This would include key recommendations for secondary, primary and community services.
• Hosting briefings with key policy contact leads in NHS England and within our network of ICS contacts. We would give particular focus to sharing the findings through NHS England’s elective recovery work and through the health inequalities network and alongside the Core20Plus5 Programme.
• Hosting an online workshop in partnership with Stella Vig, National Clinical Director for Elective Care,  with our network of 200 VCSE member organisations to highlight how addressing DNA rates can improve outcomes and experiences for their beneficiaries.