Huge drop in DNAs post-pandemic adds millions of appointments to GP workload

The proportion of GP appointments missed by patients has halved compared with before the pandemic, analysis by GPonline reveals, adding millions of appointments to practice workload and intensifying pressure on general practice.

GP workload (Photo: Martin Prescott/Getty Images)
GP workload (Photo: Martin Prescott/Getty Images)

In June to August this year, just 2.2% of GP appointments were recorded as 'DNA' - meaning 'did not attend'. In the same three months in 2019, before the COVID-19 pandemic, 4.1% of GP appointments were recorded as DNAs - nearly twice the current rate.

This colossal shift has meant that in this three-month period alone, GPs delivered around 2.5m extra appointments - close to 100 more per full-time equivalent doctor. If the pattern is repeated through winter, when demand for appointments is likely to surge, GP workload could be pushed up by far more than 10m appointments over a 12-month period.

The fall in DNAs - revealed by GPonline analysis of GP appointments data from NHS Digital - comes at a time when practices are facing an unprecedented rise in clinical administrative work - with RCGP data showing that GPs are dealing with around a third more of this work now than pre-pandemic.

GP workload

The fact that patients are showing up for a far higher proportion of appointments has stripped out time during the working day that GPs often use to complete prescriptions, referral letters and other clinical administrative tasks - likely a major factor forcing many to work longer hours and contributing to the sense of unsustainable pressure on the profession.

The figures above relate to GP appointments only - but the pattern is mirrored across appointments delivered by the wider practice team, with DNAs across all appointments delivered in general practice falling from 7% in June to August 2019 to around 4% in the same period this year. This translates to more than 5m extra appointments delivered across the primary care team.

This analysis of DNA rates reveals that the increase in appointments delivered in general practice before COVID-19 appointments are factored in is far greater than headline data suggest.

The shift to more appointments delivered by telephone during the pandemic may have contributed to the sharp drop because these appointments are less likely to be missed, but DNA rates have dropped across all types of appointments.

Face-to-face appointments

DNAs fell from 4.5% in June to August 2019 for GP face-to-face appointments to 2.9% in the same period this year, and from 2% to 1.6% for phone appointments.

Shorter gaps between booking and appointments being delivered may also have contributed to lower DNA rates - GPonline has reported previously on how DNA rates rise with time between booking at appointment delivery.

Liverpool LMC medical secretary Dr Rob Barnett said current workload pressures in general practice were 'unbelievably high' - and that the LMC had been contacted repeatedly by GPs concerned about the sustainability of their practices, with intense workload pushing some to consider leaving the profession.

BMA polling before the pandemic showed that as many as two thirds of GPs planned to quit within five years, and heavy workload driven by COVID-19 combined with rising abuse has pushed the association to survey GPs over their willingness to quit the NHS or take other action if the government does not increase support. 

Pressure on GPs

Dr Barnett added: 'We are used to pressures. But I have said to people the current workload pressures at the end of September/beginning of October feel like it is January. So I'm not sure what January is going to feel like.'

He said that local data analysis revealed an 11% increase in appointments now compared with before the pandemic, and he added: 'I would say that we hardly get any DNAs. The only ones I can think of are occasionally when we don't get through to anyone on the telephone. People come in for appointments and invariably people answer the telephone.'

He added that work from e-consultations had increased by around five times compared with before the pandemic. 'As far as I am concerned, that is additional work that is just being absorbed. It doesn't matter if that is dealt with by an email, or a phone call or inviting someone in - it's additional work.

'Previously, some of it could be done when patients DNA - but invariably for a lot of people this is being done outside core hours, because that is the only way it can be done.

Long working hours

'I do quite a lot of prescriptions in out-of-hours time. If I am doing a clinical day on a Monday I will try and clear the weekend's prescriptions that come in electronically so that I don't walk in to 50 or 60 prescriptions that need to be processed, which is then on top of everything else that needs to be done. None of this is taken into account when looking at the overall workload that people are having to contend with.'

Dr Barnett added that demand for appointments was being driven up by the backlog of hospital care, with the fact that patients are 'just not going through the system' as normal creating a knock-on impact for practices, with multiple follow-up appointments needed as patients wait a year or more for hospital treatment.

He said the increased prominence of telephone appointments had also added to pressure - with patients feeling they could call the practice even when away on holiday, creating workload that simply would not have existed previously.

Evidence of the intense pressure on GPs comes as general practice continues to face criticism over access to face-to-face appointments, and demands for in-person treatment for all patients who want it. RCGP chair Professor Martin Marshall told MPs last month that face-to-face care on demand was simply 'unachievable'.

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