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Not attenders

I have recently taken over the asthma clinic at the practice where I work but am appalled by the high DNA rate of patients. Trying to set the clinic up from scratch again is no easy task and those patients who are well over-due a review, have had recent exacerbations, or a high SAB2 users have been targeted first. I send out a detailed (but easy to read) letter explaining the clinic and need for review, enclosed the Asthma UK leaflet 'Making the most of your asthma review' and in the early days rang the most urgent patients and offered an appt at the best time for them but still some of them didn't turn up. I am open to suggestions as to the best way to target these clinics.

5 Replies


Overworked, you've sure put in a lot of work in trying to get people to attend!

To be fair I think you have done most of what you could humanly do. Some people just haven't got the motivation or interest in their health to turn up to reviews, and will only use the services when they absolutely need to.

Something the practice that I am registered with as a patient did recently (I suspect they were trying to get everyone in for their QoF points!) was to send out a letter with a pre-arranged appointment time included. This can be useful so that the element of relying on the patient remembering to make an appointment is removed. You could back this up with a brief telephone call, perhaps the day or two before, to remind them.

Another thing, although it's something I have to say I don't really believe in, is not issuing repeats until they come in for review. I think this can potentially be dangerous (although if they're really in so much need of their SAB2s they really should be seeing someone!), but it's another tactic.....however from the other side of the fence, if you're working full time it's difficult to fit things like routine reviews in particularly if you're a more experienced patient and things are stable.

Oh dear, I'm rambling, I'll shut up and crawl back into my hole now...!


Hi CathBear, I think ringing them before is a great idea, however.......... it's actually having the time to do it. At the moment I have no real admin support but am going to have to address this and hope that one of the receptionists can do this for me. I have also considered the prescription issue and wish the GPs would limit the number of repeats before a reveiw is needed like with some other meds. At the bottom of my letter I do ask them to ring and confirm they will be attending - maybe I should take it that no phone call means they're not coming and cancel the appointment and offer it to somebody else, or maybe I should take that statement out all together and hope they will turn up, but like I say it's not having the time at the mo. Think I need to discuss this with the practice manager and get some help but will definitely put forward your idea. Thanks.



Hi there CathBear & Overworked,

I have seen some discussion on the none professional site regarding this isse from the patients point of view. If I remember rightly the main reasons for not going were, nothing ever changes anyway so why bother, the nurses don't listen to me.

I know what I am doing I am an adult not a child.

There were others but can't remember. Maybe we should take into account these comments to see how to help with DNA's. It will take you time now you are starting from scratch as the patients will need to see what is in it for them now you are doing it.

I am in acute but when we get regular non attenders the consultant's I work with usually ask me to ring them to gently ask why they aren't coming. However, I don't know how many you are talking about but on average we get 3 DNA's a clinic ( 2 per week) & they usually get one chance before I am asked to ring unless they are particularly poor controlled/chronic patients. With adolescents, you could try texting them!


Hi there,

When I took over our asthma clinic, we had similar problems, and tried both sending 'made' appt's out, and just letters asking them to make appt's. We got as high as 50% DNA's when we made the appt's - people just didn't bother to cancel/ remake them, so that was a no-go.

I've found that once you DO get them in, that they appreciate that I'm different from my predecessor, and explain and make agreements with them as to what's important, rather than imposing a fixed regime on them. But you've gotta get 'em in.

I'd say you need the Practice Manager's support to allocated some admin time for sending out the letters etc, it's not best use of your time to be doing these - but if they want to allocate your expensive time to do so....

We've got our figures up from 18% of our asthma population to 64% - still some to go, but we're getting there!

Maybe the letter can be adapted again to cover some of the patient concerns mentioned above? The 'what's in it for me' angle is very common these days!

Good luck, you'll get there, and we know we can make a difference!



-a few years later!


I'm new to the forum. I hope your clinics have been rewarding.We found that telephone consultations worked well. Obviously, you cannot check inhaler technique, but for well controlled patients (who by implication probably have good technique) it works well. Ask the receptionist to book them in as an appntmnt. Once rapport is established, they're more likely to see you when they need to. For the others, a letter from the GP (rather than ""just"" the nurse) asking them to see you, often works well. Stopping repeats of salbutamol etc often helps too (but watch the repeats of other family members)- many of my colleagues have concerns about the ethics of this but I have deep concerns about the ethics of NOT doing it and leaving people at risk of longterm airways damage and of death (let alone loss of confidence, curtailed activity etc).



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