Did Not Attends (DNAs)

When a patient misses their appointment, it is referred to as a ‘Did Not Attend’ (DNA) or Was Not Brought (WNB).

During 2021/2022, nearly 7.5 million outpatient appointments were missed by patients, often for reasons outside of their control, and often linked to health inequalities.

Reducing missed appointments helps to ensure that clinical time is used effectively and means patients on the waiting list can be seen more quickly. This supports delivery of the NHS’ elective recovery plan.

Understanding the reasons why patients might have missed their appointment provides an opportunity to take action to address them.

The Reducing did not attends (DNAs) in outpatient services guidance builds on previous work to address missed appointments. It sets out actions providers and systems can take to reduce missed appointments based on existing good practice.

Provider examples show that these actions can often be implemented quickly and can significantly reduce missed appointments within a short period of time. Many of these actions can also help to support patients to take control over their own care and help to reduce health inequalities.

The Outpatient Recovery and Transformation Programme offers a range of support for providers and systems to reduce their DNA rates. This support forms part of a long-term piece of work to transform and recover outpatient services.


National guidance has been developed to help you identify and take actions to quickly and significantly reduce DNAs. The guidance provides an introduction for providers and systems just beginning to focus on reducing their DNAs, and gives additional support for organisations already making progress in this area.

A template appointment confirmation letter and template appointment reminder letter can be used to notify patients of their appointment.

Further resources are available on the outpatient recovery and transformation FutureNHS workspace (requires a login), including translated versions of the template appointment confirmation letter and the template appointment reminder letter.

For more information on the support on offer to help you reduce DNAs and WNBs, please email england.actiononoutpatients@nhs.net

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