Reducing missed appointments by making healthcare more accessible

A woman with her left arm outstretched, using a touch screen sign-in kiosk
A woman with her left arm outstretched, using a touch screen sign-in kiosk

There are many, often complex reasons why people do not attend (DNA) their scheduled healthcare appointments and these change all the time. Our Cheshire and Merseyside Outpatient Transformation Programme is focusing on understanding the issues behind DNAs to reduce their impact on healthcare and patients who may be waiting or missing out on treatment due to barriers in accessing their appointments.

Last year (2022-2023) there were nearly 420,000 missed outpatients appointments in our Cheshire and Merseyside hospitals. Our aim is to reduce this number to make sure our NHS services are being used as effectively as possible, seeing as many people as soon as possible, to ensure better outcomes for all.

We are initially focusing on hospitals with the highest rates of missed appointments, which are also based in some of the least affluent areas of Cheshire and Merseyside. By scrutinising DNA data at these hospitals, we have been able to examine the barriers their patients may be facing in attending appointments, and to start looking at ways we can better support them to access the care they need.

How does this improve services for patients?

Liverpool Women’s Hospital is one of the first trusts we have been working with, and we are seeing some good early results.

Analysing its DNA data for outpatients in greater detail than before enabled the hospital to target follow-up discussions directly with specific communities and groups of patients with the highest rates of missed appointments. Speaking with those most likely to miss appointments has given the hospital a deeper understanding around their reasons for not attending. As a result, the hospital has been able to improve its approach to appointments, leading to better access, experience and outcomes for patients who may normally struggle accessing services.

One example of the adjustments made by the hospital following discussions with patient groups was to upgrade its sign-in kiosks. It has led to quicker check in times and is preventing queues at reception that may have delayed patients and resulted in them missing their appointments.
Due to the success of this approach the hospital has now adopted a continuous process of data review and targeted community engagement towards achieving ongoing improvements in DNA rates.

Through May 2023, Liverpool Women’s Hospital has reduced its missed appointment rate to an average of 9% from an average of 11% in January 2023. This represents over 600 appointments being freed up for other patients who have been waiting for a date and time to be seen.

More widely, this approach adopted by other hospitals across Cheshire and Merseyside has contributed to a reduction in DNA rates from 10% in January 2023 to 8% in April 2023 equating to 10,000 more outpatient appointments being made available across the area.

Additionally, this approach is helping address some of the inequalities in healthcare that exist in our region, by increasing knowledge about our different patients and reducing any barriers to services they may be experiencing whenever we can.

Dr Doug Robertson, consultant physician for Mid Cheshire Hospital Trust and clinical lead for NHS Cheshire and Merseyside’s Outpatient Recovery and Transformation programme, said:


“Problems with transport, childcare and financial pressures may be behind many missed appointments and we are listening to people to gain real insight into these barriers to see how we can remove them where possible. By working with patients in this way we are making changes to our appointment systems based on their experiences and helping to fill thousands of slots in hospitals across Cheshire and Merseyside that might have been previously missed. This benefits everyone.”

What’s next?

Liverpool Women’s Hospital is now exploring a range of new systems and processes with the aim of making it even easier for patients to attend and manage their appointments.
This includes increasing the use of self booking for patients, texts to prompt confirmation or cancellation of appointments, enhanced letter translation services, one stop clinics where patients are diagnosed and treated in a single visit rather than making multiple trips and working more closely with primary care to reach patients and communities less likely to engage with healthcare.

The hospital continues to use data analysis to target its ongoing follow up community engagement with groups that experience health inequalities and barriers. It engages regularly with Merseyside Society for Deaf People and with ethnic minority and LGBTQ+ communities to inform any improvements to its appointment systems.

Our Cheshire and Merseyside Outpatient Transformation Programme continues to support other hospitals across the area in adopting similar approaches and processes, as well as developing system wide innovations and technologies to further progress this work.

We are currently developing a ‘missed appointment predictor tool’, which we expect will be available to all Cheshire and Merseyside in the near future. By using a range of demographic data, the new tool will help hospitals identify patients more likely to miss their appointments, so any additional considerations that would support them to keep their slots can be put in place.

Find out more

You can read more about Liverpool Women's Hospital's work to improve appointment bookings and reduce DNAs here