#20 2016 · NHS clinics · Healthcare
NHS clinics clawed back millions of missed appointments with reminder texts
the problem
Patients booked, then never came
background
Missed outpatient appointments — 'did not attends' or DNAs — were costing the NHS hundreds of millions of pounds a year: a clinician, a room and a slot held open for a patient who simply never turns up, with no way to fill it on short notice and a knock-on delay for everyone behind them in the queue. NHS England's own analysis put the reachable saving at over a quarter of a billion pounds a year if DNA rates could be pushed down toward 2%.
The standard fix was a generic reminder — 'you have an appointment on [date]' — which assumed patients forgot. But forgetting is only part of the story: many DNAs are patients who deprioritize an appointment they don't feel urgently attached to against everything else competing for their day. A 2013–2014 trial by Barts Health NHS Trust and researchers including Michael Hallsworth and Ivo Vlaev tested whether the content of the reminder, not just its existence, could close that gap.
the move
SMS reminder programmes and opt-out rebooking against missed outpatient appointments ('DNAs'), which cost the NHS hundreds of millions a year.
the payoff
Trials repeatedly show reminder systems cutting missed appointments by roughly a quarter. In the Barts Health trials specifically, a text that stated the appointment's approximate cost to the NHS (about £161) cut the DNA rate to 8.2–8.4%, against 9.9–11.1% for the existing reminder or a generically worded version — a difference projected to prevent about 5,800 missed appointments a year at that one trust, at no added cost.
what came after
The specific-cost framing and two-way, reply-to-cancel SMS systems it inspired have since been rolled out across NHS trusts; NHS England guidance now cites reminder programmes as capable of cutting DNAs by up to 80% in individual services, and 'tell the patient what the no-show costs, not just that it exists' has become a standard nudge-unit tool for public-service no-show problems generally.
references
- [1]Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments: Findings from Two Randomised Controlled TrialsPLOS ONE, 2015journals.plos.org
- [2]Reducing did not attends (DNAs) in outpatient servicesNHS England, 2023england.nhs.uk