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Processing Did Not Attend referrals

If the referrals you manage on e-Referral Service are booked into one, or more, directly bookable service then the service(s) are linked to a patient administration system (PAS) or another provider booking system.

When a patient does not attend an appointment, your organisation will outcome the referral as Did Not Attend (DNA) in the PAS. This sends a message to the e-Referral service and the referral will appear on the Appointments for Booking worklist, marked as DNA.

Like all referrals these should be managed appropriately, or they will fill up your worklists. It is advised to look at the history of a DNA before you action it and to know what your local Patient Access Policy is around patient’s who DNA their appointment.

screen shot of NHS e-RS showing an example of a did not attend appointment

The two main outcomes for a DNA are either to rebook an appointment for the patient, or directly advise their referrer of the DNA.

You can do this in one of the following ways: 

1. Rebook the appointment

You might rebook an appointment for the patient if they are considered 'vulnerable' or if it fits with your patient access policy.

To rebook an appointment:

  1. Select the UBRN for the patient.
  2. Choose the Record DNA option from the Actions dropdown.
  3. In the Record DNA screen complete the mandatory fields - these are Contact Attempt, DNA Reason (if not already completed) and Rebook.
  4. In the Appointment screen, select a new appointment for the patient - the patient should always be involved in the appointment booking.
  5. Complete any subsequent screens and select Save.
  6. Print or email an appointment confirmation in the usual way that you would for a patient. More information on these options can be found on the referring a patient page.

2. Advise the patient's referrer of the DNA

You might want to use this option to let a referrer know that the patient has not attended their appointment. Please refer to your local patient access policy to understand when to use this option.

To advise a referrer:

1. Click on the UBRN.

2. From the Actions picklist, select Record DNA.

3. In the Record DNA screen complete the mandatory fields - these are Contact Attempt, DNA Reason (if not already completed), Send for Referrer Follow Up.

screen shot of e_RS showing how to record a did not attend using the e-RS system


4. Complete the screens that follow and Save

The UBRN is removed from the Appointments for Booking worklist and will appear on the referrer's Assessment returned/Cancelled/DNA worklist at the originating referring organisation.

This does not close the referral but informs the patient’s referrer that they have DNA’d. This can be especially useful for vulnerable patients. The patients referring organisation can rebook an appointment, if necessary, when you use this option.

The other options available for DNA’d referrals are:

  • No Further Appointment - this option removes the referral from the worklist and may be the option used most by your organisation
  • Contact the Patient again after X days - the UBRN is removed from the worklist and will reappear in X days time (on the Appointment for Booking worklist), so will still need processing

To process DNAs using these options:

  1. Complete the mandatory fields and select an appropriate Outcome reason
  2. Save and complete subsequent screens.

There is an optional Additional Comments textbox which will allow free text to be added. This is especially useful if you have any contact with the patient as you can record extra information about why they did not attend their appointment.

This diagram shows how a referral is processed for each of the possible Outcome options:

image showing how to process a Did Not Attend referral using the e-RS system

Diagram description

When recording a DNA within e-referral Service the 'Outcome' field offers 4 outcome options:

  1. Rebook.
  2. No further appointment.
  3. Contact patient after X days.
  4. Send for referrer follow up.

In option 1 (Rebook), the next step is to book an appointment. This outcome doesn't show in any worklist.

For option 2 (No further appointment), there is no next step and this doesn't show in any worklist.

For option 3 (Contact patient after X days), there is no next step and the outcome will show in the Appointments for Booking worklist after X days.

For option 4 (Send for referrer follow up), there is no next step and the outcome will show in the Referrer Action Required worklist (patient's GP worklist).

Last edited: 24 January 2024 11:03 am