Ellie Carter, Shelford Deputy Managing Director, writes about the work Shelford Group members are doing to reduce the number of missed appointments across the NHS.
In June 2025, the Shelford Group launched its Collaborative Action Programme, a collective programme of work to be delivered across its Trusts, supporting core government priorities for the NHS and designed to have the potential for wider spread across the health service.
To support government priorities around elective waiting times, as well as the shift from analogue to digital, a working group came together focussed on reducing the number of missed appointments across the NHS and the role of artificial intelligence in supporting ‘Did Not Attend’ (DNA) reduction.
The benefits of reducing DNAs is multifaceted, including improved patient experience and freeing up capacity to treat long-waiting patients. By understanding the many causes behind DNAs and working to reduce them, NHS Trusts can ensure appointment slots are not wasted and also play a critical role in promoting equality of access to healthcare by identifying and removing barriers to care, ensuring that valuable resources are used efficiently and fairly across all patient demographics.
DNA reduction across the Shelford Group
The Shelford Group is a collaboration between ten of the largest teaching and research NHS hospital Trusts in England, providing a comprehensive range of services from community care for local populations, to highly specialised care for patients nationwide.
Over the last six months Shelford colleagues have been coming together to share examples of programmes of work underway across member Trusts to:
- Explore the role of artificial intelligence in reducing DNAs
- Understand the reasons behind ‘was not brought’ and DNAs
- Share local ‘was not brought’ and DNA reduction initiatives
- Support the London Innovation Network with the development of a new DNA (Did Not Attend) Reduction Toolkit
This blog shares case studies from across our members, along with contact details for further information.
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Shelford showcase
1. DNAPredict: Manchester University NHS Foundation Trust
Manchester University NHS Foundation Trust (MFT) has developed DNAPredict, a tool within their EPR system that helps predict whether patients are likely to attend their outpatient appointment. Each appointment is given a risk score between 1 and 100: 1 being the lowest risk, and 100 being the highest. By flagging this early, teams can reach out to patients and help remove any barriers to attendance at appointments.
The DNAPredict tool is now helping to reduce DNA rates across the Trust.
- Since August, MFTs Elective Surgical Hub, based at Trafford General Hospital, have reduced the number of DNAs in high-risk patients from 44% to 14%, resulting in an additional 2.5 patients receiving surgery each week.
- This progress is expected to continue as the number of calls increase. The percentage of high-risk patients called by teams has increased from 5% in 2024, to 14% in 2025.
Read the full case study here.
For further information about DNAPredict please contact Sam Evans – Head of Improvement, Manchester University NHS Foundation Trust.
For further information about the Connecting Conversations tool please contact Karen Hampson, Head of Improvement, Manchester University NHS Foundation Trust.
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2. London DNA Reduction Toolkit: Guy’s and St Thomas’ NHS Foundation Trust and London Outpatient Learning Improvement Network
Shelford Group colleagues have supported the London Outpatient Learning Improvement Network with the development of a new DNA (Did Not Attend) Reduction Toolkit. This practical, clinically led and evidence-based toolkit is designed to help reduce missed outpatient appointments in London.
The toolkit helps Trusts to understand why patients miss their outpatient appointments and how to implement effective, sustainable strategies to reduce them. It brings together best practice principles, research insights, case examples and practical implementation tips including:
- Using tailored interventions such as flexible scheduling, multilingual reminders, digital tools and Patient Initiated Follow-Up (PIFU);
- Ensuring strategies do not unintentionally widen inequalities; and
- Minimising safeguarding risks, particularly in paediatric services.
Read the full case study here.
View the toolkit on NHS Futures here.
For further information please contact Jo Johnson – Deputy Chief Operating Officer and Director of Performance and Planning at Guy’s and St Thomas’ NHS Foundation Trust and a member of the London Outpatient Learning Improvement Network
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3. Integration of Apprenticeship training with Transformation Action Learning Sets: King’s College Hospital NHS Foundation Trust
King’s College Hospital NHS Foundation Trust has reduced DNA rates by 25% through pioneering the integration of Apprenticeship training with Transformation Action Learning Sets, aligned directly to Trust priorities.
The Trust’s (Did Not Attend) rate has fallen by 25% in the 12 months to September 2025, with the pace of improvement doubling since the launch of the innovative integrated Apprenticeship and Transformation Action Learning Set approach. With 3,000 more new outpatient attendances per month, measurable improvements in RTT performance are now being delivered without equivalent increase in staffing.
This is directly supporting the Trust to achieve 100% delivery against the month-on-month 2025/26 annual operational plan for outpatient activity, which included an ambitious 4% annual productivity challenge, equating to 112% of Elective Recovery Fund (ERF) value.
Read the full case study here.
For further information please contact Barbara Cramond – Director of Transformation, at King’s College Hospital NHS Foundation Trust.
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4. Children and Young People’s Service Project on Reducing ‘Was Not Brought’ Rates: University College London Hospitals NHS Foundation Trust
The University College London Hospitals NHS Foundation Trust (UCLH) children and young people’s service project focussed on understanding and reducing ‘was not brought’ rates. Main reasons included unawareness of the booking or forgetting, and issues with illness. The study found that a history of non-attendance was the strongest predictor of future non-attendance, with additional influences from age, deprivation, and appointment type. A DNA prediction tool was used to identify high-risk patients, allowing the team to target these individuals with additional phone calls and reminders. This targeted approach resulted in significant administrative time savings and improved attendance, particularly in the urology team. The team also implemented an enhanced reminder service using behavioural science principles, adjusting the structure and content of emails and text messages.
For further information please contact Richard Cobill, Transformation Programme Manager at University College London Hospitals NHS Foundation Trust
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5. DNA reduction and self-scheduling pilot: Cambridge University Hospitals NHS Foundation Trust
Cambridge University Hospitals NHS Foundation Trust (CUH) has launched their Booking Optimisation Programme to support implementation of patient self-scheduling and earlier appointment offers via their patient portal – MyChart. The initiative, which began in October 2025 with a pilot across six specialties, has now been extended to 36 specialties. Early results from the project have been extremely promising with just over 8,000 appointments self-scheduled, including earlier appointment offers, theoretically saving 1200 administrative hours.
Read the full case study here.
For further information please contact Andi Thornton – Operations Manager, Outpatient Services at Cambridge University Hospitals NHS Foundation Trust.