'Data shows the trend, people tell you the story’

How podiatry reduced DNA rates by 10 per cent

When a patient DNAs, or doesn’t attend their first appointment, the impact is felt beyond an empty clinic room. Time is lost, waiting lists grow and, most importantly, people miss out on vital care.

Across our Podiatry Service, colleagues were seeing this happen too often. Data showed that by early 2025, more than a third of new patients in some clinics were not attending their first appointment. Rather than accepting the figures as inevitable, the team decided to look at the problem from the patient’s point of view.

Working closely with our Health Inequalities Team, podiatry colleagues began to dig deeper into the data to understand who was most affected and why.

The data told a clear story. New patient appointments in the most deprived areas had the highest DNA rates, particularly for routine pathway patients. Younger adults aged 20 to 39, women and people living in areas of higher deprivation were the most likely not to attend.

Wendy Winpenny

Podiatry Quality, Governance and Professional Lead Wendy Winpenny led the analysis, focusing on patients living in the most deprived areas.

“I looked specifically at patients from areas of highest deprivation,” she said. “Then I used the data to see exactly which clinics and pathways had the highest DNA rates. We wanted to focus on one area and do it well, rather than trying to fix everything at once.”

Some locations stood out. In Thanet, DNA rates for new patient appointments were especially high, with College Road showing an overall DNA rate of 19.23 per cent. That made it the ideal place to start.

The team knew the numbers alone would not give them the full picture. To really understand what was happening, they needed to hear directly from patients.

Podiatry admin colleagues began phoning patients ahead of their first appointment, particularly those due to attend College Road.

“Our admin team was amazing,” Wendy said. “They did the hard work of calling patients and talking through their initial appointment. I brought the data, they brought the human connection.”

What they heard really changed their perception of why people weren’t attending: “Some people simply forgot or didn’t realise they had been referred to us, often because there had been a long wait between referral and appointment,” Wendy explained. “But, others had mental health conditions, learning disabilities or autism, which made attending much harder without extra support.”

In one call, a relative explained that her father was blind and disabled and the appointment letter arrived too late for them to arrange transport. Another patient said the problem they had been referred for had healed during the wait.

“These conversations really stayed with us,” Wendy said. “They were a reminder that people’s lives are complex. Data can tell you the trend, but people tell you the story.”

Wendy with admin colleague Sarah Almond

Armed with a better understanding of patients’ experiences, the team began testing small, practical changes designed to make attending easier.

Appointment letters and voicemail messages were updated to include a clear email address for cancellations. Reminder text messages were rewritten to clearly state the clinic location and service, reducing confusion. Admin colleagues also gave consistent messages about what happens if someone does not attend, including when they may be discharged.

The team also introduced a pilot of two-way text messaging, allowing patients to confirm, cancel or rearrange appointments quickly and easily.

“These were not big, expensive changes,” said Simon Pendleton, Head of Podiatry Services. “They were simple things, but they were designed around how people actually live.”

The work was supported by our Health Inequalities Team, helping podiatry colleagues understand the links between deprivation and access to care.

Adam Lott, Head of Health Inequalities, said: “The team regularly reviewed their data and tested small changes, like two-way texting at different intervals. That meant they could learn quickly and adapt based on what was working for their patients.”

Early signs are encouraging, with DNA rates falling by around 10 per cent in the areas targeted: “There is still more to do,” Adam added, “but this learning is already helping podiatry make their service more responsive to people who are most likely to miss appointments.”

The Podiatry Team will continue to review DNA data each month and explore how patients in areas of higher deprivation prefer to be contacted. They will also consider whether two-way texting should be rolled out more widely across the service.

For Wendy, the work is about more than performance metrics: “This isn’t just about reducing DNAs,” she said. “It’s about making access fairer.”

Why this matters

Every attended appointment is a chance to prevent something serious. Regular podiatry care reduces the risk of complications such as foot ulcers and lower-limb amputation. In England, around 184 people lose a limb each week due to diabetes and up to 80 per cent of these cases could be avoided with timely foot checks.

Podiatrists also spot early warning signs of wider health issues, from poor circulation to nerve damage and help older adults maintain mobility, reducing the risk of falls. Missed appointments cost the NHS up to £160 per slot and contribute to a system that spends around £1 billion a year managing avoidable foot complications.