Skip navigation

Reducing DNAs at a direct access clinic

Active management of surgery lists at a primary care vasectomy clinic in Harlow virtually eliminated DNAs.

When the Harlow Primary Care Group was looking at ways to improve services they were keen to introduce a primary care based vasectomy clinic. They sought help from Dr Ken Menon, a GP in an adjacent Primary Care Group, who had run a direct access vasectomy clinic at the Princess Alexandra Hospital in Harlow for some years. As plans were being made for the new clinic Dr Menon was determined to develop a system that would keep DNAs to the very minimum: they were a real problem for him at the hospital-based clinic. While the causes of DNA were many and varied, he believed that attention to detail in designing systems might help to reduce them. Regular audits to check performance would be a feature of the service.

How does the service manage attendance?

The service is based at Keats House Health Centre in Harlow, Essex. Patients are referred by their GPs, following explanation of the procedure, to Julie Norton, the nurse in charge of the clinic, or Dr Ken Menon who performs the vasectomies. The patient's name goes on to the waiting list managed by Lynne Warren one of the secretaries at the Health Centre.

Patients are called for surgery from the waiting list usually 4-6 weeks before the date of the procedure. A letter is sent giving the planned date and time: the clinic is held once each week, on a Wednesday afternoon. Additionally the patient is asked to confirm that he would attend. If there is no response from the patient a fortnight before the date for surgery, Lynne Warren telephones him on the number provided in the original referral letter. Home telephones rather than mobiles are used. If there is no response or if the patient declines the date or the operation that slot on the clinic list is assigned to another patient. A replacement patient, taken from the waiting list, is telephoned with an invitation to attend.

Does it work?

The service has been running for two years, since April 1998. There has been only one instance in that time of a patient failing to attend. Two hundred and seventy six patients attended for vasectomy giving a DNA rate of less than 1.0% for the two years of the service. Significantly, over the two years the waiting list has reduced from about 18 months in April 1998 to about six months now. During the same period the DNA rates for a similar direct-access service in the local NHS Hospital Trust was about 29% in the first year and 34% in the second year.

Making it work

For more information contact

Dr Ken Menon

The Ongar Surgery

High Street Ongar,

Essex CM5 9AA

Telephone 01277 363976

Fax 01277 365115



ImpAct bottom line