Developed by Marion Wood and Children s Dental Needs Steering Group

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1 Title Document Type Issue no DNA Policy Policy Clinical Governance Support Team Use Issue date Review date Distribution Prepared by Dental Staff Marion Wood Developed by Marion Wood and Children s Dental Needs Steering Group Equality & Diversity Impact Assessed Not as yet.

2 DNA Policy for NHS Borders Public Dental Services Patients shall be informed by the Practice information leaflet and public notices at reception that failure to keep appointments may result in de-registration. This will ensure that those who do keep appointments are not disadvantaged in having to wait longer due to others wasting clinic time. A GP200 form will be used to de-register patients who fail without good reason. The patient should be notified of the reason, the treatment still required, how to obtain emergency care and the procedure for appeal. As the dentist carries professional duty of care, the dentist must decide if a patient is to be de-registered and must complete and sign form GP200. All persons whether registered or not are entitled to emergency care via the usual process. Adults 1. Adult patients who fail to keep the first appointment, offered after coming to the top of the waiting list, will not be offered a further appointment. If an adult patient who fails to keep their first appointment requests to be seen again they must re-apply for registration Exceptions will be bereavement or serious illness. Any other reason must be agreed by the Senior Dentist and Practice Manager. 2. Adult patients who fail a recall appointment for routine recall examination and do not respond to the DNA letters will be considered for de-registration. The patient has the right to appeal in writing to the Clinical Service Manager. As these patients are registered, the dentist must agree this action with the dental Practice Manager and the Senior Dentist and the form GP200 used if appropriate. 3. Adult patients who fail appointments during an ongoing course of treatment and have been sent the letter of de-registration, will be expected to arrange a suitable appointment to complete any outstanding care and treatment within 3 months of the de-registration letter. The patient has the right to appeal in writing to the Clinical Service Manager (reference: NHS (General Dental Services) (Scotland) Regulations. Schedule 1 Scottish Statutory Instrument 2010; No 208). Exceptions will be children, young people and those with adverse medical or special needs. Every effort will be made by dental staff to identify reasons for failure to attend by those groups graded category 1, 2 and 3 and to prevent recurrence.

3 4. Persons aged 16 to 18 years who fail to attend, will be sent adult letters but will not be de-registered provided that the Senior Dentist feels the young person is competent to take decisions with regard to their dental care and is not at risk. If the opinion is that intervention is required to protect any young person under 18 years, the Child DNA policy will be followed. See next part on Child DNA s for further information. Children and Young People Aged 0-16 years 1. First DNA letter will be sent after a failed appointment. If patient fails to contact the dental clinic within the specified time, a second DNA letter will be sent. If patient fails to contact after the second letter, the clinic will phone to ascertain the reason for the failure and encourage them to attend. 2. If clinic unable to make contact with patient the following action will take place: A referral letter will be sent to Child Health to be forwarded to their named person. A copy of this referral letter will be sent to the Childsmile Co-ordinator for follow up where appropriate. The child/young person will remain registered and will receive a recall letter after 6 months and 12 months inviting them to contact the clinic to make an appointment. If the child or young person does not make contact no further letter will be sent or contact made. The child/young person will remain registered and able to access dental care until they are 18. When the young person reaches the age of 18, a letter will be sent to them asking if they still wish to be registered with our service, and if so, to contact the dental clinic. If they do not contact us, they will be de-registered. 3. Practitioner Services will inform the dental services if a child or young person becomes registered elsewhere. Additional information The Practice Manager will produce a quarterly report to the Clinical Service Manager listing numbers and reasons for de-registration. All persons whether registered or not are entitled to emergency care via the usual process. Reminders by text messaging service must be sent to all patients with mobile phone numbers unless specifically refused. In addition, parents of children who have been shown to be unreliable should be given afternoon appointments and should be called in the morning of the appointment day to confirm attendance.

4 Patients will be asked at each visit by reception if their address or phone number has changed and reminded that it is their responsibility to inform the clinic of their change of address or circumstances. Notices will be displayed to reinforce this message.

5 CHILDREN and YOUNG PEOPLE WHO DNA - DENTAL APPOINTMENTS UNDER 16 S YEARS 1 st Child DNA letter sent. Marker with date of DNA added to R4. 1 st Young Person s DNA letter sent. Marker with date of DNA added to R4. If no response to 1 st DNA letter within specified time, 2 nd DNA letter sent. DNA marker with date of DNA put on R4. If no response to 2 nd DNA letter, the designated person at each clinic will phone those have not responded to ascertain the reason for failure and encourage them to attend. If Young Person fails to make contact within specified time 2 nd Young Person s letter sent. If no response to 2 nd DNA letter, Referral letter to Child Health and Childsmile Co-ordinator for follow up where appropriate. Child or young person will remain registered and will be sent recall letters at 6 months and 1 year (for 1 st year). If no response to recalls in 1 st year, no further action will be taken but child or young person can access dental care until they reach 18 years. When Young Person reaches 18, a letter will be sent to them asking if they still wish to be registered. If no contact, they will be de-registered. Admin staff (designated person at each dental site where appropriate) will keep spreadsheets of all children who DNA and keep them up to date each week.