Long Waiting Lists and Poor Attendance - How Can Psychiatry Do Better? a Review of Services in North West Edinburgh

Abstract

Aims

Increasing demand and high rates of non-attendance (DNA) lengthen waiting lists for psychiatric services, a topic of significant public and political interest. NHS Lothian data between 2009/10 and 2018/19 averaged a DNA rate of 19% for new patient appointments. Our aim was to analyse the waiting list and DNA rate for patients referred for a routine Consultant-led General Adult Psychiatry outpatient clinic appointment (OPCA) within the North-West Edinburgh Community Mental Health Team. The goal was to identify lost clinical time and areas for service development.

Methods

We collected data of all patients on the waiting list for a routine OPCA, excluding ‘soon’ or ‘urgent’ appointments and those on the separate Neurodevelopmental Disorder waiting list.

We collected data of all OPCA attendances between 1st of January 2020 and 1st of January 2023.

In line with Royal College of Psychiatrists guidance, we allocated 30 minutes for a return patient and 60 minutes for a new patient to determine lost clinical time due to DNAs.

Data were collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.

Results

221 patients were on the waiting list for an appointment. 52% of patients were female (n = 115). The longest wait was 10 months.

Between the 1st of January 2020 and the 1st of January 2023, 1961 new patient appointments were booked. 263 were cancelled prior to the appointment. Of the appointments remaining, 30% were DNAs (n = 505), resulting in 505 lost clinical hours, an average of 168 hours/year.

9172 return patient appointments were booked. 1189 were cancelled in advance. 22% were DNAs (n = 1812), resulting in 906 hours of lost clinical hours, an average of 302 hours/year.

Conclusion

DNAs have a direct impact on service provision. Were our service to reduce our DNAs to the Lothian average for General Adult Psychiatry new patient OPCA, we would save on average 61 clinical hours/year.

We will disseminate this information to the NHS Lothian Digital Experience Mental Health Team to support the introduction of a text reminder service, before involving the NHS Lothian Quality Improvement team to explore the impact of this intervention on DNAs.

Furthermore, being placed on a waiting list can be an uncertain time for patients. We will create a waiting list pack for patients, including information of local supports and emergency contacts. We will pilot this in our sector before disseminating to other teams in Lothian.