How Connecting Conversations enabled Manchester University NHSFT introduce a tool that helps predict Did Not Attends (DNAs)

This blog was originally published on Shelfordgroup.org. 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.  

Background

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, administrative staff can reach out to patients and help remove any barriers to attendance at appointments. This might include confirming that an interpreter will be available, helping to arrange transport or providing information in an accessible format. Learning from the initial rollout of the prediction tool identified that the tool was not always utilised even though it was available to all services and that conversations with patients were sometimes more of a reminder phone call rather than a supportive and engaging conversation. Engagement calls are more effective at reducing DNAs, as they use open questions to identify and help overcome barriers to attendance.

The aims were:

• To optimise the tool within the EPR system and create a workflow which was user friendly for teams

• To establish a way to track the use of the tool and impact on DNA rates

• To increase the use of the tool

• To increase the number of phone calls made to patients

• To embed a 'gold standard engagement phone call' approach, equipping staff with the confidence and skills to deliver meaningful conversations

Method

This was a team effort across the Trust, driven by quality improvement methods to ensure the approach was as effective as possible. To develop the tool, analysts configured the EPR as required, and data scientists then worked to analyse the data and visualise key metrics such as number of calls made and DNA rate. Operational managers co-designed the workflow and worked to drive uptake amongst their teams, supported by a dedicated SharePoint site to provide training materials, engagement packs for teams, and reports to track the impact at a specialty level.

Connecting conversations (a tool developed by the Modern Productive Series team) was utilised to gain insight and understanding from the bookings teams undertaking the conversations with patients. This approach:

• Allowed invaluable insights at an individual level

• Enabled true issues to be understood

• Made outputs more meaningful

These conversations identified the need to improve confidence, resilience and build patient connection within the bookings teams which led to the creation of bespoke training materials and tailored support. Staff reported feeling more valued and confident, and the teams identified change ideas that mattered most to them, in turn increasing motivation and morale. The outputs from these conversations were embedded into the gold standard approach for teams using the DNAPredict tool across MFT.

The impact

This work increased engagement with teams and is reducing DNA rates across the Trust:

• The percentage of high-risk patients called by teams has increased from 5% in 2024, to 14% in 2025 (more calls are being made)

• MFT's DNA rate in high-risk patients is 43% - with DNAPredict they can reduce this to 31 % (see below SPC chart from a T&O case study as an example).

• In medium-risk patients, the DNA rate is 19%, and with DNAPredict this can be reduced to 14%.

• Since beginning to use the tool in August 2025, MFTs Trafford 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.

Following the success of the DNA Predict study in Manchester, colleagues from across the Shelford Group have come together to discuss the role of Al in supporting the reduction of DNAs across the health service, and local initiatives to support patients to attend their appointments.

For further information about DNAPredict please contact Sam Evans - Head of Improvement, Manchester University NHS Foundation Trust.

For further information about the Connecting Conversations visit here.