Sunak plan for £10 DNA fines risks wider inequality and higher NHS costs

Former chancellor Mr Sunak – one of two remaining candidates to replace Boris Johnson as leader of the Conservative party and as prime minister – plans to bring in the fines as part of a ‘shake-up’ of the NHS.

He told the Sunday Telegraph that it was not right that patients were missing appointments for consultations and scans and ‘taking those appointments away from people who need [them]’.

More than 14.3m GP appointments in the year to June 2022 were recorded as did not attend (DNA) – suggesting that £10 fines for missed primary care appointments alone could cost patients around £143m a year if the policy went ahead.

DNA fines

BMA chair Dr Philip Banfield warned that fines would undermine trust between patients and doctors and threaten the core NHS principle that care is delivered free at the point of need.

He added: ‘While it is frustrating when patients do not attend, the reasons why this happens should be investigated rather than simply resorting to punishing them.

‘Financially penalising patients inevitably impacts the poorest and most vulnerable in the community. This may discourage them from rebooking, exacerbating already worsening health inequalities and costing the NHS more.’

Research published in 2017 found that socioeconomic deprivation was the biggest driver of missed GP appointments – prompting warnings from doctors’ leaders at the time that tactics such as fines would penalise the most vulnerable in society.


DNA rates are also closely linked to how far ahead appointments are booked – with analysis of data from NHS Digital showing that next-day appointments are three times as likely as same day appointments to be missed, while appointments booked a week ahead are more than four times as likely to be DNAs.

Dr Banfield added: ‘Instead of reheating ideas that are of no practical value, the next prime minister should be urgently seeking to restore the confidence of the profession in this government by tackling the huge losses in pay suffered over the last decade, scrapping the unfair pensions tax rules forcing many experienced clinicians out of the NHS, and ensuring the NHS is adequately resourced for the huge challenges it faces.’

He said it was ‘terribly disappointing that the candidates standing to be the next prime minister seem to have so little understanding of the reality facing our NHS, or what it will take to turnaround the impact of the government’s repeated mistakes and the now mammoth backlog of care’.

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