No estimates have been made centrally of the cost to the national health service of missed appointments (Did Not Attends) in general practitioner (GP) surgeries or clinics. The information available on missed outpatient appointments in England is shown in the following table. Information is not collected on the number of patients who miss appointments in GP surgeries. The Department and NHS England have not discussed missed appointments. Local NHS organisations make their own arrangements for preventing and dealing with missed appointments. NHSout-patient Did Not Attends(DNA) FirstattendancesDNA SubsequentattendancesDNA TotalDNAs 2008-09 1,430,296 4,090,929 5,521,225 2009-10 1,544,781 4,155,649 5,700,430 2010-11 1,589,611 4,138,620 5,728,231 2011-12 1,538,813 3,911,900 5,450,713 2012-13 1,595,078 3,926,450 5,521,528 Source: NHSEngland Quarterly Activity Return. Commissionerbased