A no-show is an appointment the patient neither attends nor cancels. A clinic’s no-show rate is the share of booked appointments that end that way: divide the no-shows in a period by the appointments booked in the same period, then multiply by 100.
No-show rate = (no-shows ÷ appointments booked) × 100
A worked example. In October your clinic had 360 appointments booked, and 29 patients neither came nor let you know. 29 ÷ 360 = 0.081, so your no-show rate for October was 8.1%.
No-show, late cancellation or DNA: what counts
Decide what goes into the count before you calculate anything, then keep the same rules every month. Three situations look alike in the calendar:
- A no-show: the patient doesn’t come and doesn’t tell you.
- A late cancellation: they tell you, but too late for anyone else to take the slot.
- A cancellation with notice: they tell you early enough to offer the slot to another patient.
Only the first goes into the no-show rate. Late cancellations get a rate of their own, worked out the same way (late cancellations ÷ appointments booked × 100). Write down where “late” starts, for example less than 24 hours before the appointment, and don’t move the line.
In the UK you’ll often see DNA instead of no-show. It stands for “did not attend”, the term the NHS uses, and a DNA rate is calculated with the same formula.
How to measure it at your clinic
- Use at least a month. A single week misleads: a public holiday or a flu outbreak can move the figure on its own.
- Count only the appointments that were still booked on the day. Leave out the ones cancelled with notice, because those slots could be booked again.
- Split the rate by practitioner, by appointment type (first visit or follow-up) and by time of day. That’s usually where the useful finding is. You may see that no-shows cluster in first visits, or in the first slots on a Monday.
- Recalculate every month with the same rules, so this month really compares with last month.
If your clinic software has a no-show status, mark every missed appointment with it. The count then comes straight out of a report instead of someone’s memory.
What no-show rate is normal
There’s no single benchmark. The figure changes with the country, the type of care and the patients. These are published figures, each with its source and year:
- A systematic review of 105 studies, published in Health Policy in 2018, put the average no-show rate at around 23%. By region, it went from 13.2% in Oceania to 43.0% in Africa, with 19.3% in Europe, 23.5% in North America and 27.8% in South America (Dantas et al., 2018, DOI 10.1016/j.healthpol.2018.02.002).
- In NHS hospital outpatient clinics in England, DNAs were 5.6% of appointments in 2024-25, down from 5.9% the year before (NHS England, Hospital Outpatient Activity 2024-25).
- In Spain, a study of more than 400,000 outpatient appointments at the Agencia Sanitaria Costa del Sol counted 13.8% missed appointments, at a cost of more than €3 million (Revista de Calidad Asistencial, 2017).
Most of these figures come from hospitals and public clinics, not from private physiotherapy, chiropractic or osteopathy practices. Use them for a sense of scale. The comparison that tells you most is your clinic against itself: this month’s rate next to last month’s.
The same review also lists what predicts a no-show most often. The two determinants reported most frequently were a long lead time (the wait between booking and the appointment) and a history of previous no-shows. You can act on both.
What no-shows cost your clinic
The basic sum multiplies the empty slots by what a slot is worth:
Monthly cost = (no-shows + late cancellations) × average fee per appointment
Late cancellations go in here because the result is the same empty slot. An example with made-up numbers: the clinic above, with 29 no-shows in October and an average fee of €50, lost €1,450 that month. If October was a typical month, that’s about €17,400 a year, before late cancellations.
The sum leaves out costs that are harder to count: the practitioner sitting without a patient, the last-minute shuffling of the calendar, and the patient who drops their treatment halfway and doesn’t come back.
What brings it down
Most no-shows aren’t bad faith. The patient forgets, something comes up, or cancelling means phoning during their own working day. What works is making it easier to confirm or move an appointment than to skip it: reminders that ask for a reply, rescheduling by message at any hour, a waiting list for cancelled slots and a closer look at the patients who often miss.
We go through each one in how to reduce patient no-shows: 9 tactics that work. To see the reminders HeyCAi sends and how patients answer them, go to appointment reminders on WhatsApp. Patients can also book or move a visit by writing to your clinic, which is what our WhatsApp chatbot for clinics does.
Frequently asked questions
What is a good no-show rate for a clinic?
There’s no single target. A 2018 review of 105 studies put the average at around 23%, and at 19.3% in the European studies. NHS hospital outpatient clinics in England reported 5.6% DNAs in 2024-25. Settings differ too much for one number, so compare your clinic with itself month by month and look for a steady fall.
What does DNA mean?
DNA stands for “did not attend”. It’s the NHS term for a no-show, and many private clinics in the UK use it too. A DNA rate is calculated the same way: appointments missed without notice, divided by appointments booked, times 100.
Should late cancellations count as no-shows?
Keep them as a separate rate, so you can see whether patients forget or cancel too late. Add them together when you work out the cost, because a slot nobody can fill costs the same either way. Write down where “late” starts, for example under 24 hours, and keep that rule.
How often should I calculate my no-show rate?
Once a month, with the same rules each time. A monthly figure shows the trend without one bad week alarming you, and it tells you whether changes such as reminders, confirmations or a waiting list are working.