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Introduction NHS Lothian outlines a target DNA (did not attend) rate of 6% for all outpatient services across the Trust. Missed appointments have a detrimental effect on waiting list times, delaying access to diagnostic services and treatment. An NHS Lothian study suggests the average cost of a missed outpatient appointment is £30 (Lothian NHS Board 2024).The aim of this service audit was to identify themes that may be driving DNA rates amongst patients referred to the Respiratory Physiology Service (RPH) by their GP. The Scottish Index of Multiple Deprivation (SIMD) was used to identify potential barriers to attendance, and defines deprivation by seven key markers; income, employment, health, geographical access, crime, and housing. It is hoped this audit will allow us to identify areas within the health board that have inequitable access to the service and improve attendance rates.Methods The SIMD was used to identify the ‘most deprived 20%’ (MD20) zones across Edinburgh and the Lothians. NHS GP practices located within these areas were then highlighted as such. Attendance figures from April 2023 to March 2024 were collected, providing data by GP practice and council area for each hospital site (Royal Infirmary of Edinburgh, Western General Hospital, and St John’s Hospital).Results Over the 12-month period, 6,315 RPH appointments were scheduled following a direct referral from primary care, of which 23.4% were not attended. 14% of the 119 GP practices included in this audit are in a MD20 area. Referrals from these practices accounted for almost a quarter of missed appointments.Conclusion Data evaluation is still ongoing, however is so far proving useful in raising suggestions for reducing DNA rates. Based on the information that has been considered to date, a) improving the accessibility of appointment and pre-test information and b) increasing the availability of high-quality spirometry in primary care, reducing the number of patients required to attend the hospital outpatient department, would be sensible recommendations. It is hoped a repeat audit can be conducted once service changes have been approved and implemented to assess the efficacy of improvements.Reference Lothian NHS Board. https://org.nhslothian.scot/foi/wpcontent/uploads/sites/22/2024/10/9120.pdf