SMS platform integration helps increase participation in preventative programmes

Bromley by Bow Health Centre in North East London was keen to find new ways of increasing participation with preventative healthcare programmes, especially with those patients who are less likely to engage with these programmes.

Like many primary care settings, the health centre would typically send public health and preventive campaign information to patients in the post, as well as carrying out follow up calls to ensure they knew how to take part. This was heavy on administrative time and didn’t necessarily meet the needs of those patients deemed 'hard to reach'. The practice needed to find a different, more effective approach.

Dr Osman Bhatti, a GP at Bromley by Bow practice and CCIO of former North East London Clinical Commissioning Group enlisted the help of social enterprise, Appt Health, to explore approach options.

Founded by a former GP receptionist, Hector Smethurst, Appt focuses on preventive healthcare and public health campaigns. Its mission is to tackle health inequalities with simple, practical tools to create healthier communities by increasing public participation in preventative healthcare, such as screening. Having worked in frontline primary care, Hector understands the pressures and barriers practices face when it came to implementing improvements in preventative healthcare.

Appt looked at how best to increase participation in preventative healthcare programmes and developed an idea to use SMS messaging for call and recall health campaigns. This was tested in the Bromley by Bow Health Partnership where people were contacted by SMS and asked to call the practice to arrange an appointment. 

A trial of this approach saw improvements with engagement from the public but calls into the practice were adding additional volume to an already difficult to manage call load. This led to some further thinking around offering patients appointment slots to book directly to prevent spikes in calls to receptionists and improve uptake. 

With the support of Innovate UK, an organisation that supports business-led innovation in the UK, Appt were given six months to build a prototype to deliver a scalable solution that would allow for direct patient booking.

With 98% of GP practices in England using GP Connect: Appointment Management, it was absolutely vital that Appt’s SMS platform could integrate with this product. The GP Connect team at NHS Digital worked with Appt to make sure the solution could integrate with other suppliers and to manage relevant assurance processes. 

GP Connect: Appointment Management allows GP appointments to be shared across primary care networks providing interoperability between different practice clinical systems. It’s used by NHS 111 and facilitates appointment management for the COVID-19 vaccination programme.

Integrating Appt with GP Connect: Appointment Management would help to deliver an SMS solution that allowed direct appointment booking at scale. Working with the GP Connect team, integration was achieved and the Appt solution was released in July 2021. It has since been rolled out across 270 practices.

Appt identifies and contacts existing patients by SMS to their mobile phone, where relevant consent is in place. Patients can then book their appointment directly via the SMS they receive and the system also messages people who have not responded, to maximise the chances of participation. Appt integrates with existing systems, with some modification needed based on how practice appointments are managed, but saves time in administration and call handling.  

Implementation is not without its challenges, but these are more focused around how practices choose to manage appointments for their campaigns.

Another benefit of using GP Connect is that 98% of all GP practices now use this one standard API for appointment management. This simplifies changes and developments as it removes the need to update or develop multiple APIs, again saving time and effort.

The integration has had an impact for hard-to-reach patients, specifically for call and recall activities. Using the SMS platform for cervical screening in Bromley by Bow has resulted in patients being picked up that haven’t previously attended. Dr Osman Bhatti attributes this to the simplicity of use and familiarity that most people have with using SMS on mobile phones.

Bow Health Centre have suggested the impact of combining SMS messaging with appointment booking was evident when an NHS Health Check campaign in Barking and Dagenham saw a 40% increase in participation. Cost comparisons between running campaigns via letter and phone calls showed real savings. Traditional costs per appointment were calculated at £5.12, with the SMS approach this was reduced to £3.89.

Anecdotal feedback from patients has also been positive. This feedback suggests it’s good to be offered a choice and a convenient way of booking. A patient doesn’t have to call the practice to get an appointment or try to change an appointment made for them on a day and time they cannot make.