Dr Akunjee - Improving patient understanding leading to satisfaction and savings

1. by Dr Akunjee
GP Partner West Green Surgery
SMSing & Emailing patients
Improving patient understanding
leading to satisfaction & savings

2. Patients
- London highly mobile community, people move a lot!
- Temporary accommodation, social housing, expensive rent
- Sending a letter does not mean a patient will receive it!
- Patient largely keep the mobile phone numbers
- Younger population - 85% of UK use smartphones
Why use SMS?

3. Practice
- Writing letters are expensive >£1.00 each
- Envelopes, stamps, printing costs, manpower to send
- If write a single letter to every patient needing flu jab for average
practice would cost at least £1000
- Requires significant admin time (time consuming)
- ?Does letters really protect confidentiality
- SMS cost 3p each or free if use NHS.net service
Why use SMS?

4. Patient feedback questionnaires
- Friends & family responses
SMS reminders for routine and chronic disease appts
- Reduces DNA, helps remind patients need for health check-ups
- However no context for the patient (not personalised)
what are SMS currently used for?

5. Sought patient consent at point of registration
Convey personal health information
- Send patients their blood test values and scan results
- Short explanation about what the results mean
- Offer links to website (nhs choices/patient.info) about condition
- Offer red-flags advise what to do in an emergency
- Advise next steps; see dr, refer to hosp, start/change
medications, reassurance
How did we use SMS?

6. Example: Low ferritin
Informing pts their own results
Educating via dietary advice,
offering PILs to reinforce
Promotes self care
Safety netting / Red Flag advice
Directing patient where to get
medications
Dear Minnie. Your blood results shows low iron
levels [10ng/ml] that can sometimes cause you
to feel dizzy, tired & lose hair.
You require diet advice (eat green vegs, red
meat, pulse). Buy OTC iron tablets from your
chemist. Read tinyurl.com/y7qyn5od.
In the RARE event you have abnormal
bleeding, weight loss, bowel changes, excess
tiredness seek advice urgently 111/GP/AE.
Repeat test in 2 weeks. Collect from reception.
ProActive GP | SMS blood results

7. SMS links sent to the patient
providing more information
- Relevant weblinks
- Up-to-date information
- Trusted sources
- Self care: empowers patients
to take responsibility for health
ProActive GP | SMS blood results

8. Templates for common conditions
Common results
- Ferritin, Cholesterol, Vitamin D, Potassium
Sodium, LFTs, eGFR, HbA1c, TFTs
- Other: , Stool- H. Pylori
Urine- UTI, swabs- thrush
- Guides clinician through the common scenarios i.e.
advise, recall, repeat blood test, scripts
ProActive GP | SMS blood results

9. Example: Meniscal tears
Informing patients their results
Educating via PILs
Empowers patient
Safety netting advice
Directing patient to await appt
ProActive GP | SMS scan results
Dear Minnie. Your scan confirms a
common finding of meniscal
tear/damage. This is following a twisting
motion in the knee the rubbery meniscal
disc lining the knee can get damaged.
More info tinyurl.com/ybd5ra4t
We have referred you to the specialist.
Please pick up the appointment card from
reception

10. Scan results template
- Common scan results
- Fibroids, PCOS, Ovarian Cyst,
- Fatty Liver, Hernia, BPH
- Prolapsed Disc, Meniscal Tear,
Bursitis, Rotator Cuff Disorders,
- Varicoceles, Hydroceles, OA, Ganglion
Provides information to the patient and informs them
of recall, red flags, repeat scan or referral to specialist
ProActive GP | SMS scan results

11. ProActive GP | SMS The impact
Pathology
- 600 tests a week, 10% abnormal
- 40 patients weekly are being totally managed virtually
Scans
- 100 X-rays, US & MRI Scans weekly
- 15 pts/wk informed of results & referred without repeat GP appt
- Savings of around £20,000+/yr from locum GP time

12. Not routinely used by NHS due to ?confidentiality
How do we use Emailing?
- Email patients their blood test form / hospital appt / information
- Sent securely (password protected attachment)
- Patient sent SMS of the password
- No need for the patient to attend
- Saves patient/practice time, appointment letters do not get lost
The future now: Emailing

13. Blood Test Request form
Email patients
- Send patient blood request form via email
that is password protected
- SMS the password to patient mobile
- Advise date to attend the test
- Form not lost and present on email
ProActive GP | Email test forms

14. e-Referral Letters
Email patients
- Send eRS appt letter by email securely
- Send password via SMS
- Code generator on password that is also
pasted into records
ProActive GP | Email e-referrals

15. Savings
- Used to spend £3000 on postage fees per year, now £400
- Toner costs, paper costs, envelopes reduced dramatically
Staff
- Staff used to spend 1-2hrs /wk sending letters at post
office
ProActive GP | Email The impact

16. Patient X
“Getting a text with my results on it is very helpful as it allows me to keep
this with me at all times. If I go to hospital, i can show them my most
recent result that helps me not having to repeat it. The online information
leaflet are also good as I could read about the condition before seeing
the doctor. I felt that I understood it better and could discuss with the
doctor about what will happen next.”
ProActive GP | The experience

17. Patient Y
“I received a text telling me that I had a tear in my knee and I was also
told I had been referred to the hospital for more advise. I read the leaflet
online they sent me and found it very helpful. Knowing that I had been
referred meant I did not have to come back to see the doctor to pick up
the appointment letter; which was emailed to me. Saved me a day off
work!”
ProActive GP | The experience

18. Discussions held for possible roll-out to
- Haringey Federation
- Islington Federation
- Haringey Public Health
- Individual GP Providers
ProActive GP | SMS At Scale

19. Our app has had the following recognition
- Winner 2018 NHS Sustainability award
- Winner 2018 Zenith Healthcare award
- Winner 2018 RCGP Bright Idea award
‘pioneer’
- Finalist 2018 GP Awards (diabetes)
awaiting decision 30/11/18
ProActive GP | Awards