No more letters from the hospital

DrDoctor tries to make appointments digital

A few hours before I met the man striving to bring hospital appointments into the 21st century, I spotted a tweet by a man called Nigel Edwards which seemed to sum up the problem:

“My increasing obsession that admin is part of the solution demonstrated by @LNWH_NHS [London North West University Healthcare] sending an op appointment to my mother on 29 December for 2 Jan which, of course, arrived 2 days after the appointment. No one answers the phone. It takes some effort to make a system so poor.”

Appointments are obviously a key part of the NHS infrastructure and if the way they are arranged and communicated to patients is faulty, then that is like throwing sand into the workings of the health service machine.

In 2012, Tom Whicher set up a company called DrDoctor after working in hospitals on projects to boost productivity and being struck by what he saw of the appointments process.

“I used to watch people turn up to reception with all these pieces of paper,” he says “and they'd probably have been changed for whatever reason and they were told that they had missed their appointment or it had been moved to a week later - super frustrating for patients.”

Five years after the iPhone was launched smartphones were becoming the route. to everything and he saw no reason why they should not transform hospital appointments too. “I thought what if we use phones to allow patients to manage their outpatient appointments? Surely that's a good idea?”

Informing patients of appointments by post was, he reasoned, costly, inefficient and inflexible. The answer was to move as many as possible towards digital means of managing their appointments. So far, that has mostly meant text messages and DrDoctor has provided hospitals with the same sort of service that Accurx - which I wrote about for the BBC - does for GPs.

“40% of NHS outpatient activity touches our platform in some way, “ says Tom. “And this year we hit 110 million NHS appointments that have been through our system.”

But the graph he shows me of the progress towards that milestone illustrates how long it takes to push even a simple innovation through in the health service, with DrDoctor’s platform only really taking off since the pandemic focused minds on new approaches to patient care.

As someone who has embraced this digital approach, checking up on my forthcoming hospital appointments via the increasingly indispensable NHS app, I am glad that the postman has just about stopped pushing envelopes with hospital logos through my letterbox. (As an aside wouldn’t it be great if after a consultation the doctor sent their summary to the patient, copied to the GP, rather than the other way round?)

But I put it to Tom Whicher that, for a good while at least, a sizeable slice of the population would need to keep being contacted about appointments by letter or phone call. He agreed - though stressed that it was no longer the elderly who could automatically be assumed to be the wrong side of the digital divide.

But he said even those who could not or would not choose the digital option benefitted when others did - for one thing it meant they would find it easier to get through on the phone; “What it does is it reduces the overall phone call volume and in the process of doing that, it means that the people that need to get through can get through. By digitising it for 70 to 80% of people, it improves the experience for everybody.” 

Now that it has built a large platform with vast amounts of data to learn from, DrDoctor is looking to add more sophisticated services for hospitals such as an algorithm which can spot those patients most likely to forget about an appointment and send them an extra reminder. More ambitiously it is getting into what is known as patient initiated follow up where the patient gets involved in deciding whether they really need to spend a day getting to the hospital and back for a routine appointment rather than perhaps having a phone call or text exchange with the doctor. Such initiatives are already delivering major reductions in the numbers of people coming to outpatient appointments, according to Tom Whicher.

But he stresses that it all starts with persuading both hospitals and patients of the urgency of going digital: ”I suspect 2024 is going to be the year of the tipping point,” he says hopefully. “There's been a massive investment last year in patient portals and patient communication so every trust in the country now has something. But they don't all utilise them as well as they should, hence people are still getting letters.”

After I had spoken to Tom Whicher I managed to contact Nigel Edwards, the man who sent that angry tweet about his mother getting letters about appointments days too late. It turned out that he was a healthcare consultant and he expressed - in more frank tones than Tom - his frustration with the slow pace of change in the NHS compared with the wider world:

“With big organisations outside healthcare you can register your preferences. Many of them default to electronic communication. There is an option to post if that's what you want. You register that in advance and then they have processes and systems that get you what you need.”

He also made the good point that this kind of thing “isn’t sexy” like robot surgeons or AI radiologists so does not get the attention it deserves. But as DrDoctor is showing, once you fix the costly appointment problem and start having a digital relationship with patients, other more sexy things will follow. So let’s get on with it.