Public health activity in primary care still proves extremely difficult to deliver. For example, national uptake of the NHS Health Check programme, a free intervention designed to detect early signs of cardiovascular disease (CVD) like heart disease, diabetes, and kidney disease, has only been 35% across England. This is a low figure given more than 75% of eligible patients were invited by the NHS primary care health service.
The NHS Health Check programme, when done right, is a powerful intervention for improving population well-being. For every 1 million people that have the health assessments, the programme can contribute to 9,000 extra years of life and 10,000 QALYS thanks to the numerous diseases that are caught and subsequently treated early.
This programme and other NHS screening programmes can significantly improve health outcomes and contribute to a reduction in health inequalities. The primary outcome of most public health programmes and health assessments is the discovery and reduction of risk factors of disease.
GP practices can make a good amount of extra revenue for delivering NHS Health Checks. If the 65% of eligible people who don’t attend a health check were to do so, this would represent £300 million of incentive payments that are currently not being paid out. That’s more than £40,000 per practice.
As a healthcare company who increase uptake of NHS Health Checks and other screening programmes nationally, we have been in a unique position to discover the best practice of the numerous care providers we work with. Here is what we've seen and can share so far.
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The NHS offers a letter template to all GP practices that you can find on the NHS website. The best thing about it is that it gets updated as new research discovers what combination of words and layout is most effective at getting a response from patients. It’s important to stay informed of these updates because improvements to the template can give your general practice a competitive advantage when it comes to all patient communications.
We broke down the existing research into letters that improve call and recall and also compared results against telephone calls and SMS recall. We found that telephone calls are most effective at increasing uptake of health checks.
The same study that proved the most recent template letter also tested the use of SMS messaging before and after a letter is sent. For providers already using a text messaging system (like Appt, Accurx, Mjog) this method is a low-cost way to increase Health Check uptake amongst those invited.
Consider priming patients before they receive a letter with a short messaging letting them know to look out for it in their morning post. Not only will this make your letter top of mind, but it will encourage patients to open their letter when it arrives.
Whilst talking to patients earlier in 2019, we found that multiple patients never even opened their letters. Often expecting bills or junk mail. A simple SMS message lets them know it’s coming, so you don’t waste the paper.
Build on this method by adding a reminder message. We all forget to do things we care about and a simple SMS reminding the patient to book can refresh their memory. At Appt Health, we took this one step further by allowing patients to book a date and time by responding to an SMS and we saw uptake go through the roof!
In Southwark, it was discovered that prompts to staff on GP IT systems increase uptake by 65%. These pop-ups remind staff to invite eligible patients as they come into the practice, or when they’re already on the phone. Most PAS's have the functionality built-in, so it's the easiest and most cost-effective way of improving uptake.
We discovered the top reasons why patients don’t attend prevention appointments (be the first to read about in our newsletter) and it can go a long way if you address these in your communications.
For example, a common excuse is ‘I don’t want to bother my GP/the NHS’. You could counter this argument by including the line in your letter template ‘Your GP says: I want you to attend the NHS Health Check, as it can help prevent you developing more serious conditions which will take up more NHS resources’. It was found that this line alone increased uptake by 5%.
Additionally, letters that included ‘Your GP has already set aside funding to pay for your appointment’ increased uptake by 4% because patients felt less guilty about visiting their GP and adding to their costs.
Telephone outreach is still proven to be the most effective way to get patients into appointments (until we launch our automated patient recall system in 2020, that is!) Research suggests that calling a patient gets an uptake of 47.6% (18% higher than letters), yet it is still the least used method of engaging patients.
We talked with Professor Gidlow, a researcher into the NHS Health Check programme, and he noted that most practices still considered phone calls a high-cost approach to getting patients in, however, it's more cost-effective than sending letters overall.
In ambitious practices, employees are often set up to book patients into appointments whenever the opportunity arises. Receptionists should be trained so that when a patient enters the practice for any reason they can be booked in then and there.
Practices that do this know that the usual letter invites are easy to ignore or forget, but grabbing a patient when they are already engaged is highly effective.
Upon registration at the practice, patients are at their most engaged, making it a great time to book them into an appointment. Explaining the health benefits and importance of the NHS Health Check, as well as the simplicity of the appointment, goes a long way to reassuring the patients.
Patients don’t book themselves into an NHS Health Checks for a variety of reasons: they’re too busy, they forget, they don’t understand what it is, or perhaps they previously had a bad experience at an appointment. As their healthcare provider, getting them engaged upon registration can help foster a positive ongoing relationship where they are more likely to book and attend prevention appointments like the NHS Health Check in the future.
If you don’t have a dedicated member of staff like an HCA to focus on invitations, we’ve seen many practices split their list of eligible patients amongst receptionist staff. This method allows them to utilise the few quiet moments in the practice for a purpose – inviting and booking patients into NHS Health Checks. Practices are always trying to cut costs. Saving more highly paid clinicians from doing too much administrative work like calling and inviting patients is a cost-efficient way of boosting uptake.
Keeping practice staff up to date on preventative health measures is a good way to get them both actively engaged in the role and motivated whilst doing call and recall. The practices we saw with the highest uptake had a practice manager who understood that prevention was key for GP practices and NHS success, rather than viewing it themselves as another administrative task.
It’s also important that all staff are ready to convince patients why programmes like the NHS Health Check are beneficial to them, so patients feel fully informed and comfortable to attend. This tip is a key method to cheaply drive an increase in practice revenue.
At Appt Health, we study extensively what makes a person book an appointment. Research shows that getting someone to perform behaviour it requires three things. The motivation to do it, the ability to do it, and a trigger to remind them to do it. These three things can all be optimised individually when it comes to inviting patients to Health Check appointments. And, it’s important to do so in your communications.
Letters and SMS messages act as a trigger to remind the patient to book an appointment, but the content (i.e. the writing) is where you can generate motivation.
Using behavioural economics, like ‘nudges’, work well here. We found that using the words ‘we reserved you an appointment’ in an invite, rather than ‘here are three appointments’ triggered 30% more patients to book into an NHS Health Check. The nudge of the word ‘reserved’ led to patients feeling we had done something for them, and they felt more obliged to reciprocate by responding to our SMS invite.
We are testing two-way SMS as part of patient recall. Sign up to our newsletter to be the first to catch the results.
A potentially big problem for uptake in health screenings is incorrect eligibility. I'm sure you've submitted screening results to your local CCG or Council only to be told your practice has screening ineligible patients and you won't be paid for the work.
It's hard to save how to solve this problem but it is a significant disability for practices to waste their precious time. We recommend contacting your CCG and asking for the exact search criteria they use to determine eligible patients. That way you will have the same search terms as them and will minimise this risk.
The practice's who are earning the most revenue and delivering the best care tend to think often about ways they can improve their management processes. We hope these 10 methods inspire you to improve health check uptake and you'll dive into the rest of our resources to get the best from your practice management team.
Please leave a comment to share your favourite ways of boosting uptake or to let us know what you want more of on this blog!
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