Screening text reminder programme to increase the uptake of routine screening appointments

London has the lowest cervical screening coverage in the country and current rates are significantly lower than in 2013. Text message reminders were implemented across all participating London GP practices from September 2018 to March 2019 to help increase the number of women taking up the offer of cervical screening.

Situation

Cervical screening has contributed to an 80% reduction in deaths from cervical cancer over the last few decades. Cervical screening rates have been steadily declining every year, particularly in London. As at least 95% of people in the UK have mobile phones, there has been a call for the NHS to make use of technology to reverse this trend.

Previous research has indicated that text messages are an effective means of increasing attendance at screening appointments. Text message reminders have shown to increase uptake by at least 5% in other types of cancer screening programmes.

Aspiration

GP-endorsed text message reminders were implemented in order to encourage women across London to attend their cervical screening appointment, thus leading to earlier detection and more lives being saved.

Solution and impact

NHS England and NHS Improvement rolled out text message reminders across London. Working with the Cervical Screening Administration Service, iPLATO Healthcare was commissioned to facilitate the service through their myGP Engagement Hub which is also used by GPs and health commissioners for similar healthcare campaigns.

As part of the programme, women due their cervical screening, with an active mobile number registered at a London GP practice, were sent a GP-endorsed text reminder 2.5 weeks after being sent a standard invitation letter.

Upon GP practice sign-up, Primary Care Support England (PCSE) provided iPLATO with the NHS numbers of women who had been invited for their cervical screening on a weekly basis. The iPLATO hub platform was used to extract the mobile phone numbers from the relevant patient records in order to send a text message reminder to women due their cervical screening.

Impact

For women who received a text reminder, uptake of cervical screening at 18 weeks was higher by 4.8% in all age groups. This equates to an additional 13,400 more women being screened as a result of the campaign. The programme evidenced a significant uptake of cervical screening attendance across all groups:

• 4.8% in women aged 25 to 49
• 5.9% in women aged 50 to 64

Women who received a text reminder attended screening two and a half weeks earlier than those who were only sent a letter invitation (54 days compared with 71 days).

Functionality

• Cloud-based service which enables multi-media mass communication

Capabilities

• Instant multi-channel communication tool that centralises patient communication (SMS, letters and telephone outreach)
• Enables communications to be targeted to specific patient cohort groups
• Facilitates earlier diagnosis, treatment and access to relevant services
• Can code to patient records
• Centralised regional reporting to monitor patient outcomes
• Ability to extract data from a patient’s record

Scope

Enables patients to be contacted at any time by text message, letter and/or phone call.

Key learning points

As well as improving participation in cancer screening services, GP-endorsed text messages have proven to be a highly effective means of communicating with patients at scale.

A centrally controlled and distributed message ensures that all patients receive appropriate and consistent information, while also relieving practices of the administrative workload.

Key figures/quotes

• 97% of practices in London signed up to the project, with 80% signing up within the first 6 weeks.
• 384,112 women were invited for screening from consenting practices.
• Mobile phone numbers were extracted for 88% of these women.
• Messages were successfully sent to 75% of these women (the most common reason for non-delivery of the text message was incorrect phone number).
• Attendance increased over a 6 month period by 4.8%. That is the equivalent of 13,400 more women being screened at 18 weeks.
• The average time between invitation and screening was 54 days for women who received an invitation letter and a text reminder and 71 days for women who only received an invitation letter.

Find out more

Text Reminders for cervical screening, PHE

Report of The Independent Review of Adult Screening Programmes in England, Sir Mike Richards (PDF, 1.7MB)

Population Health service, myGP

Lancet article on behavioural text message reminders for cervical screening

Key contact

Dr Josephine Ruwende, screening and immunisation lead (Cancer Screening), NHS England (London Region)

josephine.ruwende@nhs.net

Luke Wyatt, head of population health services, myGP

Luke.Wyatt@iplato.com