Transformation Directorate

Using digital follow-up assessments to reduce unnecessary face-to-face appointments

Many face-to-face follow-up appointments are not necessary and contribute to increasing DNA (did not attend) rates and lowered patient satisfaction. Assessing the patient digitally can improve patient experience, save time and money, and help to ensure capacity is used for patients with a clinical need.


Unnecessary face-to-face follow-up appointments were placing a burden on admin and clinical staff at the Nottingham University Hospitals NHS Foundation Trust (NUH). With a mandate to reduce face-to-face appointments, the Trust needed a digital solution to assess patients’ follow-up needs. With existing hectic schedules in the cancer services, the solution had to reduce existing admin burden on staff and improve the patient experience to keep them engaged.


Encourage patients to complete a digital assessment to significantly reduce face-to-face follow-up appointments, improve the patient experience, and enable staff assessment of patient follow-up needs digitally.

Solution and impact

NUH partnered with DrDoctor to implement follow-up management. This digital-first service helps clinicians identify if there is a need for a follow-up appointment using digital forms and keeps the patient informed through automated communications.

In a focused pilot for breast services, with smart automated features, such as SMS reminders, the response rate was as high as 99%.

Of the patients signed up to the service, 96% did not need a face-to-face appointment. This reduced total appointments by 23%. Additionally, clinicians are now doing an average of 4 minutes of work to assess patients instead of 10, with significant long term-cost saving implications.


The assessment forms are viewable on the DrDoctor patient portal. Links to the forms, as well as reminders, are sent by secure SMS, so there is no need to download or use an app. Integration with Trust IT systems is straightforward, as only demographic and appointment data is needed.


The cloud-based web portal is accessible from any web-enabled device and a telephone number for patients is provided. Follow-up need assessment forms are easy to create and send directly to patients by SMS. Reminders can be set up to ensure the patient fills out the form in a timely manner. When completed the clinician decides on the outcome which is then automatically communicated back to the patient.


Patients can fill out the forms at home saving time in clinical appointments. Clinicians can configure and review forms in the same place.

Further use cases include pre- and post-clinic assessments, longitudinal studies and ad hoc assessments.

Key learning points

Feasibility studies showed that 70% of follow-up appointments could be managed by telephone or video, or did not need to happen at all.

Key figures/quotes

“Clinicians don’t necessarily just want to do something because it saves their hospital time or money. The key driver for clinicians is patient care and using follow-up management allows them to do just that.”
Daniel Wardle-Millar, project manager, Nottingham University Hospitals NHS Trust

Find out more

Find out more about the NHS Cancer Programme resources to support personalised stratified follow up (PSFU) with digital remote monitoring systems (RMS) from the Cancer Alliances Workspace on the FutureNHS Collaboration Platform (access via your Cancer Alliance - contact details here).

DrDoctor is included in the NHSX/NHS England and NHS Improvement 2021 Digital Remote Monitoring System Implementation Guide, available from the Workspace here (account required).

Key contact

Shaun Cullen, DrDoctor

Ian Kingsbury, NUH communications team