Transformation Directorate

Using text messages to communicate with patients in a musculoskeletal service during COVID-19

During the COVID-19 pandemic, a community musculoskeletal and rheumatology therapies service stopped its routine face-to-face contact with patients.


The team needed to find an innovative way to remotely assess, advise and rehabilitate patients and record interventions in the patient record.

The team also wanted to communicate quickly and easily with patients about their appointments using text messages.

This would incorporate evolving healthcare access advice alongside COVID-19 symptom screening policies to ensure patients are safely cared for.


To improve the way the team communicates with patients from an administrative or a clinical perspective.

  • The first contact with patients would be a telephone or video consultation.
  • Patient photographs will aid clinical diagnosis before being saved to the patient’s record.
  • Enable two-way communication with patients to help capture email addresses for electronic rehabilitation programs and communication.
  • Patients can receive digitised information like leaflets, decision aids and links to NHS-endorsed websites to help first-line, self-management.
  • Be able to screen patients for COVID-19 before they attend face-to-face appointments and give instructions on attending appointments in ever-changing circumstances.
  • Be able to configure standardised text message templates and ensure quality information is provided by 168 staff at 12 different geographical localities.

The team wanted to investigate how to deliver the best patient care by restoring the service and planning for the future after the pandemic. This could be returning to the way they used to do things or by building on some of the changes they had adopted.


The team introduced a new software tool called accuRx.

This enables clinical and administrative teams to communicate through digital channels. They can now:

  • carry out phone or video consultations
  • send bespoke text messages
  • receive patient photos to store in their medical record
  • start two-way conversations through text message or email

The text message can include:

  • appointment details
  • COVID-19 symptom screening
  • information from NHS Choices patient leaflets
  • sign posting to NHS self-management advice
  • third party and charitable resources

The team can also direct patients to resources that are related to services, like:

  • information on specific procedures
  • treatment decision aids
  • website information on first-line management and exercise videos

The team conducted a quality improvement project to audit the experience of clinical and administrative staff and patients during the rapid adoption of new software.

2 questionnaires were designed to understand the experiences of using text messages to communicate and share information throughout COVID-19. This would inform future practice, particularly to help the service save money.


  • 75 surveys were completed by clinical and administrative staff and 55 surveys completed by patients.
  • The results showed that the new model was well received by all 55 patients surveyed.
  • Patients, clinicians and administrative staff all gave a user satisfaction score of 9 out of 10.
  • The system enriches the service’s digital transformation in line with Trust values and objectives.
  • There are opportunities for future improvements through software enhancements.
  • accuRx helps health systems work together within and across organisational boundaries for the effective delivery of healthcare for individuals and communities.
  • The new system helped to streamline workflows.
  • Communication with patients is immediate, there are no postal delays and treatment can start immediately.


  • accuRx works with EMIS and SystmOne, but can also be used on its own.
  • Text messages are preloaded with the patient’s demographics and the content is saved directly into the patient record.
  • accuRx is a two-way communication tool. Patients can reply to messages or send photographs.
  • Information can be sent by text message or email, allowing flexibility depending on patient preference or connectivity.


  • Processes for things like printing and posting patient information are significantly simplified, saving time, reducing the service’s carbon footprint and saving money.
  • Patients receive their information instantly, rather than waiting for a letter.
  • Patient information can be sent from NHS Choices or a specific document can be attached, perhaps relating to a procedure or investigation.
  • All communication is automatically duplicated in the patient record and is fully auditable. Colleagues can pick up where another left off. For example, if a patient responds to a missed call or contact us message.


The system can:

  • be used effectively by both clinical and admin staff
  • reach anyone, but is particularly useful to EMIS and SystmOne users

Key learning points

  • User training and engagement are key from the beginning and should be a continual, rather than one-off process.
  • Configure the tool to meet the needs of your staff and patients using pre-built templates for commonly used items.
  • Remember everything sent to the patient forms part of their medical record. Always spell check and maintain professionalism.
  • Patients with a mobile phone can receive a standard text message without incurring any charge. Any attachments (like links to a website or patient information leaflets) require data or WiFi connection to open. The accuRx software lets clinicians email the information or send it using a mobile phone.
  • The team identified numerous patients with a suitable tablet or computer but an unsuitable mobile phone. From a visual perspective, reading the information on a bigger screen is helpful.
  • Patients without access to a suitable device to receive their information digitally have the option to have their information printed and posted to their home address.

Key figures

  • Almost 117,000 text messages have been sent to patients and 3,400 video consultations conducted.
  • Almost 36,000 COVID-19 symptoms screening questionnaires were sent in the 24 to 48 hours before patients’ appointment to aid patient and staff safety.

Key contacts

Louise Waters, Extended Scope Physiotherapist and Divisional Clinical Information Officer