Transforming care through technology

This toolkit outlines examples of how Shelford Group trusts are using technology and digital innovations to transform outpatient services in the NHS


This toolkit brings together the work of 10 of the largest teaching and research NHS hospital trusts in England, working together under the umbrella of the Shelford Group. The emergence of new models of care using technology is a primary  theme of the work of the Shelford Group transformation directors, who have summarised the progress in their organisations.

The toolkit shows how Shelford Group organisations have started to deliver many of the  changes highlighted in the NHS Long Term Plan, describing how digitally enabled care  can deliver faster, better access for patients.

The Shelford Group is a collaboration of 10 of the largest teaching and research NHS hospital trusts in England. Case studies from these organisations are included throughout the toolkit and include initiatives that support patients to self care; the provision of better information and advice from patient portals; and the development of wearables and apps.

Full document: Transforming care through technology – a toolkit for new models of outpatient care


Text message reminders increase attendance at NHS health checks

NIHR | September 2019| Text message reminders increase attendance at NHS health checks

An RCT assessed the impact of patients receiving a text message reminder as a means of increasing attendance at NHS health checks.  Currently, NHS health checks are offered to adults aged 40 to 74 years. Identification and management of cardiovascular risk factors has been shown to save lives. Yet only half of adults attend a check when it is offered.


This trial was conducted across 28 general practices in South London assessed the effect of sending pre- and post-invitation text messages, along with different forms of invitation letter.  Patients were first assigned to receive either a pre-notification text or not. They were then assigned to receive one of 4 types of invitation letter:

  • standard control letter, detailing the health check in several paragraphs
  • open-ended letter, briefly saying their check was due and asking them to call and book
  • time-limited letter, as open-ended letter but asking them to attend in a limited time period, such as ‘your check is due in March’
  • social-norm letter, as open-ended letter but adding testimonials from patients saying how the health check helped them.

Finally, they were assigned to receive a reminder text or not.

The reminder text appeared to be the most effective addition. For all three intervention letters (open-ended, time-limited and social-norm) fewer people attended a health check when a reminder text was not sent. Although the time-limited letter with both texts was most effective, there was not enough evidence to support the value of the pre-notification text.

Amongst invited patients, 24% attended health checks. This ranged from 18% of those sent the standard control letter with neither text pre-notification nor reminder, to 30% of those sent the time-limited letter with both text pre-notification and reminder. Comparatively, this latter group had almost doubled odds of attending (Source: NIHR).

Sallis, A., et al |2019| Pre-notification and reminder SMS text messages with behaviourally informed invitation letters to improve uptake of NHS Health Checks: a factorial randomised controlled trial| BMC public health| 19|1|P.  1-12.


Background: The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake.

Methods: We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included. A double-blind randomised controlled trial with a mixed 2 (pre-notification SMS – yes or no) x 4 (letter – national template control, open-ended, time-limited, social norm) x 2 (reminder SMS – yes or no) factorial design was used. The open-ended letter used simplification, behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC. The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month. The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt. The outcome measure was attendance at an NHS HC.

Results: Data for 12, 244 invites were analysed. Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS (Uptake 18%), with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder; 10 percentage points for the open-ended letter with reminder and a 9 percentage point increase using the time-limited letter with reminder. The reminder SMS increased uptake for all intervention letters. The pre-notification did not add to this effect.

Conclusions: This large randomised controlled trial adds support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can increase uptake of NHS HCs. It also provides novel evidence on the effect of SMS reminders and pre-notification on NHS HC attendance.

Full article available from BMC Public Health 

Nesta report: A brief introduction to digital transformation

Nesta | September 2019 | A brief introduction to digital transformation

Much has been promised about the potential of digital technologies to positively
enhance the work of government and the public sector. A brief introduction to digital transformation, is a recent report from Nesta – an innovation foundation- counsels against adopting a ‘technology-driven’ approach, the risk of being ‘technology driven; recommending instead that the focus must be on technology’s potential to enable real-world outcomes.
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The report explores:

  • Examples of how digital technologies are being used by public sector organisations to improve their operations, deliver better public services and engage citizens
  • How to put in place project management, governance, team and budget structures to help digitally-enabled projects to thrive
  • The principles that organisations should apply when procuring or building their own technology solutions
  • The roles required in public sector organisations – including in digital and leadership teams – to succeed in the digital age.

A Brief Introduction to Digital Transformation [report]

A Brief Introduction to Digital Transformation [pres release]


Doncaster and Bassetlaw to launch ‘Electronic Observations’

Doncaster Clinical Commissioning Group | September 2019 | Local Hospitals to launch ‘Electronic Observations’

Starting this month (September) staff at Doncaster and Bassetlaw Teaching Hospitals will be adopting a new system to enable health professionals to electronically record patient observations. The launch of eObservations  forms part of DBTH’s ‘Digital Transformation programme’, a scheme of work which is looking at making the most of new technologies in order to improve patient care, safety, experience and treatment.

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One of the most important tasks within any hospital, ‘clinical observations’ is the term used to describe the multitude of tests and exercises which are used to monitor the health of a patient. From temperature checks to heart rate monitoring, these observations help doctors and nurses understand the condition of their patients, guiding treatment if anything changes.

‘eObservations’ will launch within all six adult wards at Bassetlaw Hospital. Using a mobile device (handheld phones), health professionals will be able to record patient observations using a secure app, which then calculates whether these results fall within the ‘normal’ range for the patient, alerting a senior nurse or doctor if urgent attention is required (Source: Doncaster CCG).

The full details of this innovation are available from Doncaster Clinical Commissioning Group



Improved access to MSK services for North Lincolnshire residents

North Lincolnshire Clinical Commissioning Group | September 2019| Improved access to MSK services for North Lincolnshire residents

North Lincolnshire Clinical Commissioning Group (NLCCG) tendered for a new service to provide a single point of referral for the triage, assessment, diagnosis and management of MSK and chronic pain conditions, this represents a significant change to the way in which Musculoskeletal (MSK) and pain services are provided in North Lincolnshire.


Now patients will be referred directly into the new service, meaning they are seen by the most appropriate healthcare professional to meet their needs more quickly. The service is designed to support patients to be more involved in the management of their own condition supported by a range of professionals and resources to meet their needs (Source: NLCCG).

The new service will aim to improve patient outcomes and promote self-management strategies including lifestyle improvement programmes; it will start in January 2020.

Read the full story from North Lincolnshire CCG 


What will future doctors look like?

NHS Employers | September 2019| What will future doctors look like?

This is the question being asked by Health Education England (HEE) as they seek views from all stakeholders as to what they consider will be the role of doctors in the future. 

They have opened a call for evidence following their commitment in the Interim NHS People Plan to determine what the NHS, patients and the public require from 21st century medical graduates.


The ‘future doctor’ work will look at the role of the doctor based on future multidisciplinary teams and asks stakeholders to think about how they engage with evolving roles of other healthcare professionals.

Employers have until September 26 to submit their responses and are asked to consider:

  • the expectations of doctors in the future
  • the factors that will impact the role of the doctor in the future
  • what the role of the future doctor will be compared to what it is now
  • the skills, knowledge and behaviours doctors will need to perform their role in the future.

This evidence will be combined to produce a consultation document on the future doctor work and a national consultation for patients and the public will be launched in November 2019.

How to submit your response

NHS Employers will be responding on behalf of employers and encourage any employers who wish to share views with us directly, to send their responses to by midday on September 19.
HEE is urging employers to also submit their own evidence by downloading the relevant form from the HEE website. The deadline to respond by is September 26.
Full details from NHS Employers