SMS Text Message Policy

Summary

Claypath and University Medical Group uses a service called AccuRx Chain SMS to send text messages to patients for a range of purposes including recall, care plans, patient information and delivering test results.

We assume that as a patient, if you provide your mobile number, you give implied consent for the surgery to use your number to contact you. This includes by text message.

We respect the choice of any patient who would prefer not to be sent text messages. If you would like to opt-out of text messages, please contact reception and a note will be made on your health record to indicate your preference.

Detailed policy

Introduction

The Claypath and University Medical Group uses Chain SMS to send text messages to patients for a range of purposes including recall, care plans, patient information and delivering test results. This policy outlines appropriate use of the service and how it is embedded in the running of the practice.

Why SMS?

Over 95% of the UK adult population use a mobile phone. Most messages take a few seconds to arrive, and the short format keeps messages concise. Patients are also able to receive messages when away from their home address. There is no need for an account/login/install (as with an app) and there are low levels of ‘spam’/marketing (as with email and post). Further information on the benefits of text messages can be found here: https://www.behaviouralinsights.co.uk/trial-design/why-text/

What is Chain SMS?

Chain SMS is a software service developed for primary care, allowing anyone in the practice to send a message to a patient. It is provided by AccuRx Ltd, a London-based software company.

Benefits to the practice

Using SMS messages to contact patients creates benefits for the practice, including:

  • Time saving – reducing the amount of time spent phoning a patient or sending a letter;
  • Cost saving – reducing the spend on postage, paper, paper and printer toner;
  • Improved access – avoiding inappropriate appointments (e.g. normal results) and signposting to local services;
  • Improved QoF – improved screening and immunisation performance, by sending invitations and reminders;
  • Engaging ‘hard to reach’ patients – who may ignore postal letters or calls from an ‘Unknown’ phone number;
  • Supporting efficient ways of working – e.g. enhancing telephone consultations;
  • Audit trail – documenting any safety netting advice and patient information given;
  • Standardisation, – enabling a common and efficient approach to working, for example in how blood results are reviewed and actioned;
  • Admin reduction – as patients can be contacted directly, without the need to task a member of the admin team.

Benefits to patients

Using SMS messages to contact patients creates benefits for the patients, including:

  • Patient education – providing information leaflets and self-care guidance;
  • Convenience – avoiding the need to wait for a phone call to answer a simple question;
  • Immediacy – receiving correspondence immediately rather than waiting for a letter;
  • Safety – allowing prompting of overdue investigations when issuing repeat prescriptions;
  • Experience – e.g. letting a patient know that their prescription is ready to collect;
  • Improved access – avoiding inappropriate appointments;
  • Adherence – when providing a clear documented care plan and health goals that can be referred back to;
  • Improved communication – making it faster, cheaper and easier to inform the patient.

Responsible individuals

Tracy Watson, Deputy General Manager, is responsible for overseeing the use of SMS at the practice, embedding use within normal ways of working and using the service to improve patient care and experience.

Nickola Brown, Data Quality Supervisor,  is responsible for ensuring that all appropriate computers have a working version of Chain SMS installed, and that all appropriately trained staff are enabled and know how to use it.

Any questions and concerns should be directed to them.

Setup

Chain SMS will be installed on all appropriate practice computers. All users will be required to create an account when they use Chain SMS for the first time.

Chain SMS will install for all users of a given computer, unless the user installing does not have sufficient administrator privileges. If this is the case, an error message will be shown, and an administrator will need to run the installation for all users.

Chain SMS is updated regularly, and these updates are automatically downloaded and installed. Users may be prompted to allow certain updates permission to install, and should allow the software to do so.

Staff access

All appropriately trained staff in the practice, both clinical and administrative, should have access to Chain SMS. Each role will find SMS messaging useful for a different purpose, and this should be discussed within teams and as part of new staff induction.

Training and familiarisation

Chain SMS has been designed to be simple and intuitive and therefore does not require much training; however all staff should familiarise themselves with the software by sending a message to their personal mobile, in relation to a dummy patient. All new staff will also have a brief introduction to Chain SMS and the time to familiarise themselves as part of their induction.

Message content

There is no way of guaranteeing that a message has been read by the intended recipient, therefore:

  • Messages containing critical information should not be relied upon (e.g. abnormal blood results requiring immediate action), unless they are followed up to ensure the information was received.
  • Use the ‘letter test’ – would I be happy sending this in a postal letter that may not arrive?
  • If the patient’s mobile phone number has been verified, the delivery receipt can confirm that the message has arrived on their phone.
  • Staff should avoid sending sensitive information as SMS messages may be overseen and therefore may be viewed by a patient’s relative, friend or colleague.
  • Sensitive information can be sent if the patient provides ad-hoc consent:

e.g. for sending details of IAPT services during a consultation;

e.g. for answering a medication query, if reception have asked if they are
happy for this to be answered by SMS when recording the query.

Use cases

For full flexibility, any SMS message can be sent to a patient.  Staff should, therefore, use their individual judgement of what is appropriate. For guidance, examples are given below:

Appropriate messages

  • Administrative information, e.g. prescription ready to collect;
  • Care plan sent in a consultation, e.g. dosing of new medication;
  • Recall e.g. advising the patient to book an appointment;
  • Advice and safety netting sent in a consultation, e.g. link to NHS Choices information or MSK exercise videos;
  • Signposting to third-party services in a consultation, e.g. exercise classes;
  • Normal test results e.g. Chest x-ray normal;
  • Some abnormal results e.g. Low Vitamin D, with advice for sun exposure and OTC supplements;
  • Telephone information e.g. you tried to call but could not reach them, or will be calling;
  • Reminders e.g. for cervical screening or overdue blood tests;
  • Follow-up e.g. checking a patient has received a hospital letter after a referral.

Inappropriate messages

  • Worrying, complex or sensitive test results e.g. STI test or high PSA;
  • Long or complex messages e.g. multiple medication changes;
  • Links to sensitive patient advice without consent e.g. family planning advice; Signposting to third-party services without consent e.g. Macmillan contact details;Critical information without follow-up e.g. urgent appointment required.

Sending Times

Text messages should not be sent to patients before 08:00 or after 21:00hrs, unless it is felt appropriate to do so (e.g. patient awaiting an urgent prescription before their holiday).

Delivery reports

Staff can see when a message was delivered to a patient, or if that delivery failed, by opening “Delivery Reports”. This list can be used to identify patients whose mobile number needs updating.

Tone

Messages should be phrased professionally, but do not require the same level of formality as a letter. Text abbreviations (e.g. ‘thnx’, ‘u’) are not appropriate, and the spell-check functionality in Chain SMS should be used to remove typos.

Information Governance

To be confident that SMS messages are being received by the intended recipients, it is important that patient mobile numbers are kept up-to-date. The reception team should verify a patient’s mobile number at any opportunity when speaking to a patient. Other members of the team should opportunistically update mobile numbers e.g. confirming a mobile number before sending patient advice at the end of an appointment.

Data Processing

Text messages should only be sent for the delivery and administration of health and care services. They must not be used for marketing third-party services, or any other reason that a patient would not reasonably expect.

AccuRx Ltd are registered with the Information Commissioner’s Office (reference ZA202115) and hold an up-to-date NHS Digital Information Governance Toolkit Level 2 (ODS code 8JT17). The full Data Processing Agreement between the practice and AccuRx Limited provides further information on how data is processed, and can be found at: https://docs.wixstatic.com/ugd/7b3cd0_f7d4dbc26ac643b7bce2272debe9c2e3.pdf

AccuRx Ltd follows NHS Digital best-practice guidance on the use of cloud services. Further information on this guidance can be found at:

https://digital.nhs.uk/data-and-information/looking-after-information/data-security-and-information-governance/nhs-and-social-care-data-off-shoring-and-the-use-of-public-cloud-services

GDPR

In accordance with The General Data Protection Regulation (EU 2016/679):

Personal data is processed under the following legal basis for the purposes of direct care and the administration of health and care services:

Personal data concerning health is processed under the following legal basis for the purposes of direct care and the administration of health and care services:
9(2)(h) ‘…medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems…’

Personal data concerning health is processed under the following legal basis for the purposes of public health:
9(2)(i) ‘ .. necessary for reasons of public interest in the area of public health .. or ensuring high standards of quality and safety of health care and of medicinal products or medical devices ..’

6(1)(e) ‘…for the performance of a task carried out in the public interest or in the exercise of official authority…’

Further guidance on GDPR and the legal basis for data processing can be found at:

https://digital.nhs.uk/data-and-information/looking-after-information/data-security-and-information-governance/information-governance-alliance-iga/general-data-protection-regulation-gdpr-guidance

Opt-out

‘Consent’ is not used as a legal basis for data processing and messages are, therefore, sent on an ‘opt-out’ basis. If a patient informs the practice that they do not wish to receive SMS messages, a member of staff must update their ‘Notification Preferences’ in EMIS. Chain SMS will show any codes related to consent and dissent when sending a message.

Continuous improvement

To fully embed SMS messaging as a way of working, and maximise the benefits for the practice, staff and patients, Dr Mike Smith is responsible for leading improvement initiatives, and other staff are strongly encouraged to participate. These include:

  • Practice meetings – e.g. presenting usage across the team and asking top users to share what they use SMS messaging for;
  • PPG meeting – gathering patient feedback on the service and identifying other opportunities to provide a better patient experience using SMS messaging;
  • Custom templates – developing the library of practice SMS templates, and relating these to other practice protocols (e.g. care navigation, test results, self-care);
  • Audits – running reports to audit the mobile number coverage of the patient list, and reviewing the types of messages sent.