London NHS Trust
2024

Turning better booking into thousands more appointments

How a London NHS trust standardised booking, improved digital communication and expanded patient-initiated follow-up to make better use of outpatient capacity.

The Challenge

Inconsistent booking processes and low use of patient-initiated follow-up were limiting outpatient efficiency.
Productive Partners’ initial assessment found DNA rates above the 6% national average and PIFU uptake below the 5% national standard. Booking teams were using digital systems and appointment processes inconsistently, making it harder to reduce missed appointments sustainably. PIFU adoption also varied widely between specialties because there was no trust-wide approach. The trust needed a more consistent model for booking, communication and identifying suitable patients for the pathway.

Results at a glance

+8,346

outpatient bookings above projection

1.9% to 2.6%

increase in patient-initiated follow-up

3.4% reduction

in vascular surgery DNAs

Lower DNA rates

across three specialties

What we changed

Productive Partners worked with booking and clinical teams to standardise everyday processes and release additional capacity across the pathway.
Standardise booking practice

Introduced structured booking processes, trained agents in proactive patient communication and created a simplified access policy aligned with RTT guidance.

Use digital communication consistently

Used manual text messaging to fill capacity within the following three weeks and reviewed digital applications that could improve appointment management and patient experience.

Improve capacity oversight

Embedded consistent use of the forward-look report and introduced daily morning huddles to align workforce and clinic capacity with service demand.

Expand patient-initiated follow-up

Created a step-by-step guide for clinicians and worked directly with clinical leads to identify suitable patient groups and reduce unnecessary face-to-face follow-ups.

The outcome

More appointments were delivered while missed appointments fell in the specialties using the new processes consistently.

The trust booked 8,346 additional new appointments above the projected baseline. DNA rates fell from 11.9% to 8.5% in vascular surgery, from 8.5% to 7.1% in dermatology and from 9.5% to 8.4% in trauma and orthopaedics.

PIFU uptake increased from 1.9% to 2.6%, supported by new trust-wide processes designed to help services progress towards the 5% trajectory target.

The programme left booking and clinical teams with clearer, more consistent ways to use capacity and manage outpatient pathways.

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