We looked closely at our outpatient appointment workflows and realised that patients were receiving the same information multiple times:

• A digital letter via their Personal Health Record (PKB)
• A paper letter through the post
• SMS appointment reminders
• Appointment information displayed directly in their PKB record

Although 70–80% of patients read their appointment letters digitally, many did not do so within the set timeframe. As a result, paper letters were still sent, even though patients often read the digital letters a few days later. This meant the trust continued to pay for millions of paper letters each year.

We saw a clear opportunity to eliminate this waste, but we had to balance potential savings against the risk of rising ‘Did Not Attend’ (DNA) rates. With each missed appointment costing approximately £125, any dip in attendance could quickly offset the postage savings and compromise patient safety.

We decided to stop sending paper letters for all PKB-registered patients and move to a fully digital-first correspondence model. To ensure this wouldn’t negatively impact DNA rates, we implemented a layered risk-mitigation strategy:

1. Effective communication to patients: The trust took a proactive approach by sending mailshots well in advance informing patients of the benefits of receiving their letters digitally and gave them the opportunity to opt out. We also updated their PKB welcome message and email footer to reflect the upcoming changes. 
2. SMS reminders already in place: Patients continued receiving reminders 5 days and 24 hours before their appointments.
3. Digital read-rates monitored in real time: Using PKB reporting, we tracked delivery, read rates, and behaviour across patient cohorts.
4. DNA monitoring window: We closely monitored DNA rates during the expected attendance window for appointments booked weeks in advance.

Rapid Implementation

Once approved, the changes were implemented quickly:

• Paper letters were stopped for PKB-registered patients
• Read-receipts for documents were disabled
• Reporting processes were built to monitor safety and impact

Cost Savings to Date

Since implementation in March 2025 to March 2026, we have achieved approximately £536,000 in savings from the reduction of paper documents being sent via post with an estimated saving of 11,466 staff hours on associated administration, allowing teams to focus more on high-value tasks and improving overall efficiency.

SMS Registration Campaign

To further increase PKB adoption, we launched an SMS campaign linking patients directly to PKB registration. Early results show sustained increases, with expectations to reach 60–70% registration rates adoption within the next year.

Projected Cost Savings

We send 3.2 million letters through Synertec each year and the trust now sends over 50% of its letters digitally via PKB. Since adopting this model, digital read rates within PKB have increased from 60% to 69%, and the proportion of letters shared digitally has risen from 42% to over 50%. The trust aims to exceed 70% digital letters by continuing to grow patient registrations and increasing the number of letters shared through PKB.

• £1.2 million potential annual savings by converting to digital

• With a reduction of 1 minute and 17 seconds of administrative time per letter, the project is set to return more than 25,000 hours to staff, enabling them to focus on higher-value patient care activities. [note: Some departments could spend over 2 hours a day folding letters and on occasion have to pull in clinical staff to help.  This has now significantly reduced in time and doesn’t require support from clinical staff meaning their time is spent caring for patients]

Patient Engagement and Feedback

Before launch, we consulted the Sussex Patient Panel. Feedback was overwhelmingly positive:

• Patients welcomed the shift to digital-first communication
• Suggestions focused on notification refinements for neurodivergent patients and those with dementia

After launch, the majority of patient enquiries were either about PKB registration or understanding digital letters. Requests for paper reinstatement were rare. UHSussex maintains a flexible approach: any patient can opt back into paper, and no one is disadvantaged for choosing digital alternatives.

Impact on DNA Rates

Contrary to initial concerns, DNAs decreased. Digital letters combined with SMS reminders proved more effective than post, confirming that patients primarily rely on receiving appointment details reliably, not on paper letters.

Benefits We Have Realised

• Significant cashable savings on printing and postage
• Reduced administrative workload and nurse time
• Increased clinic capacity
• Reliable communication with patients
• Flexible patient-centred approach allowing opt-in/opt-out of paper

Our transition to fully digital correspondence for PKB-registered patients demonstrates that a carefully planned, patient-centred digital strategy can deliver meaningful benefits for both patients and the NHS. The success of this approach is informing adoption across the region and beyond.