Established integrated SMS communication in primary care: patterns of use and perceptions of utility

Problem

Use of SMS for personal communication with patients by GPs has been limited until recently. All forms of digital communication in clinical practice in primary care have expanded during the COVID-19 pandemic. This has been particularly true of integrated SMS communication. We assessed the patterns of use of integrated SMS by GPs in England and their perceptions of its utility.

Approach

We described the pattern of use of individual GP initiated SMS messages to patients (not as part of bulk recall) and explored the utility and acceptability of this method of communication in primary care from a GP perspective. We also looked at the impact of the pandemic on use and utility. We obtained GP user data from one integrated SMS provider. Integrated SMS (iSMS) is personalised SMS that is integrated with the patient record. Anonymised user data of an iSMS service was obtained for 3 timepoints (October 2019, March 2020, and October 2020). This was combined with practice characteristic data for England obtained from NHS digital. We conducted an online survey of the perceptions of GP users of this service in Autumn 2020. At the time of survey, the iSMS service was free to use. Responses to survey questions were reported using total numbers and rates. Free text answers were analysed using thematic analysis.

Findings

9123 GPs were using iSMS in October 2019, sending mean 36 SMS per GP per month. Use of iSMS by GP users rose to 12281 by March 2020. More rapid increase was seen by October 2020 with 34940 GP users, sending 57.5 iSMS per GP per month. There is considerable variation in frequency of use by users, weighted practice population and CCG. In the survey, GPs reported that use of SMS saves time and avoids telephone or face to face appointments. They report use during consultations with patients, reporting utility with signposting to local services. GPs reported the covid-19 pandemic increased use of iSMS and changed the sort of information shared with patients. There were some concerns around confidentiality and gaps in understanding of information suitable to send by SMS.

Consequences

Use of personalised SMS communication is now embedded in UK general practice. Patterns of use vary significantly. Use of individual iSMS increased with experience of using SMS. GPs were overall positive about utility. Many GPs reported use during a consultation. This has the potential to significantly alter the patient experience. Further work is needed to explore the variation in use of integrated SMS initiated by GPs and perceptions from a patient perspective.