Cambridge Hospitals achieves one of the lowest DNA rates in the UK


Decrease in missed appointments.


Monthly increase in Payment by Results (PbR) Income.


Lowest Did Not Attend (DNA) rate in England.

Cambridge Hospitals NHS Trust is one of the largest and well-known hospitals in the UK with approximately 750,000 outpatient visits last year.

Their reminder process was disjointed with staff having to call patients individually about canceled clinics or to fill last-minute slots, a time consuming and expensive process.

Using Webex Connect they were able to achieve one of the lowest DNA rates in the country and by reducing missed appointments, their PbR income increased by a staggering £40,000 a month.


A traditional appointment system that wasn't fully serviceable on digital channels.


A reminder text is sent enabling patients to confirm, cancel, or rebook their appointment.


Drop in DNA rates by 27%, with cost efficiency savings of over £40,000 a month.


Cambridge relied solely on Interactive Voice Messaging (IVM) to remind all patients of upcoming appointments. Mobile texting is the most popular form of UK communications, yet it was not deployed as part of the patient communications strategy.

  • The Trust’s Did Not Attend (DNA) rate was low at 5.5%, however this had stagnated for some time and the current solution could not reduce DNA’s any further.

  • The reminder process was disjointed with minimal automation built in to work flows. Staff were required to ring patients individually about cancelled clinics or to fill last minute slots; hugely time consuming, archaic and expensive, which diverted staff from optimizing clinics.

  • The system received high levels of complaints from patients who were suspicious of its origin and wary of phone scams; older patients were particularly concerned about this.


Text reminders are a common practice for a range of appointments in our everyday life. Delivery is instant and 95% of SMS messages are read. However, not all patients can be reached this way, so we worked with the Trust to ensure reminders were inclusive to all patient groups whilst improving on service quality.

How did we help?

The team created a solution whereby a conversational reminder text is sent enabling patients to confirm, cancel, or rebook their appointment without having to call the hospital. If the SMS is not delivered, or no mobile number is held for the patient, the platform automatically generates an IVM (Interactive Voice Message) to be sent at the optimum time to reach patients. In addition, 48 hours prior to the appointment, a one-way reminder text message or IVM is sent to patients.

If a reply to the first message is not received within 48 hours, another text is sent to ‘nudge’ the patient to communicate intentions. The Envoy platform automatically triggers a second message only to those that have not responded.

Key insights
  • In the month of July 2018, 218 patients responded ‘cancel’ to the second message, equating to £34,880 potential income and a net gain of 14-18 clinics.

  • 571 patients also ‘rebooked’, opening up slots for waiting list patients with a net gain of 38-47 clinics.

  • Without the second message prompt, potentially 789 appointments may have been wasted.

Resource efficiences

The platform is data driven and automated, freeing staff from repetitive, manual tasks to focus on clinic efficiencies. The booking team can now send a single text blast to 100’s of patients to fill short notice clinics, rather than attempting to contact 150+ patients, which generally takes all day.

Using the bulk send, a clinic can now be filled within 60 minutes. And last minute clinic cancellation notifications have improved. A single text message can be sent to all patients and received instantly to ensure they do not attend unnecessarily.

Helping patients to self serve with proven results.

DNA drop: within 1 month, DNA’s dropped by 1% and have since lowered even further from 5.5% to 4% - overall a 27% decrease in missed appointments.

Cashable efficiencies: From the reduction in missed appointments, Payment by Results (PbR) income has increased by £40,000 a month.

Improved patient experience: Patients can now respond at their own convenience and digitally, without the time and effort to phone the hospital to reschedule.

Measurable service quality improvements: Patients are no longer mistaking communications as fraudulent significantly reducing complaints.

Our new reminder service helped reduce our DNA rate to one of the lowest in the country. ”

Sian Freeman, Deputy Operations Manager Outpatients Service, Cambridge University Hospitals.

Ready to take the next step?

Talk to one of our experts today.