In May, PKB’s first customer went live with mass registration through home letters. This is part of PKB’s letter-savings program: when patients switch receiving letters from post to PKB, institutions can generate in-year cash savings. Avoiding posting a letter saves £1 and a hospital posts hundreds of thousands of letters a year. So channel shifting to digital can save a lot of money.

PKB’s risk-sharing program offers customers the chance to pay PKB after delivery of this channel shift (i.e. when they have achieved these cash savings). PKB’s APIs allow mass registration with home letters or kiosks. Synertec has already integrated with these APIs so Synertec customers can start the mass registration with home letters without spending any integration time or effort. If you want to discuss channel shifting your patients, please contact us.

Channel shift is large and sustained

In the UK in 2017, 83% of people had broadband and 76% had smartphones. Ofcom data shows broadband use as the largest technology adoption in the UK, and the second fastest. Smartphone adoption is the fastest and trending to overtake broadband to reach universal usage. Most of your patients already have smartphones and internet at home.

At the same time, letter usage is collapsing in the UK as PwC had documented for the Royal Mail in 2013.

This is not because UK consumers do not like postal service – package deliveries are rising quickly. It is because consumers know that letters have information and information is best received digitally. Fast, free and filterable, managing communication digitally is better for everyone. If you offer NHS patients digital communication they will take up your offer.

The UK is particularly good at the channel shift

The UK is a world leader in digital channel shift. When we started PKB in 2008, one of the reasons we identified the UK as the right country to start in was UK consumers’ adoption of technology. One indicator that had struck me was that spending on digital advertising per capita was the highest in the world. Even though income per capita in the USA was higher than the UK, US technology giants found the UK’s consumers to be the world’s most digitally advanced. In 2015 the UK became the first country in the world where digital advertising was higher than non-digital.

The driver for this is the private sector, unlike the government-supported shift in Scandinavian countries. Abandonment of letters was earlier in Denmark than in the UK because the Danish government started implementing an ambitious digital strategy to make all government interactions paperless by 2015. (The 2016 digital strategy continues to build on this.)

In the UK it is the private sector that trained consumers. The UK’s electronic commerce sales share of overall retail spending is the highest in the world.

Why did UK health care take longer to channel shift?

Health care institutions in the UK took longer to channel shift because of worries about inequality and security. Internet usage is higher if you are richer and younger.

The workload of the NHS is less about the healthy and wealthy, and its egalitarian mission is to serve everyone.

However, even in the older poorer population, internet usage is high and rising. For many, digital is a bridge not a divide. Screen readers are easier to access and use than braille print-outs. Smartphones are a lifeline for homeless people. And for people who do not speak English, digital records and consultations can be translated. PKB works in 19 different languages, on smartphones, with screen readers.

Security is the other barrier. SMS appointment reminders do not need high security, but clinic letters are too sensitive for SMS or email and access to the full record requires a secure scalable infrastructure. That is why so many PKB customers like the letter-savings approach: it secures the full digital journey to support a patient’s care.

Clinical transformation: the real goal of channel shift

Because the biggest savings are in clinical transformation. Avoiding spending £1 on postage for an appointment is great. Avoiding the appointment saves £100, and this is possible if you switch to just-in-time appointments for those who need them rather than just-in-case follow-up for everyone. That is what North Bristol’s severe trauma team did. And avoiding emergency department visits saves £500 if you provide care plans for self-assessment and self-management, along with remote monitoring to identify patients needing early intervention. That is what Luton’s inflammatory bowel disease team did.

What slowed down this whole-pathway approach is that pathway-specific apps required too much work from professionals to engage patients and delivered too little for patients to bother registering. That is why PKB’s mass registration approach is so powerful. Large cohorts of patients register at scale across every pathway without costing staff time. The patients register because they have the immediate benefit of seeing their appointments and the long-term benefit of seeing their record across all diseases: PKB is a platform not an app. As patients register, professionals gain confidence in the viability of clinical transformation. And as professionals provide the clinical transformation tools of online consultations and shared care planning, patients’ engagement increases online, reducing the more expensive offline activity. A virtuous circle begins. If you want to start this with your patients, please contact us.