After a few drinks down the pub on a sunny spring day last year, three young men decided to quit their jobs with a big consultancy firm to focus on “changing patient experience in the NHS.”

Within a few months, Tom Whicher, Perran Pengelly and Rinesh Amin had started up a small company, begun creating an online booking system, and received interoperability toolkit funding from the Department of Health.

“It was really exciting; we sat down in the pub one night and came up with this idea that we could improve patient communication in the NHS. We all handed in our notice, finished work on the Friday and started the company on the Monday,” says Whicher.

The company, which they named DrDoctor, is now implementing a patient communication platform at Heatherwood and Wexham Park Hospitals NHS Foundation Trust, allowing patients to book, cancel and rebook their appointments either online, via text, or via a smartphone app.

The system will be linked directly to the trust’s patient administration system. “We wanted to make a system that isn’t a pain in the arse,” says Whicher.

28 letters later…

Having recently settled into trendy new offices in Central London, the team is looking forward to seeing its ideas in action. “Right now we’re really looking forward to our first go-live, which will hopefully happen in April,” says Pengelly.

“We reckon we can save the NHS billions through productivity and improvement,” Amin chimes in. “The system helps hospitals keep appointments in control and helps them bring down waiting times and referral to treatment times without any increase in admin work. It’s about using the capacity the hospital already has.”

The team believes strongly in open source as a way for trusts to share and contribute to work they are doing.

Because creating an open source connector that is ITK compliant is a very large specification, they have teamed up with other small companies – Tactix 4, Black Pear Software and Isis – which all received ITK funding for very similar projects at different trusts.

“We thought that instead of all doing it separately, we could pull our resources together and take advantage of our skills,” says Whicher, who adds that a lot of time has been spent coding “like crazy” in the office.

The DrDoctor online booking system is one of five hospital admission, discharge and transfer systems that have been ITK accredited, after the submission of several tests and supporting evidence.

Cancellations on top

Whicher, Pengelly and Amin all had experience of the NHS through working for their old employer, Newton Consulting which helps NHS organisations with IT implementations.

They were fairly certain they knew exactly what patients wanted when they sat down to design their system but after surveying hundreds of patients at Heatherwood and Wexham Park’s outpatient clinics, they tweaked their ideas a little.

Their research found that half of patients had seen their appointments rescheduled at least once, while 91% of were willing to take up a cancellation with less than a week’s warning.

Whicher recalls speaking to a woman who came in with 28 referral letters. Her appointment had been changed so many times she didn’t know when her appointment actually was. “It shouldn’t be that much hassle to be seen by a doctor,” he argues.

“When we spoke to patients, what was most important for them was to be able to access and cancel appointments online or via text on short notice,” Pengelly agrees. “It’s about making it easy, convenient and engaging to use.”

Already booked?

Of course, the NHS already has an electronic booking system – Choose and Book – which was developed at considerable expense as part of the National Programme for IT in the NHS.

Choose and Book went live in 2004 and more than 35m referrals have been processed since, but once GP incentives to use the system stopped, usage dropped below 50% nationally, and there it has stayed.

The DrDoctor team is familiar with Choose and Book, but argues its system has some clear differences. For a start, they argue that Choose and Book is focused on making sure that patients have a choice over where they are treated, and on booking a first outpatient appointment. Changes and rebookings are not really its focus.

“There are some similarities, but things like Choose and Book are designed to be used in the consultancy room with the GP, not by the patient at home,” Amin argues. “Our system gives patients more freedom to manage their own appointments.”