Time for Chip and PIN card payment

Is the cheque obsolete as a payment method? Well not quite according to the Cheque and Credit Clearing Company which reveals that in the UK in 2017 some four hundred and five million cheques were issued either as payments or to draw cash. Nevertheless this does represent a 15% reduction in cheque volumes and continues a trend seen in previous years of cheques being replaced by faster or direct card payment methods.

As a result direct payment forms are seeing a corresponding increase in volume with a 23% rise in single immediate payments in 2017. Interestingly, perhaps because of the fall in cheque payment volumes, the average value of a cheque actually increased by 5% in 2017 to £1217. Nevertheless, the way in which public perception is changing in respect of acceptable forms of payment does help those businesses which are looking to move away from cheques as a form of payment.

So what has replaced cheques as the preferred payment method? A recent survey revealed that 42% of people in the UK see credit or debit card with pin number as their preferred method of payment. Contactless methods of payment are also rising in popularity; although the majority of those interviewed indicated that they were happy with the current £30 contactless limit, citing security concerns should the limit rise.

What does the move away from cheques mean for businesses? Well, for a start it could mean a chance to speed up receipt of payments whilst simultaneously reducing administration time. Take a private healthcare business such as a chiropractor or physiotherapist for example. Relying on cheque payments often meant time spent in paperwork, in drawing up invoices after the time of the appointment, posting them out and then waiting for cheques to be posted back. Even if the cheque payment was made at the time of the appointment, administration time was still required to take the payment to the bank and await clearance.

Simply by taking card payment details as part of the appointment process, at a stroke all of that burdensome administration time can be avoided. With card details to hand, as soon as the appointment has taken place, the card payment can be taken. Moreover, by pre-authorising the payment at the time of booking, health practitioners can be reassured that funds are available to pay for treatment.

There is another benefit of pre-authorising card payments and that is client attendance rates. Provided the health practice ensures the client is fully aware of potential non-attendance fees, clients are far more likely to attend appointments or to telephone well in advance should they be prevented from doing so. This not only helps to ensure clients receive the treatment they need at the time at which it is most effective, it also helps to ensure that treatment times are fully utilised. Not only did this maximise potential income for the health practice, it also means that practitioners are not turning aside potential clients due to fully booked treatment times and then finding that some of those slots are left vacant due to no-shows.

Is the cheque obsolete? Well no, not quite, but with chip and pin card payment systems to hand practices at least should be working to encourage automated payments for the benefit of the practice and its potential clients.

 

 

 

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Treating the person not the condition

The importance of treating the patient not the condition has been brought into sharp focus by a Cambridge University study published in the British Journal of General Practice. Reviewing the health records of more than 400,000 adults, the study revealed that 30% of females and 24.4% of males were suffering from more than one health condition, otherwise known as multimorbidity. Moreover, those who reported experiencing more than one health condition accounted for 52.9% of GP consultations and 78.7% of prescriptions.

Breaking down the statistics by underlying cause, the most prevalent conditions according to the report were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). Interestingly, those aged between eighteen and forty-four or having been identified as having lower socio-economic status were more likely to report a combination of physical and mental conditions.

Whilst the findings may not come as a huge surprise to health professionals, nevertheless they do serve to highlight the way in which individual conditions should not be treated in isolation. As the report’s authors highlight “multimorbidity has a substantial impact on various health services ranging from general practice to end-of-life care.” Moreover, gaining a better understanding of the complex relationships between conditions could help the health service in general to target resources appropriately. As Dr Duncan Edwards, one of the authors commented “It may be that we need to think about a drastic restructuring of services: no longer will people be seen in ‘single disease’ services but in new multimorbidity clinics designed for the future.”

Where does this leave health professionals in the meantime? For some, it may simply a question of heightening awareness rather than changing practices. For example, physiotherapists, osteopaths and chiropractors are well used to thinking holistically when treating muscle and ligament pain. That’s because carrying the body differently in response to an injury is very likely to lead to referred pain or contribute to additional musculoskeletal damage.

Where the challenge becomes more complex is when it crosses disciplines; for example where obesity gives rise to a range of conditions including chronic pain, hypertension, diabetes and depression. In these instances whilst the potential causal link may be understood, care may be provided by a number of health specialists. Not only does this condemn the patient to multiple doctor and hospital appointments, a delay in treating one aspect of the condition may contribute negatively to the chance of recovery in other areas.

The five-year forward review of health practices in the UK had already identified the need for treating patients holistically. This study sheds further light on the reasoning behind that review as well as calling into question the current structure of health services within this country. Treating the condition in isolation may not restore the patient to full health and could even lead to further complications. As Professor Helen Stokes-Lampard, Chairman of the Royal College of GPs, commented: “This large-scale, comprehensive research is further evidence of the increasing complexity of cases that GPs are dealing with, and the inadequacy of the standard 10-minute consultation.”

 

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Too cold for snow: An Olympic lesson

If you are a fan of winter sports then there is a fair chance that the Winter Olympic Games may deliver a pinnacle of sporting viewing. However, as all sports fans know only too well, truly memorable contests come about when athletes are able to perform to the best of their ability. And that requires optimum conditions.

With that in mind it was somewhat concerning to see the weather reports ahead of the 2018 Winter Olympic Games which predicted wind chill factors as low as -25°. Some of the teams were reporting skis warping thanks to the effect of extreme cold on snow crystals and concerns abounded over the effect of unusually low temperatures on athletes. Ironically; despite the cold, or perhaps because of it, there was also concern over snow levels with machines being brought into supplement natural precipitation.

At the time of writing, a few days in to the games, high winds have also proved hazardous with some athletes unhappy at having to compete in what they considered were dangerous conditions. Under such extremes, successfully completing courses is more a lottery than a game of skill; something which no athlete wishes to encounter at the end of four years hard training.

From the safety of our sofas it is hard to imagine the physical and mental effect of extreme cold on the body. Low temperatures can sap brainpower, slowing down decision-making and reducing coordination; not something you want when faced with the challenge of extreme downhill skiing through slalom gates or over jumps. Preparation and training, inbuilt muscle awareness allied to physiotherapy and other physical and health support can go some way towards helping athletes to overcome conditions; but at the end of the day when the weather becomes so extreme inevitably accidents and injuries will occur.

And when breaks, fractures and ligament damage occur, our Olympic athletes are put in the same position as any recreational skier. There is an imperative to heal as quickly as possible in order to return to the normal routine. The only difference is that whilst for most of us that everyday routine will be away from the slopes, for Winter Olympians the slopes are their way of life.

This is where physiotherapists and other health professionals truly come into their own. For whilst naturally there is a core treatment plan in order to rehabilitate the injured limb, at the same time athletes have to undergo a programme of training which helps their whole body stay as strong and supple as possible. One leg may be broken but that’s no excuse not to continue to exercise appropriately in order to ensure that core and arm strength and tone are not lost.

It’s a lesson which we can all benefit from; the fact that one injury should not be allowed to affect the entire body. No matter whether we’ve followed our Olympic heroes on to the slopes or injured ourselves in some other fashion, the more we work with health professionals to ensure rehabilitation across the entire body, the better chance we have of regaining full strength and mobility as swiftly as possible.

 

 

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Flu: Catch it, report it, deliver care

In December we wrote about the challenges faced by A&E departments and in the process made a passing mention of the effects of winter flu on the health service. Now that potential has become a reality with “Australian flu” rapidly spreading across the country and in the process placing even further strains on health provision.

At the time of writing according to the Influenza survey operated by Public Health England, there are only a few pockets of resistance which have yet to report flu cases with many areas heading rapidly towards the red, or very high, end of reported cases. Having said that, whilst any flu is a matter for concern, according to PHE the number of cases reported to date is broadly in line with previous years.

The flu survey, which was originally launched in 2009 in response to the swine flu epidemic, is part of a pan-European initiative to monitor influenza like illnesses. These are described as sudden onset symptoms displaying:

  • at least one of Fever (chills); Malaise; Headache; Muscle pain and
  • at least one of Cough; Sore throat; Shortness of breath

More than 7,500 people across the UK already participate in the flu survey but Public Health England would like more people to take part by signing up online in order to boost research and understanding. In the meantime there are a number of measures which people can take, either on their own or in the workplace, to reduce the spread of flu. These include regularly washing hands, sanitising common work areas such as phones and keyboards and encouraging the use of tissues to catch and bin coughs and sneezes.

Nevertheless, flu is placing a strain on health resources with elective surgeries being postponed and health staff, including backroom employees, being redeployed in order to maximise care time. Although only the most serious cases should end up in hospital, inevitably pressure on hospital resources has a knock on effect right throughout the health system. For example, physiotherapists and others may have to continue to provide a level of ongoing care for those whose operations have been postponed. Similarly, with pressure on hospitals to discharge patients in order to free up bed space, additional post-operative treatments may have to be carried out in the community, adding to pressure on health resources.

All this at a time in which health professionals including physiotherapists and osteopaths together with their own support staff may be short staffed due to flu. As with any patient-facing service there is little option for people to work from home. Nevertheless, sending staff home when they feel unwell does make sense if it avoids them passing illness around the health practice. This is where a virtual assistant service may come in handy. Delegating routine tasks such as phone answering and diary handling over to an external virtual assistant service enables continuity of care whilst maximising front line resources. Similarly, switching to an online patient records service could save administrative time and enable patient details to be available at the touch of a button rather than found by searching in a filing cabinet.

However the flu season develops it pays to plan and be aware. By catching possible cases early staff can be sent home before they affect others. Online reporting will help to monitor the outbreak and provide data for future research whilst moving processes online could help to provide continuity of care. The flu season affects everyone in the health sector; it’s never too late for all of us to play our part.

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Waiting for A&E care

Accident & Emergency; we can’t live without it but it appears that increasingly we are having to be patient if we have need of its services. So much so that research carried out by the BBC has revealed that in the past year three million A&E attendees had to wait in excess of four hours in order to be treated.

To put that in context, nearly twenty-four million people were treated or admitted within the four hour time band. Or to put it another way, if each A&E attendee visited once then 41% of the UK’s population stepped through the A&E doors in just one year. It’s hardly surprising therefore that the president of the Royal College of Emergency Medicine, Dr Taj Hassan, commented to the BBC that the A&E system had been “stretched to its very limits.”

Accepting that the answer probably isn’t going to come from finding the money required to set up and staff an additional twenty A&E units, health services across the UK are looking to new ways of coping with demand; adopting a variety of methods in order to reduce footfall and speed up throughput. Whilst the Department of Health has turned aside suggestions that patients should be required to receive a referral from their doctor or NHS 111 before visiting A&E, it is true that just 20% of those attending A&E have first tried to access health advice via the 111 service. Perhaps if they had sought alternative advice either from 111 or their local pharmacy they would not have resorted to A&E for help with broken false fingernails, splinters in finger, paper cuts or shaving cuts; all of which featured in the 2016 top ten list of inappropriate trips to A&E in Cambridgeshire.

It’s hardly surprising therefore that a number of health trusts have been launching awareness campaigns in a bid to educate people on A&E alternatives including one video from NHS Wakefield Clinical Commissioning Group set to the tune of the 12 days of Christmas. Inappropriate visits aside, health authorities are also working to free up beds in order to speed up treatment times. Measures here include partnering with care homes and other health care professionals in order to deliver more health care in the community.

Undoubtedly this will put additional pressure on external health care services but perhaps it will also help to ensure that treatment is available at the most appropriate point of contact. For example, another on the Cambridgeshire inappropriate visit list was an individual who had suffered months of back pain without calling on the services of a health professional. Had they been given access to a physiotherapy service they could have saved themselves months of pain and saved the A&E department from having to assess their needs.

The winter flu season is not yet upon us and that will undoubtedly bring further challenges for A&E departments as will an increase in demand for treatment of strains and sprains as a result of icy conditions. Many of these conditions can be treated equally well by health providers such as pharmacists, physiotherapists or chiropractors. We’ve already seen pharmacists take up the strain in respect of flu jabs; perhaps this is the start of a wider acceptance of alternative providers helping to deliver health care in the UK.

 

 

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Time to heal? Consult your body clock.

What is your clock telling you? Time for lunch, time for that next appointment, or maybe it is something far more profound which could affect your entire wellbeing. Perhaps the answer depends on which clock you have tuned into. The clock on the wall may be telling you one thing, your body clock quite another.

The concept of the body clock isn’t a new one.  Anyone who has travelled abroad knows all too well the effect which multiple time changes can have on their system.  And even if you are more of a staycationer then you may still be all too aware of the impact of twice yearly UK clock changes on eating and sleeping patterns.

However, it seems as though the clash between imposed time and personal body clocks may only be the tip of the iceberg when it comes to our personal time zones. Indeed, the more that scientists study the body clock, more they are learning about the interaction between time and well-being. In this last month alone two important studies have illustrated the way in which well-being is influenced by our body clocks.

In the first study led by Professor David Montaigne of the University of Lille, researchers highlighted the way in which our body clocks influence our chances of recovering from heart attacks and heart surgery. Identifying some 300 genes which link the body clock to heart well-being, the study found that ongoing heart damage was more prevalent in those had undergone heart surgery in the morning than in the afternoon. So much so, that those who had surgery in the afternoon had a 50% lower chance of cardiac event than those scheduled for morning surgery.

The implications are profound and could lead to complete rethink of the way in which surgery times are scheduled not just for hearts but in respect of a range of conditions. The second study reinforced the importance of considering the body clock, and indeed the clock on the wall, when it comes to understanding recovery times.

The study reported by the Medical Research Council revealed that wounds received during the day healed 60% faster than those at night.  This apparently is down to ‘actin’, an essential protein which governs the ability of skin cells to migrate into wounds and to start the healing process. Actin is itself governed by the circadian clock, being more active in the day than in the night and therefore more able to in initiate the healing process by day.  Interestingly the study also revealed that in nocturnal mice the process is reversed.

Other studies in the past have cast light on the way in which our body clocks influence mood, concentration and our ability to carry out day-to-day tasks. Whether you are a morning or evening person could profoundly influence the way in which you approach your daily round; with tasks allocated in accordance with your circadian rhythms improving outcomes in areas such as productivity, accuracy and so on.

The more we understand our body clocks, the more we can optimise treatments and increase chances of recovery. Given their individual body clock, should a patient see a physiotherapist in the morning or afternoon, at what time of day would it be best for the individual to exercise in order to promote fitness or healing, and when is the best time to tackle that mountain of paperwork? We may not have all the answers yet, but as more and more studies report their findings it may not be too long before circadian rhythms are seen as an intrinsic part of managing well-being.

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Mental health is everyone’s problem

It scarcely seems a year ago when we were celebrating World Mental Health Day and examining the 2016 theme of psychological first aid. Now we are returning to the subject, looking at this year’s theme of mental health in the workplace.

It’s a fitting topic for this twenty-fifth World Mental Health Day, highlighting the way in which mental health isn’t simply something which is hidden away at home, but travels with people out into the wider world; impacting on workplaces, employee and customer relationships, and the ability of people to perform everyday tasks. Think of mental health in the workplace and stress may come up as a topic but the truth is that just as the nature of work can contribute to a range of physical problems, so too can the nature of work contribute to a number of mental health issues.

Indeed, according to the organisation MHFA England, three out of five employees have experienced mental health issues in the last year because of work. It’s a shame therefore that the same organisation comments that just 24% of line managers have received any form mental health training.

So what’s the solution? NHS employers have put together some guidance which is aimed at helping NHS managers to support workplace mental well-being. The suggested approach is split into two sections, supporting staff who are experiencing mental problems and promoting a healthy approach to work.

The advice is all fairly straightforward and ties in with other best practices such as boosting work culture and improving employee engagement. It talks about promoting work-life balance, giving people control over their workloads and providing resources. As such, although the guidance is targeted towards those working in the health service, it would also be appropriate in other fields. In particular, it would also be appropriate for other health professionals who may be in danger of letting their work overwhelm their mental well-being.

Stress is a very overused word and whilst the connotation is generally negative, stress can in some instances help to push us towards achieving goals which we may not have thought possible. Nevertheless, some forms of stress can be debilitating, leading to problems with sleep, depression and even physical health problems. And stress doesn’t simply arise because of an excessive workload. Worries about finances, uncertainties around patients missing appointments, repetitive tasks which distract from core competencies; all these and more can affect mental well-being.

And the trouble is that when our mental equilibrium is out of balance it is all too easy to be locked in the problem without being able to step back and see the solution. So we brood over fluctuating appointment patterns when we could be opening our business up to online booking or sending out appointment reminders in order to cut down on no-shows. And at the end of a long day, when we should be stepping away and unwinding, the challenge of sending out invoices or dealing with day-to-day paperwork seems overwhelming; so much so that we simply don’t have the mental capacity to look for other solutions such as taking secure card payments at the time of booking or electronically filing patient records.

Mental health issues come in many forms and many guises. Some we have little control over, but there are some which we have it in our power to prevent or mitigate. Technology can help to manage the routine, to remove time pressures and to provide a measure of control over workloads. This World Mental Health Day let’s take time to step back and look and see what we can do to make a difference.

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Suffering from cyber-chondria?

Feeling a bit funny?  Worried about those lumps and bumps?  Got a strange collection of symptoms which don’t seem to add up?  Yes you may need to consult your doctor, but you should also be prepared to be told that you are suffering from a newly identified disease which according to a recent study is costing the NHS at least £420m a year.

The study looked at the causes and effects of cyber-chondria which the researchers say could be the underlying reason for as many as 1 in 5 of hospital outpatient appointments.  As Prof Peter Tyrer, one of the authors of the study, explained “Dr Google is very informative, but he doesn’t put things in the right proportion.”

Cyber-chondria does create a dilemma for the health profession. On the one hand, we are being asked to reduce the burden on the NHS by self-treating minor ailments or consulting local pharmacists in the first instance. On the other hand, a propensity to misdiagnose the causes of symptoms following an internet search could either lead to unnecessary appointments or to patients not presenting at their GP surgery when early treatment for a condition could prevent ongoing problems.

There appears to be no one straightforward answer. And it’s certainly true that when someone presents with a range of symptoms, some may be related to a genuine ongoing illness, whilst others can be laid at the door of health anxiety. Ignore all the symptoms and the chance for early intervention can be missed, treat all symptoms as potentially genuine and hospital referrals increase significantly. So awareness and proportionality, knowing your patient, can play a significant role in sifting illness from the cyber-chondria maze.

That’s not to say that cyber-chondria isn’t an illness in its own right. Indeed the report’s authors suggest that for those suffering from acute forms of health anxiety, some form of psychotherapy may be in order. And as with any other illness; the earlier the treatment, the better the prognosis.

This approach was borne out in another field recently when the results of a back pain pilot were released.  The pilot run by a primary care service in Hertfordshire saw a physiotherapist with spinal expertise triaging and providing advice to patients who self-referred to a clinic.  With further expertise available as a back up and the ability to directly book ongoing treatment the experiment saw 85% of patients discharged after a first appointment.  Moreover, on the spot advice on exercise and rehabilitation meant that only 3.5% of patients needed to be referred to secondary care as opposed to a 12% GP referral rate.

The main message which arises from studies such as these is the importance of early intervention when treatment is required.  In a health system which is seeing an ever increasing demand for its services this isn’t always easy. However, even little tweaks to processes and procedures can make a measurable difference to boosting patient treatment times. Even something as simple as SMS text messaging which reminds patients to attend appointments can not only boost early treatment, it can also ensure that treatment times are fully utilised.

Of course, there are times when the chance for early intervention has been missed and the mantra ‘better late than never’ comes into play. We are indebted to the Jewish Chronicle for highlighting just how effective physiotherapy can be. Four years ago, Ann Rowe was wheelchair bound and dependent on hoisting equipment. Now, thanks to intensive physiotherapy, at the age of 87 she has completed the Parallel London 5k event.

Early treatment, late treatment, ongoing treatment; what this story and others show is that when health professionals are freed from administration and able to do what they do best, providing good and targeted therapies, great things can happen.

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Opening the door to physiotherapy

The government’s announcement that it intends to fund an extra 10,000 training places for nurses, midwives and other health professionals has been welcomed by the Chartered Society of Physiotherapists (CSP). Whilst the exact breakdown between the various disciplines is as yet unclear, any increase in physiotherapy training has to be welcomed.

Despite an increase of 15% in the number of physiotherapists graduating this year, the CSP estimates that the profession requires an additional 500 graduates per year in order to cope with rising demand. Commenting on the announcement Karen Middleton, the CSP’s chief executive, said “This opens the door for more physiotherapists to contribute to patient care in much-needed ways, and to address current workforce shortages.”

The demands which an ever ageing population place on the physiotherapy profession cannot be underestimated. Those who are young and relatively fit may see physiotherapy as purely delivering a one-off series of treatments following a sporting injury or other accident, but in fact the physiotherapy remit is far wider.

The NHS choices website comments that “Physiotherapists consider the body as a whole, rather than just focusing on the individual aspects of an injury or illness.” Approaches highlighted by the website include education and manual therapy, together with advice on movement, tailored exercise and physical activity. This means that at any one time physiotherapists are dealing with a complete mix of complex and routine conditions. For example, the first appointment of the day may require the delivery of some form of manual therapy, manipulating the body in order to ease stiffness following a car accident. The next patient through the door may need advice on simple exercises to ease the pain in arthritic fingers, and so on.

Opportunities available for physiotherapists are wide-ranging. Whilst some will work directly within the National Health Service, others may join private practices or work directly for other bodies such as sports clubs or companies. Whichever pathway they follow, they will generally work alongside other health professionals, looking to deliver a complete service which is designed either to keep people fit and healthy or to return them to full mobility as swiftly as possible following an event.

As with everything in the health profession, time is of the essence. Individuals want to be mobile, and health professionals want to help as many individuals as possible to achieve that aim. That’s why the CSP are looking for increased numbers to join the profession, but it’s also why health professionals themselves are increasingly adopting digital solutions to take care of routine tasks.

Quite frankly, every minute of administration time saved is a minute which can be used in helping to improve people’s lives. As a result systems such as the electronic filing of patient notes, the use of secure email to transfer records, and the maintenance of an electronic diary system are now firmly established in many health practices. Add to that services such as appointment reminders by SMS text or email which are helping to reduce the number of no-shows, and physiotherapy time is increasingly being targeted towards treatment rather than administration.

In 2017 there are 2,136 places for physiotherapy students at universities across the country. With the government initiative opening the door for further increases in years to come it can only be good for the future of physiotherapy and of those who rely on it.

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Paying by card?

£58 billion!

That’s the total spend on all credit and debit cards in the UK in April 2017, the most recent figures available at the time of writing. Credit cards accounted for just short of £17 billion, whilst the debit card spend was boosted by the growing acceptance of contactless payments.

Overall our growing love affair with the card as a form of payment has resulted in a 6.8% year-on-year rise in card spending. Partially thanks to the contactless element, this translates into a 12% increase in transaction numbers.

What does this mean for business? Well for a start it makes it far easier for businesses to move away from cheques and cash and towards card payments. The old arguments about cards and businesses which accept cards being the preserve of the few now simply don’t hold sway. So much so, that this writer was surprised recently to be asked for a cheque in payment. Luckily the request came in advance, saving a round-trip to retrieve the cheque book from its secure drawer.

 Quite simply, card payments are convenient for both customers and businesses. More importantly, they speed up the receipt of funds for the business. Particularly so in businesses which have traditionally relied on the service/ invoice/ cheque payment route. Simply sending out the invoice and waiting for the cheque to arrive in return could easily take up a couple of weeks; and by the time bank clearing has taken place and funds are available for use the original service is a distant memory. Secure card processing generally delivers cleared funds approximately one week after the appointment.

The growing acceptance of cards as a means of payment has also brought further benefits, particularly for those businesses such as health providers which rely on an appointment system. Taking card details at the time of booking, whether on the phone or online, tends to concentrate the mind and that means that clients are far more likely to turn up for their appointments. Particularly so if the health practice operates a ‘no-show fee’ system, charging clients who fail to turn up a percentage of the overall fee.

Adding a further service such as sending out SMS text messaging or email to remind clients of the appointment also helps to ensure that clients either turn up to their appointment or cancel well in advance. It can be all too easy in a busy life to forget the date or time of an appointment so scheduling reminders acts as a handy aid memoire.

When it comes to health services, anything which can boost attendance numbers is welcome. Both in the public and private sectors time is of the essence and resources are stretched. Those who fail to turn up to appointments not only jeopardise their own treatment plan, they also block or delay the chances of treatment for others. So the hidden cost is far higher than simply having a team of health professionals sitting and waiting for a client who has either forgotten or has no intention of turning up.

 

 

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