Population Call and Recall

Overview of the programme

‘Call and recall’ is a method we use to increase the participation of patients in different areas of their healthcare. We contact patients in north Southwark on behalf of their GP practice to invite them to take part in health and wellbeing surveys, have an NHS Health Check with a GP and direct them to clinics for certain health conditions such as latent tuberculosis (latent TB) or Hepatitis C.

Purpose of programme

The purpose of call and recall is to:

  • To improve the health and wellbeing of our local population by engaging with patients to improve the uptake of services
  • Support GP practices to meet their targets
  • Target patients at a population level to develop a systematic call and recall process across multiple organisations
  • Facilitate joint-work working alongside and across partner organisations

What have we done so far?

Call and recall delivered for the following priorities:

MMR 2nd dose vaccinations

We are inviting parents/carers to book their child’s 2nd dose of MMR vaccine. In Southwark it is encouraged that all children have this by the time they are two years old to help keep everyone healthy and safe as possible from potential measles outbreaks.

Polio vaccinations

We are currently inviting young people for Polio vaccinations.

Children and Young People’s Health – Partnership (CYPHP)

CYPHP is working in Southwark and Lambeth to develop a cross-organisational, system-wide, transformative, and academically rigorous approach to improving child health services. Their model of care is designed to deliver significantly better healthcare outcomes, and better value for children and young people.

QHS has supported CYPHP to reinvigorate a project aimed to contact families across north Southwark who have children with asthma, eczema and constipation to invite them to take part in a survey. QHS worked in collaboration with CYPHP and our GP practices to create lists from EMIS of children with the relevant conditions. We launched an SMS text and mail campaign inviting families to take part in the CYPHP survey.

The initial response to the pilot successfully generated a 10% response rate and the methods and learning was shared with federations in the south of Southwark and across Lambeth

National Diabetes Prevention Programme (DPP) & Walking Away from Diabetes (WAFD)

QHS are involved in call and recall work for the NHS Diabetes Prevention Programme (DPP) and Walking away from Diabetes (WAFD) scheme, inviting high-risk patients with pre-diabetes to attend a behaviour change programme.

Southwark CCG is the lead organisation for the national programme in south London.

QHS is supporting this program by identifying north Southwark patients who are pre-diabetic to be contacted on a monthly schedule throughout the year.

Self Management UK

Self Management UK are the Southwark CCG commissioned charity for providing educational courses aimed at helping patients with long term health conditions to better understand and manage their condition.

QHS is supporting our GP member practices by identifying patients with long term conditions who would benefit from the courses being offered, whether they be generic or condition specific, contacting them with an SMS text and a letter detailing the benefits of the program, the location and date of the next course starting locally to them, and how they can book a place.

For more information visit Self-Management UK’s website.

NHS Health Checks

QHS offer this recall service on behalf of our GP member practices, sending regularly scheduled text messages to eligible patients directing them either to their registered GP or to our EPCS service for an appointment.

The NHS Health Check is a free health check-up helping to prevent the onset of diabetes, heart disease, kidney disease, stroke and certain types of dementia.

Patients can also complete a short version of the health check at the Southwark Digital NHS Health Check website.

Latent Tuberculosis (TB)

QHS are conducting a recall to screen patients in north Southwark identified by Public Health England who may have Latent Tuberculosis (TB). We will be working with each of our member GP practices in north Southwark to identify these patients and offer them a  simple blood test which can be done either at local hospital clinics. Please read further details for screening including accessing blood tests and people at risk of TB.

Transform diabetes study

In 2022 QHS supported a recall and referral process for this study on behalf of all practices. The Transform study, delivered by Oviva, is aimed to understand the acceptability and impact of dietary interventions in diverse populations with high levels of deprivation, seeking to provide a unique opportunity for both GP practices and their patients with a focus on patients who are generally hard to reach with interventions of this kind. 120 patients for one-to-one and group-based coaching were successfully recruited.

What are our plans for the future?

Future call and recall activity will align with the priorities of the North Southwark Primary Care Network.

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