Salford Royal rolls out Digital Letters with DrDoctor

Learn how together we've rolled out a digital letters solution built to drive patient uptake and reduced printed letters by 67%


reduction in printed
appointment letters


opted to go paperless
for future communications
About Salford Royal

Salford Royal NHS Foundation Trust has formed a new healthcare organisation by combining with Pennine Acute Hospitals NHS Trust. The new organisation, to be called the Northern Care Alliance NHS Group will have 17,000 staff covering Oldham, Bury and Rochdale, Salford and North Manchester.



Annual appointment volume



SRFT is focused on developing new ways of working that will ensure patients receive consistently high standards of care so that patients, no matter where they are treated, will experience a high standard of personalised care. SRFT identified accessible information and digital communication as two key areas to focus on in order to achieve part of this objective, and partnered with DrDoctor and Synertec to implement their Digital Letters solution.

"The combined solution empowers users to communicate with patients faster, through their preferred channels, and in the formats that best suit them."

 Naheed Nazir, Associate Director for Inclusion & Engagement, Northern Care Alliance


  • SRFT’s project with DrDoctor and Synertec is centred on three primary objectives:
  • Reduce print costs: SRFT will reduce print costs by sending digital letters to patient’s through DrDoctor’s secure Patient Portal.
  • Improve patient experience: Provide patients with a range of communication options so they can choose which one is best for them.
  • Improve accessibility: Comply with the legal obligation of NHS England’s Accessible Information Standards.


SRFT adopted DrDoctor’s Scheduling solution in March 2018, enabling patients to book, change and cancel their appointments online or through conversational SMS. Synertec are entering their 10th year working alongside the 5 different hospital sites and 20+ community sites that form The Northern Care Alliance. Accumulatively these sites process over 2.2 million documents annually via Synertec’s Prism software. 

SRFT wanted to leverage existing technologies and operational processes to deliver an organisation wide digital transformation project that would have minimal disruption to the established ways of working. Using SRFT’s existing Prism software, letters addressed to a patient who has elected to go digital can be isolated and transformed along with any additional supporting leaflets into a digital format. This is then seamlessly displayed within a patients DrDoctor record accessible through their smartphone, tablet or computer.

The pilot phase focused on patient outpatient appointment letters for SRFT. In total, these letters account for 33% of the total number of patient letters sent via Prism. DrDoctor and Synertec therefore proposed a solution that would rapidly enable patients to receive their letters digitally from this large area. It would also accommodate the remaining letters from all hospital systems to maximise the potential return on investment and deliver all patient communications in their chosen method consistently.


DrDoctor and Synertec worked with SRFT to improve patient communication through digitising their letters, in line with their digital strategy as a Global Digital Exemplar. The solution needed to also generate realisable financial savings for the Trust.

Using Prism to process and upload letters to DrDoctor’s Patient Portal through a ready-to-go API, together a solution was implemented that:

  • Reduces costs through a reduction in printing physical letters
  • Reduces administration time spent on printing and sending letters
  • Delivers high patient experience by allowing patients to manage their appointments and correspondence in one place
  • Gives patients control over how they would like to be communicated with
  • Can be implemented in two months or less to allow the Trust to start generating realisable savings


The project team piloted the Digital Letters solution in SRFT’s Dermatology clinic. During the pilot phase, 02/05/19 to 09/06/19, 213 letters were uploaded to the DrDoctor patient portal, as demonstrated in Figure 3.

Figure 3. Breakdown of letters activity. Of the 213 letters uploaded to the DrDoctor portal, 124 (58.2%) had the associated patient’s mobile number in the Patient Administration System that DrDoctor could contact via SMS* (compared to the Trust average, this is a low send rate), 82 were viewed via the DrDoctor patient portal and 28 were for patients who opted to go paperless.

By migrating up to 67% of patients to a digital communication method the trust are set to realise a further significant reduction of mail associated costs.

The patient now has a powerful set of communication options at their disposal; they can elect to receive communications digitally in a few quick steps using their smartphone which allows them to receive letters in a matter of hours rather than days. This has enabled patients to manage their upcoming appointments in a much more convenient and robust way.

Patients of SRFT now have the choice to receive their appointment information in an accessible, Easy Read, large font or Braille format via post or the Patient Portal. This ensures SRFT is compliant with AIS.

“I’m most proud of our acheivement to empower patients with letters that can know call ‘my letter’ - they’re no longer reliant on someone else to inform them where and when they need to go”. They’re now in control of their care.”

Naheed Nazir, Associate Director for Inclusion & Engagement, Northern Care Alliance


As part of the planning and implementation of the project, a series of factors need to be considered to ensure the solution being put in place benefits both SRFT and their patients.

SRFT wanted to ensure that there was zero risk of a communication not being read by the patient. To guarantee this, we applied a decision to print date for all letters uploaded to the portal. Each digital appointment letter will automatically revert to a posted letter after a defined number of days of upload. Additionally, if the appointment falls within a defined proximity to the current date, the letter will be posted. SRFT can configure these settings on a clinic-by-clinic basis.

It was agreed that Prism would exclude Braille correspondence from routing digitally and instead send via the post. However, EasyRead and Large Font versions of letter would route to DrDoctor’s Patient Portal. This ensured that patients recieved their letters in an accessible format, whether printed or digital.

The project team quickly identified exceptions which includes National Screening services, patients at risk, HMP or Armed Forces to ensure they continue to receive print letters and not invited to receive digitally. 

SRFT had a choice of two print models to consider when implementing the joint solution. Namely ‘Print by Default’ and ‘Digital by Default’. Both have been outlined below:

Print by Default

Under a Print by Default model, patients are required to opt into paperless correspondence and read their letter for the paper copy not to be printed. In this case, 22.6% of paper letters would have been averted.

Digital by Default

Under a Digital by Default model, patients would not be sent a physical copy if they view the letter online and do not explicitly request for a paper copy. In this case, 66.1% of postage would have been averted. This small-scale example demonstrates how a Trust can achieve three times more savings through reducing printing without having to incorporate unnecessary risk into the process.

Next steps

Looking forward, DrDoctor and Synertec are working with SRFT to roll out Digital Letters trust-wide in order to maximise savings throughout the Trust.

Specialties where Synertec are not fully rolled out will be prioritised, and once set up, DrDoctor’s Scheduling solution will be phased in to ensure the combined service is improving patient experience and staff are happy using the system.

“This project has been an instrumental part of ensuring we’re providing patients with their appointment information in a timely manner, and in the formats that best suit them."

Paul Moore, Group Digital Programme Lead