From reactive to proactive - a digital HRT recall system

Hove Medical Centre

Project summary

At Hove Medical Centre, HRT prescribing has grown from 74 patients in 2020 to 360 patients in 2025, almost a fivefold increase. Without proactive review, patients may continue on repeat prescription without any clinical oversight. Contraindications may go undetected, symptoms such as unexpected bleeding may go unreported, and patients on prolonged sequential HRT face an unmonitored risk of endometrial cancer.

In early 2022 a prescription checkpoint was introduced, whereby the prescriptions team sent patients an AccuRx HRT review questionnaire when they requested their medication. This improved review completion rates from a baseline of 41% to 85%. However two weaknesses remained. The system relied on the prescriptions team consistently actioning the check, and by the time a patient requests a prescription they typically have only days of medication remaining, leaving insufficient time to action any clinical changes before they ran out of medication.

In December 2025 a formal audit identified two problems: inconsistent coding was significantly distorting the true level of review completion, and patients were being missed entirely. A more robust system was needed.

The pathway was redesigned with proactive monthly recall as the primary process. A monthly SystmOne population search identifies all patients due their review, and the HRT review questionnaire is sent to all identified patients at once via AccuRx. Returned questionnaires are reviewed clinically and triaged across four pathways, with standardised AccuRx text templates directing patients to the right clinician via direct booking links. An auto-consultation built in SystmOne embeds the Ardens HRT review template, automatically applies the correct HRT review code, and sets a 12 month recall on completion, ensuring the cycle is self-sustaining.

Since the proactive system went live, all recalls for January, February and March 2026 are complete, with every patient reviewed. Of 88 patients reviewed through the proactive questionnaire pathway, 17 required clinical action - 9 needed a prescription change, 4 were referred for genitourinary symptoms, and 4 for investigation of unexpected bleeding. Nearly 1 in 5 patients had a clinical need that would not have been identified without this system. The recall process is managed in approximately 3 hours of pharmacist coordination time per month, at a cost of £1,023 per year - approximately £2.84 per patient - demonstrating that a growing HRT population can be safely managed within existing primary care capacity.