Automated Recalls - Getting Started

🙋 Meet the expert

Rey is an Abtrace Expert, with over 10 years' experience as a Practice Manager and Business Manager in primary care. He has run single-site and multi-site practices ranging from 3,000 to 30,000 patients, across both city and rural settings - so he's seen just about every recall challenge a practice can face.

In this guide, Rey answers the questions new Abtrace practices ask most often about getting started with Automated Recalls.

🚀 Where to start

"I've just joined Abtrace — how do I get started?"

Before building anything, think about your priorities. Automated Recalls can be built across:

Long-term conditions
Medications
Vaccinations and screening

💡 Top tip: Decide which of these matters most to your practice right now - trying to build everything at once isn't necessary. Start with your priority area and expand from there.

✅ Your first recall: An easy win

"What's a quick, easy recall I can set up first?"

Rey recommends starting with a vaccination and screening recall, such as cervical screening. It's a good first choice because:

It's simple to configure and get running quickly.
Patients start receiving messages with appointment booking links by email or text - so they get familiar with the Patient Portal early on.
Your practice staff get used to seeing these messages appear on the patient consultation notes, building confidence in the tool before tackling more complex recalls.

🔄 Birth month recall vs. recalling by "Most Overdue"

"I'm currently doing birth month recall and I'm not sure it's working for me — what do you suggest?"

Abtrace supports birth month recall, but you can also recall based on Most Overdue - and Rey recommends considering the move.

Birth month recall is a rigid framework: patients are split into 12 equal cohorts by birth month, purely because it's a simple way to divide up a patient list.
Recalling by Most Overdue lets you manage patient workload more flexibly throughout the year, rather than being tied to a fixed monthly structure.

On QOF timing specifically:

Practices traditionally plan QOF around the full 12-month QOF year, but Rey suggests being more innovative about your internal deadline:

Why complete QOF over 12 months? Why not aim for 9?

If you set your internal target for, say, month 9 instead of month 12, you build in a buffer. When patients DNA or staff go off sick - both of which are inevitable - you're far more likely to still hit the 31st March deadline, because you have time left to bring off-target patients (e.g. those off-target for HbA1c or hypertension) back in for repeat monitoring before the year ends.

💡 Top tip: Setting your target earlier in the year doesn't mean less work, it means a safety net if things overrun.

📈 Benefits of moving away from birth month recall

"What are the benefits of moving away from birth month recall?"

1. You can focus earlier on disengaged patients

If a patient missed their chronic disease review last year, they may miss their review again this year. The earlier you identify this patient group, the earlier you can start re-engaging them. With birth month recall, a disengaged patient isn't called back in until their birth month comes round - if that's December or January, you may only have 3 months left in the QOF year to bring them in before you fall out of the QOF window.

Recalling by Most Overdue instead means you catch disengaged patients in the first few months of the year, giving you up to 9 remaining months to complete their review and bring any off-target indicators (e.g. HbA1c) back into range.

2. You can plan work around your actual capacity

Rather than spreading recalls evenly across 12 months regardless of when your practice actually has capacity, you can time recalls to match your workforce and patient availability, for example:

Inviting asthmatic children in during the school summer holidays, rather than year-round.
Front-loading diabetic reviews (biometrics, foot checks, bloods) so this are completed as early as October/November, so if a patient is off-target for HbA1c, you still have time to up-titrate medication, retest, and bring them into target before the QOF year ends.

Spreading this work evenly across the year, by contrast, leaves no slack to react when patients come back off-target.

3. Newly registered and newly-diagnosed patients are picked up automatically.

Birth month is irrelevant to a Most Overdue recall - a newly registered patient (e.g. transferred GP to GP) or a patient newly coded with a long-term condition will automatically be pulled into the recall as soon as they meet the filter criteria, based on whether they have the condition coded and whether their review is outstanding. There's no need to wait for "their month" or potentially miss them all together.

4. Patients don't need to be told anything.

Patients used to phoning in on their birth month can keep doing so - reception won't turn them away. Meanwhile, a Most Overdue recall will naturally prioritise the most disengaged patients first when it launches, then work chronologically from April through to March, so patients who had their review last March are invited last. Over successive years, this gradually pulls those "end of year" patients earlier and earlier, so the workload stops bunching up at year-end.

💡 Top tip: Run Most Overdue recalls over multiple years - the benefit compounds, as patients who were previously reviewed right at the year-end gradually get pulled earlier each cycle.

🎯 Rey's top tips for getting started

"What are your top tips to get started?"

Rey narrows it down to three things to focus on first:

Capacity planning. How much work needs to be done, when do you want it completed, and what's your staff skill mix to deliver it?
Birth month vs. Most Overdue. Decide which recall approach fits your practice.
Automate with Abtrace. Use automated recalls to cut admin workload and free staff to focus on disengaged patients, while engaged patients self-serve by booking their own appointments.

"What are your top tips for setting up recalls?"

Before planning capacity, fix your register size first:

Start with your coded register (e.g. your asthma register) - but don't stop there. Check your Optimisation view for "hidden" patients who aren't yet coded but meet the criteria.
Example: You might have 100 patients coded for asthma, but another 20 sitting in Optimisation who should also be on that register. If you plan capacity around 100 and miss the extra 20, your capacity planning will fall short all year.
Address coding issues first, then calculate your true register size.

Once your register size is accurate, decide how quickly you want to complete the work, and think about this innovatively rather than defaulting to a flat 12-month spread:

Long-term condition reviews are planned work, so you can concentrate it where you have the most capacity, for example, completing the bulk of LTC reviews over the summer months, when winter pressures haven't yet hit and staffing is stronger.
That frees up the winter months to focus on unplanned, acute work - minor illness and other winter-pressure demand - rather than trying to run planned LTC reviews and winter acute care side by side.

💡 Top tip: Fixing your coded register size before you plan capacity avoids under-resourcing your recall - hidden, uncoded patients in Optimisation can catch you out later in the year.

🩺 Recalling patients with Long-Term Conditions (LTCs)

"I want to recall my long-term condition patients - how do I approach that?"

Start by splitting your chronic disease patients into cohorts by condition. Most practices begin with respiratory patients (Asthma, COPD, or both) - think through the patient pathway for how these patients are typically seen in your practice.

Avoiding message overload for patients with multiple conditions:

If a patient has multiple long-term conditions, don't recall them separately for each one - they'll end up bombarded with multiple invites, which is inconvenient, frustrating, and confusing.

Instead: build recalls around patient cohorts with shared comorbidities, so a patient with (for example) both diabetes and hypertension receives a single, combined recall rather than two separate ones.

🔍 Using Advanced Filters

"I noticed there's an Advanced Filters section - how can I use that?"

Advanced Filters let you build more sophisticated, multi-step searches. Ray's example - a two-stage respiratory pathway:

Stage 1 - Identify and question: Filter for asthma patients who don't have an Asthma Control Test (ACT) score and don't have a condition review on record. Send this group an ACT questionnaire.

Stage 2 - Automate the follow-up: Once the ACT questionnaire response comes back into the clinical record, set up a second automated recall that triggers automatically based on the score - pathwaying each patient to the right kind of appointment:

ACT Score	Suggested pathway
20–25 (well controlled)	Shorter appointment, different clinician, or telephone review
Below 20 (poorly controlled)	Traditional 20-minute face-to-face appointment with a respiratory nurse

💡 Top tip: This kind of chained, score-based recall means patients are only booked into the appointment type they actually need — protecting nurse/clinician time for the patients who need it most.

💡 Top tips recap

Prioritise before you build. Pick one focus area (LTCs, medications, or vaccinations/screening) rather than tackling everything at once.
Start simple. A vaccination/screening recall like cervical screening is a low-risk way to get staff and patients used to the tool.
Move away from rigid birth-month cohorts where it makes sense - Most Overdue recalls give you more flexibility to manage workload across the year, and catch disengaged patients earlier rather than waiting for their birth month to come round.
Build in a buffer for QOF. Target completion before the 12-month deadline so DNAs and staff absence don't put your 31 March target at risk.
Fix your register size before planning capacity. Check Optimisation view for hidden, uncoded patients so you're not under-resourcing your recall from the outset.
Time planned work to your real capacity. Front-load long-term condition reviews into your highest-capacity months (e.g. summer) so winter pressures don't collide with planned recall work.
Group comorbid patients into a single recall rather than recalling each condition separately, to avoid overwhelming patients with messages.
Use Advanced Filters to chain recalls together — e.g. questionnaire first, then an automatic, score-based follow-up recall - to pathway patients into the right appointment automatically.
New and newly-diagnosed patients are picked up automatically under Most Overdue recalls - no need to wait for a birth month or manually add them.

💡 What's next?

Setting Up Automated Recalls (full step-by-step guide) ·

Example Automated Recall Suggestions · Reviewing Recall Analytics