Atlacare
In one UK study, introducing SMS reminders reduced missed appointments across most age groups but increased them for patients aged 70 and over. In another, phoning elderly patients to reconfirm cut unexpected non-attendance from a potential 21% to 5%, and revealed that 14% of them did not know they had an appointment at all.
Every practice management article recommends SMS reminders. For a caseload whose median age is high, which describes most routine podiatry, that advice may be actively wrong.
What does the evidence actually show?
Two studies, pointing the same direction.
Phone reconfirmation, care of the elderly clinics. At Hammersmith Hospital, baseline non-attendance across care of the elderly clinics ran at 21%. Across seven clinics, 84 patients were telephoned in advance to reconfirm their appointment. Twelve of them, 14%, turned out to be unaware they had an appointment at all. Unexpected non-attendance fell from a potential 21% to 5%.
SMS by age group. A 2015 study at a Manchester practice found that after introducing SMS reminders, non-attendance fell substantially for patients aged 0 to 15 and 30 to 39, but increased for the 70 and over group and for 16 to 29 year olds. The authors concluded that SMS was more effective for patients aged 40 to 70 than for younger patients aged 16 to 29.
A caveat that belongs with the second finding: it is a single-practice conference abstract with a small sample. Treat it as directional rather than definitive. But it points the same way as the first study, and the first study explains why.
Why would a text make things worse?
Because the mechanism it addresses is not the mechanism that causes the problem.
An SMS reminder assumes the patient knows about the appointment and might forget it. The Hammersmith finding suggests that for a meaningful proportion of elderly patients, the appointment was never successfully communicated in the first place. A text cannot remind you of something you never knew.
Add the practical layer. A text arriving on a phone that is kept in a drawer, or is a landline, or belongs to a relative, or has a screen the patient cannot easily read, has not been received in any useful sense. A text that replaces a letter or a call is a service reduction dressed as an efficiency.
What works instead?
Four things, in rough order of return for an older caseload.
A phone call to reconfirm. The intervention with the strongest evidence here, and the one that surfaces the patients who did not know. It costs staff time, and the Hammersmith numbers suggest it pays for itself several times over on a 21% baseline.
Book in the room. The single most reliable appointment is the one made face to face at the end of the previous session, written on a card the patient takes with them. For patients who do not use digital tools, that card may be the only record they have.
Post as well as text. A letter is not obsolete for this group. For a domiciliary round or a care home, a written schedule left with the patient or the home is worth more than any message.
Involve the person who actually organises them. Many elderly patients have a family member or carer who manages appointments. With consent, sending confirmations to that person is more effective than any channel aimed at the patient directly.
Does that mean skip SMS entirely?
No. It means segment.
The general benchmark from the UK Private Practice Barometer 2026 is that clinics running reminders see non-attendance of around 6.3% against 7 to 8% without, so reminders work on average. The point is that an average across all ages conceals a group for whom the default channel underperforms.
A practical segmentation:
| Patient group | Primary reminder |
|---|---|
| Under 70, smartphone user | SMS, with a reschedule link |
| 70 and over | Phone call, or SMS plus a call |
| Care home or domiciliary | Confirm with the home or carer, in writing |
| Anyone who has missed twice | Phone call, every time |
That last row is worth adopting regardless of age. Two missed appointments is a signal, and the cheapest response is to find out why rather than to send a third text.
What about the wording?
Where you do send messages, wording matters more than most people assume. Randomised evidence shows that reminders stating the cost of a missed appointment outperform vague requests to cancel, and that specificity beats general social pressure. Our guide to reducing no-shows covers that evidence in detail, and it applies to letters and phone scripts as much as to texts.
What it is worth
Run the numbers on your own diary rather than on a benchmark.
Take your session fee, your weekly appointments, and your actual non-attendance rate, separating no-shows from cancellations. On a 20-appointment week at £45, moving from 15% to 7% recovers roughly £1,650 a year. That funds a considerable amount of reception time on the phone.
The reason to measure rather than estimate is that most practitioners guess high, because a wasted slot is memorable and a full day is not.
Practical steps
- Measure your actual rate by age band. If your system cannot tell you, that is the first fix
- Introduce phone reconfirmation for over-70s, and measure the change over a quarter
- Book in the room and give a written card
- Record a carer contact, with consent, where one exists
- Escalate to a call after two misses, regardless of age
- Keep SMS for the groups it works for, rather than abandoning it
On the first point, being able to segment attendance by age is the thing that turns this from an opinion into a decision. Atlacare holds appointment status against every booking with patient records alongside, so the analysis is available rather than anecdotal, and recalls let you flag who is due back and why.
The broader lesson generalises past podiatry. The reminder channel that suits your practice is the one that suits your patients, and for an older caseload that is frequently not the one the software industry recommends.
Study findings are cited as published. The age-group SMS finding comes from a single-practice conference abstract with a small sample and should be treated as directional. This is general practice guidance, not clinical advice.
Sources: Hammersmith care of the elderly clinic reconfirmation study · Harman, SMS reminders by age group, 2015 · UK Private Practice Barometer 2026
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