University of Nottingham

Hybrid Mail University Case Study

UK Trial Manager at University of Nottingham uses hybrid mail to attract trial participants by driving patient engagement with print and post.

University of Nottingham run a series of trials to help future proof the medical industry and find preventions for chronic diseases and illnesses. To do this, they rely on GP practice and patient participation to run the trial and gather results, which all starts with effective communication.

Case Study CFH Nottingham University
Icon Carbon Footprint
25,000 patients required
Icon Our Promise
250,000 patients engaged
Icon Time Saving
2-3 year trial period
Icon Medical Practices
14,000 medical practices
Icon Revenue
Saving the NHS money
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Trusted and secure
Icon Experience
Expert support
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CFH Docmail

The brief

The latest study the university is conducting is the ATTACK study, which looks at whether we should prescribe aspirin to prevent heart attacks and strokes in patients with chronic kidney disease. The study is looking at the risks and benefits of using aspirin in this patient group.

For the ATTACK study to be successful they require the participation of over 25,000 patients in order to deliver broad and effective results. With a 10-15% uptake in medical trial participation, this requires the study to communicate with 250,000 patients.


The recruitment for a trial this size typically takes 2-3 years, however, due to COVID-19 the trial recruitment stage was paused and likely to be extended by 2 further years. The trial will eventually end in 2025.

Case Study Logo Nottingham University Right

The solution

The UK Trial Manager from University of Nottingham is responsible for ensuring that the trials are run successfully using providers they can trust. This has led to a partnership with CFH Docmail, for over 10 years, spanning multiple trials, to deliver postal communications to drive patient participation.

“It’s hard to imagine not using Docmail now because it brings efficiencies to the trials”

The partnership began through a recommendation by CRN Eastern, who recognised Docmail, the hybrid mail tool of CFH Docmail, as a repeatable, trusted, secure supplier to the health industry. The partnership has since grown from strength to strength, with Docmail being utilised for all medical trials organised by the team, including the ATTACK study.

"Docmail is very simple, very reliable and very trustworthy"

Business Communications

The process

When running these trials, the first step is to recruit GP practices and then use the practices to connect with eligible patients to encourage participation. As the trial is unable to access patient data directly this is the only way to recruit patients for involvement and this all starts with communication. There would simply be no patients to participate without communication, which is usually done by post.

Traditionally, before using Docmail, the mailing process would be completed manually, requiring trial managers to print and then hand deliver all of the materials required for practices to communicate with patients. This process also meant practices would have to ensure the correct versions of communications were being used, which is very difficult when communicating with up to 14,000 practices. This was a time consuming and costly exercise and was not a viable solution for trials which are run on government funded budgets. Using Docmail removes this process and enables the University to securely and efficiently manage its mailings and be sure that the right letters are being sent.

When setting up a study on Docmail, the University first have to create their documents which require approval from an ethics committee and regulatory authorities, to ensure the documentation is relevant, easy to understand and complies with legislation.

Once everything is approved, the documents are sent to the study’s IT company who then turns the documents into viable mailpacks and add the mailpacks to Docmail via the secure API connection. This method ensures that only the correct mailpacks are available within the Docmail system at any one time, removing room for error.

After this GP practices can go into Docmail choose the relevant mail pack and then securely upload their patient data to the account. The data cannot be viewed by the study team or any other practices. The orders are then submitted, where the cost of the mailing is then absorbed by the study.

The Docmail team are always on hand to provide support, mailing assistance or answer any questions for both the medical practices involved and the study team itself. The study team is provided with additional support in the form of a dedicated account manager, Shanie Skelton, who is always on hand to offer direct support or assistance, providing instant replies to any questions or queries.

This long-standing relationship means that the study team have no worries when it comes to Docmail, because they can be sure support will always be there when they need it.

Using Docmail provides the university with a seamless process that offers less room for error. It allows the University trial team to have complete control over what is being sent and ensures that the right letter is going to the right person at the right time.

The results

Initially, the solution was adopted for cost saving purposes. However, Jennifer recognizes the solution as a money saving tool and much more. The system saves the NHS money all around, with the reduction of resources required to communicate effectively and generating patient participation in trials that are aimed at preventing diseases and illnesses.

Docmail provides the study with a trusted, secure way of encouraging patient participation by driving patient engagement in a way that matters through communication that delivers responses. The method minimizes room for error, provides a way of tracking communications and managing budgets by providing accountability for all mailings sent.

The solution continues to meet the studies changing requirements allowing the team to include additional elements into their postal mailings including QR codes, return envelopes and additional information, whilst remaining a quick and easy processes for the clinical trials to adopt.

Furthermore, the use of Docmail directly helps the study recruit practices to take part in the study, through the market presence the solution has within the health market. It is a recognised provider of communications and evokes familiarity with those the study communicates with. In addition, the solution provides impressive time savings for practices, that influence their participation in the study. This enables effective communication to be sent and patients to be recruited, helping the trials run effectively and deliver the results required.

Jennifer and her team have since recommend Docmail both personally and professionally to colleagues and friends, through their long standing partnership.

By working together CFH Docmail and University of Nottingham are able to successfully deliver patient communications, which are the cornerstone of the trial rollout, to help the studies run effective campaigns, drive patient engagement and deliver positive results for the medical community.

“Having worked with Docmail for many years now, I cannot recommend their services highly enough. They enable effective communications with tens of thousands of patients at a cost-effective price, within a secure environment which is trusted by our NHS partners. We cannot imagine running trials without them: in terms of document management, version control, mailing tracking and efficient processing, working with Docmail means our trials can run so much better than they could previously.”


UK Trial Manager,
University of Nottingham

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