Messaging best practice

The NHS App has a secure inbox that allows patients to receive messages from health and care services, such as their GP surgery. Using the NHS App to deliver your messages is a convenient and cost-effective way of managing communications between your service or national programme and your users. NHS commissioned services can use NHS App messaging for free. For the channel to be most effective, users need to have push notifications turned on. 

Benefits of NHS App messages:

• free, secure and trusted by patients
• safely link out to documents and letters
• sent using NHS number, ensuring the message reaches the correct person
• can send a variety of message types such as batch invitations, appointment reminders and booking links
• supported by a nation-wide mixed media campaign encouraging patients to download the NHS App and turn on notifications
• track delivery and read status to check if your message has been received

It is important that NHS App users switch on push notifications so that they:

• will be alerted when they receive messages related to their care
• get better health outcomes by accessing messages about their health faster and more securely
• support the NHS by messages going through a cost effective, reliable and secure communications channel

Find out more about notifications and messaging in the NHS App.
 

Text messages, also called SMS messages, are a reliable fallback channel when NHS App messages are not read, for example, when patients do not have the NHS App installed or have not turned on notifications. 

Benefits of text messages include:

• they are cost-effective when compared with sending letters
• widely accepted as an NHS message channel by most patients

However, text messages do have some drawbacks when compared to NHS App messages.

These include:

• lower trust – evidence shows patients are reluctant to click on links in text messages due to phishing concerns
• no read confirmation – unlike NHS App messages, it is not possible to confirm if a text message has been opened or read
• safeguarding – text messages can be read by anyone with access to the recipient’s phone, so should not contain sensitive information
• cost – if a text message is longer than 160 characters (including spaces), it will be charged as more than one message

Find out more about NHS Notify text message pricing.
 

Email is an effective digital channel and is free at the point of use. Some national programmes have found that users prefer email when a message is long, complex or contains sensitive personal information such as test results.

However, there are limitations when using email to contact patients and these should also be considered:

• lower trust – because email is often used for phishing, some users may distrust links or ignore messages
• safeguarding – emails can be read by anyone with access to the recipient’s phone or computer and email account
• unreliable delivery and visibility – emails may be filtered into spam or low-priority folders, or simply not checked regularly, so they may not reach the user at the right time

Letters are a reliable fallback channel and offer several benefits to patients, particularly where digital access is limited. These include:

• accessibility – availability in large print, braille or translations
• sensitivity – some national programmes found users preferred letters when communicating sensitive information such as test results
• clear messaging – some national programmes found letters were better for explaining complex booking or screening procedures

However, letters do have limitations when compared to digital alternatives. These include:

• delivery – letters cannot support time-critical updates as delivery times vary and may be affected by postal delays 
• digital accessibility – letters cannot be used with assistive technology such as screen readers
• connectivity – patients cannot click through to digital services, meaning letters can create extra steps for booking, checking results or updating details
• environmental impact – printing and postage create a significantly higher carbon footprint compared with digital channels
• safeguarding – letters can be read by individuals other than the intended recipient
• cost – printing, postage and administrative handling make letters more expensive than digital channels 

Find out more about NHS Notify letter pricing.
 

Patient health data is protected by law. The law allows confidential patient information to be shared between those providing care to patients, and ensures that patient confidentiality is protected at all times. It protects patient confidentiality when the data about them is used for purposes other than direct care.

NHS England offers information governance (IG) support and guidance to ensure that all messages sent to patients meet NHS service standards. However, it is your responsibility to ensure these standards are met.

If you are unsure you should consult with your Data Protection Officer (DPO), IG team or senior staff before sending any messages. If you use NHS Notify as your messaging service provider, their team will discuss with you the steps to send your first message, including any IG requirements. 

To recap:

• NHS England offers IG advice to message senders
• it is your responsibility to ensure your message content is compliant with NHS governance 
• consult with your DPO, IG team or senior staff before sending any messages
• check your organisation’s local procedures for messaging and ask for help if anything is still unclear
• NHS England has published detailed guidance on messaging patients, security measures and how to practically meet legal requirements for protecting patient data.

Read NHS England’s information governance guidance.

If you do not have someone you can ask about IG requirements for messaging, you can submit a query to NHS England's IG team. Your message will go to a shared mailbox. 

Submit a query to NHS England's IG team.

Clinical Safety Officers (CSOs) ensure that digital systems and services do not introduce avoidable clinical risk. They do this by following NHS safety standards.

These include:

• identifying and assessing clinical risk to patients
• documenting and managing those risks
• providing clinical safety advice
• maintaining assurance documentation such as hazard logs

Messages relating to patient care or clinical information must meet the same safety standards as other parts of the service. If your message includes clinical or personal information, confirm with your Clinical Safety Officer (CSO) that it’s appropriate for the chosen channel and follows your risk-assessment process.

If you use NHS Notify as your messaging service provider, your CSO may need to complete a Supplier Conformance Assessment List (SCAL) as part of the clinical safety and governance checks. 

You should prioritise digital security when messaging patients. If you have your own cyber security team they will be responsible for testing the resilience of your service. If you use NHS Notify as your messaging service provider you should be aware that it is not responsible for approving the content of the messages it sends. 

Every message must have a legal basis to be sent. It is your responsibility to justify that the message is tied to someone’s care or the functioning of the health service. Messages need to balance an individual’s privacy with necessary healthcare communication. If you are unsure about your obligations, you should consult with your legal representative.

Read more about NHS Notify’s acceptable use policy.