Paper letters have historically been used by health and care to communicate with patients, out of habit and lack of alternatives, but they have many drawbacks. These include:

• millions of pounds are spent on letters every year by the NHS
• risk that the letter will not reach the intended recipient
• they are hard to track and difficult to analyse their effectiveness
• they provide a poor user experience as they are slow to reach the patient, can't link easily to further information and do not have the accessibility options that digital channels have

Other channels have issues around security and the ability to fake messages. During the COVID-19 pandemic, we’ve seen a rapid increase in fraudsters sending fake emails and SMS messages, reducing trust and causing difficulties for users who need to decide which messages to act on.

Opening up messaging within the NHS App to more health and care providers is exciting because it gives users more choice in how they are communicated with. Messages are delivered almost instantaneously and it’s free to senders.

Initial uptake from services who wanted to integrate with the NHS App and use the messaging feature was a challenge because they did not have the staff capacity to complete the development work required for the integration with the NHS App. To overcome this barrier, the feature was developed so a full integration with the app was not required. This made it easier for services to send messages to their users through the NHS App.

After joining the NHS App team in July 2021, specifically on the notification and messaging discovery, I have seen the feature go from strength to strength. We have seen interest grow from large services, especially as the user base has grown and the benefits of notification and messaging has come to fruition for those services.

When it was first possible to download the NHS App, people became used to booking GP appointments and ordering their repeat prescriptions.

Then the COVID-19 pandemic encouraged an uptake of digital services and even more users downloaded the app when the COVID Pass service became available, resulting in 39 times as many users as from before the pandemic hit.

Test and Trace and the COVID-19 vaccination programme have also increased digital uptake, and our research tells us that users now expect to receive digital communications from the services they use, and to use digital channels to manage their health. In user research we conducted with the Digital Transformation of Screening programme, we found that 79% of users were likely or extremely likely to move to a digital communication channel if it was possible.

Messaging services in the app have been used during the pandemic to encourage blood plasma donations and to alert users to new services. Our user research shows that patients trust the app as a channel and act on the messages they receive through it.

When we sent a message encouraging eligible patients to sign up to their personal health care record (Patients Know Best), the sign-up rate for the following 10 days nearly doubled, with an increase of 88% on the 10 day period before the message.

We’re using the notifications and messaging feature to help more services communicate with users.

We can send in-app messages to large numbers of users who have fully proved who they are, using just their NHS number. We can also send a notification to alert users to such messages, provided they have opted in to receive notifications on their device.

Senders can easily integrate NHS App notifications and messaging into their services by using our internet-facing NHS App messaging API. The API conforms to the FHIR global standard for health care data exchange, is RESTful and aligns with FHIR Core. The API is available on the internet and indirectly on the Health and Social Care Network (HSCN).

We can also provide message status analytics and reporting to understand, for example, how many users have opened the message, allowing for back-up messages to be sent by other methods if needed.

The NHS App can currently support the sending of 3.4 million in-app messages and associated push notifications each day, within a 16-hour window.

NHS App messaging is designed for large service teams such as national programmes, Integrated Care Systems (ICS) digital teams and commercial health software providers commissioned by the NHS, who want to communicate with their users quickly and without it being costly.

We can provide information and support for products and services that want to integrate with NHS App messaging.

We provide a specification overview for the API integration and provide information on how to ensure integration meets our standards through Quality Assurance (QA) testing.

For the NHS App API for notifications and messaging we provide technical specifications for the API used which a developer can try out before integrating.

Detailed information about implementing web integration process flow, NHS App Javascript API capability and specific changes such as hiding your headers and footers are also available through the NHS App developer documentation on GitHub.

We’re making this feature available to high volume senders of patient communications across the NHS, in addition to PHR and online consultation providers who are integrating with the NHS App. Explore notifications and messaging on our NHS App web pages for partners and developers, and contact us at [email protected] to discuss your options.