Messaging best practice

This is for anyone involved in planning or sending patient messages, including product teams, programme leads, operational staff, service managers and content designers.

This page explains:

• when and how to message patients and the public
• the benefits of digital-first channels
• what governance to follow to protect patients and their data
• how to use NHS Notify

This guidance is evidence-based and was developed with clinical safety, governance and delivery teams across NHS England. It combines established NHS standards with user research and aligns with existing policy. It was created to help teams send clear, safe and effective messages to those using NHS services.

Messaging infrastructure varies across the NHS. Some teams send messages directly through the national messaging service NHS Notify, while others use third party messaging providers. However you message patients, you should aim to apply these best practice principles.

Patients are less likely to understand a message if it contains clinical terminology, acronyms, and internal NHS language. 

Duplicate messages, unclear appointment information, inconsistent reminder schedules, and varying options for booking, rescheduling, or cancelling appointments also create confusion. 

These inconsistencies can contribute to poor patient experience, increased Did Not Attend (DNA) rates, and inefficient administrative processes.  

The Writing NHS messages page has additional guidance on tone of voice, formatting and writing for different channels, with examples of NHS App messages, texts, emails and letters. 

Using the right channel to send your message can have a big impact on its effectiveness and patient health outcomes.

It is NHS policy that providers proactively offer NHS App-first communications to patients, whenever possible. Most messaging services allow you to create a routing plan with fallback options to alternative channels such as text message, email or letter.

Check spelling and grammar.

If you can, check new templates or review existing templates before you send them.

Send test messages to yourself or a small group to test comprehension.

When you send your message can impact how quickly the recipient reads or responds to a request.

Some message sending services will only deliver messages between certain hours and days of the week. For example, NHS Notify will send messages to the NHS App at any time, but will only send text messages between 8am and 6pm on weekdays.

Put the needs of the patient first when deciding when to send a message. For example, avoid sending non-urgent messages at weekends, in the evenings or very early in the morning unless there is a clear user need. For urgent or time critical messages, consider whether delaying the message could increase clinical risk. Ensure there is an appropriate escalation or fallback route in place.

Think about what impact your message will have on the person receiving it. Patients are less likely to respond to a message if they are irritated or annoyed by it. Similarly, some may become anxious if they are unable to respond immediately.

When choosing when to send your message consider:

• the impact multiple messages in one delivery or in quick succession could have on the patient

• if you are expecting a response from the patient and within what timeframe

• the time of day you send a message

• type of message you are sending and if it is urgent or non-urgent, expected or unexpected

• time you leave between the initial message and a reminder, so you are not overloading the patient with information

• channel you have chosen to send your message and your fallback strategy, for example App first, then text and then letter

• overlap with other NHS services such as national vaccination campaigns

• patients you cannot message

In the NHS, governance refers to the systems, processes, and leadership structures that ensure health services are safe, effective and accountable. When messaging patients you have a legal obligation to follow specific laws, regulations and policies to protect patient data and ensure their clinical safety.

Before you message patients or service users you should check that you are following your organisation’s local procedures, and ask for help if you are unsure.

The following sections explain more about the teams overseeing governance and patient safety obligations within the NHS.

Not all teams are able to use NHS England’s national messaging service, NHS Notify. Some teams use commercial messaging platforms to communicate directly with patients and service users.

However, it is NHS policy that teams endeavour to use NHS Notify whenever possible.

NHS Notify allows you to:

• tailor your messages to specific groups of patients or service users
• select a channel routing plan that includes NHS App, email, text message and letter
• choose when and how messages are sent
• reduce costs, with competitive rates for SMS and no charge for NHS App messages
• send letters to patients and members of the public in additional languages

During the NHS Notify registration process you will be asked about:

• your organisation or service
• your use case
• any previous messaging experience
• how you want to pay
• how you plan to integrate with the service
• agreeing to NHS Notify’s terms and conditions

Messaging providers often ask organisations to create reusable message templates for different channels and message types. 

This means that over time your template library will grow as new templates are added. If it is not managed properly, it can become difficult to find the right template and increase the risk of sending outdated or incorrect messages. 

How to manage your template library

Before creating a new template, check whether there is already one that can be used or updated. 

 Creating fewer templates makes the library easier to manage. It also means that changes, such as updating a web link or clinic opening times, only need to be made once. 

Use a naming convention and version control

Give templates clear, consistent names so staff can find them easily. 

Use version numbers or dates to show which template is the most recent.

Archive old templates 

Regularly archive templates that are out of date or no longer needed.

Organise templates into folders 

If your system allows it, group related templates into folders. For example, you could have folders for appointments, waiting lists or service updates.

Give ownership to a member of staff 

Assign responsibility for the template library to a named member of staff or team. They can review templates, keep content up to date and make sure standards are followed.

Benefits of a well-managed template library 

A well-managed template library: 

• reduces the risk of outdated or incorrect messages being sent 
• saves time when staff need to find a template 
• makes updates quicker and easier 
• helps keep messages consistent in quality and tone of voice 
• reduces the amount of training staff need to use the system

Changes to templates containing clinical information, instructions or calls to action should be subject to appropriate review and approval before publication.

Find out how to write clear and effective NHS messages.

Those receiving the message should be able to quickly understand who is contacting them and why. Research found that many patients do not recognise NHS organisational structures, trust names, department names, acronyms, or internal service terminology. Using clear, patient-friendly service names helps them identify the right service, trust the message, and take action.  

Use a name patients recognise 

Choose service names based on the words patients use and understand, not the words used internally by staff or systems. Service names should be informed by user research and describe the service in plain language.

Good examples include: 

Health Visiting Service 

School Nursing Service 

Diabetes Clinic 

Children's Speech and Language Therapy 

Community Mental Health Service 

Less effective examples include: 

CYP Community Integrated Care Pathway 

PCN Enhanced Access Service 

Community Health and Care Directorate 

Division of Integrated Children's Services

Keep names short and clear 

Long names make messages harder to understand and take up valuable space in text and NHS App messages. NHS guidance recommends that names are clear, logical, descriptive and concise. Avoid acronyms and abbreviations. 

Use service names, not programme or team names 

Internal team names often have little meaning to patients. For example, use “School Nursing Service” instead of “Public Health Nursing Team”, or “Physiotherapy Service” instead of “MSK Transformation Programme”. 

Some services have official names that must be used in specific contexts. When this happens, consider adding a patient-friendly description. For example “Community Integrated Care Team (your district nursing service)” or “NHS Healthy Child Programme (health visiting and school nursing)”. 

Be consistent 

Patients become confused when the same service is described differently across messages, appointment letters, websites, and the NHS App. 

Create a single agreed service name and use it consistently.

Test names with patients 

Names should be tested with patients and based on evidence, not assumptions. Government and NHS guidance both recommend engaging users and patients to check whether names are clear, understandable, and recogniseable. 

Checklist 

Before sending a message ask: 

• Is this the name patients are most likely to recognise? 
• Have we avoided acronyms and jargon? 
• Is the service name short and clear? 
• Would a patient know who is contacting them? 
• Is the name used consistently across all channels? 
• Have we tested the name with patients or used existing research?

It is important to test your messages before you send them.  

Research has revealed that some messages are poorly formatted or unclear. This can lead to frustration, anxiety and failure to complete a task that could impact their health.   

Follow some basic rules to ensure your messages are read and understood. 

• check spelling and grammar 
• send test messages to yourself or a small group to test message comprehension and how it would look as a text, email or App message 
• review existing templates and make sure they follow guidance on writing NHS messages

In addition, consider the following best practice: 

• make it clear who the message is for, especially if you are writing to someone with a carer 
• check your sender name makes it clear who the message is from and any email subject lines are short and describe the contents of the email or the action required, for example “Your appointment details” or “Booking an NHS blood test” 
• use plain simple English 
• try to only include one action for the recipient to take 
• put all the information the patient needs to complete the task first 
• only include extra information if it helps the recipient complete the task  
• never ask for personal information

Digital-first does not mean digital-only. Teams are encouraged to always consider accessibility and inclusion when communicating with patients.

Your messaging service may allow you to set routing plans. This makes it more likely that messages will reach their intended recipient through a channel they will engage with. For example, patients without the NHS App or an email address can still receive healthcare messages by text message or letter.

Find NHS guidance on creating accessible content for digital services. 

Use this section to help support your decision to follow an NHS App-first approach to your digital messaging strategy.