This guidance has been reviewed by the Health and Care Information Governance Panel, including the ICO and NDG.

The panel exists to simplify information governance guidance. Have we done a good job? Let us know at datapolicyhub@nhsx.nhs.uk.

Email and text message communications

Mobiles.jpg

Organisations are increasingly using digital methods, e.g. email and text messages, to communicate with patients/service users. We are supportive of text and emails being used where they can support the delivery of care.



Guidance for patients and service users

Your health and care organisation (e.g. GP, hospital, social care provider) may use email and text messaging to contact you with:

  • Appointment reminders

  • Appointment letters

  • Individual invites to screening, medication reviews, vaccination appointments

  • Test result notifications/advice to call the practice where action is needed

  • Friends and family test surveys

  • Interactive messages with the ability to confirm/cancel appointments.

Some health and care organisations will let you contact them via email and text message for the following:

  • Ordering repeat prescriptions via email/online message

  • Requesting appointments or non-urgent advice

  • Updating them on your health and care.

Your health and care organisation should inform you that they may communicate with you in this way. They should also make you aware that you can choose not to receive emails and text messages from them. If you make this decision it will be noted on your record so other members of staff know how you wish to be contacted. You can change your mind at any time by informing your health and care organisation.

Your health and care organisation should also make information available about how your information is used and how they may contact you. This may be when you register with an organisation e.g. at a new GP practice and should be available online or on notice boards e.g. at your GP practice, clinic or care home.

You may find there are benefits to using email and text messages to communicate with your health and care provider as it:

  • Provides an easy, low cost way for you to contact your health and care provider 

  • Saves you time waiting on the phone to get through e.g. to the GP practice or hospital appointment line

  • Supports people with hearing difficulties and other sensory impairments.


Things to consider

You should consider the following before agreeing to use emails and text messages for communications with your health and care provider.

  • Does anyone else have access to your phone or email and if so, would you be happy for them to see any messages you may receive?

  • Health and care providers use encrypted emails which means that no one can see or tamper with the data while it is being transferred across the network or internet. Your own emails to them may not be encrypted.

  • You are responsible for ensuring you provide the correct email address and mobile number. You must inform your health and care provider of any changes. This will ensure you don’t miss any information and it avoids information going astray should it be sent to the wrong email or phone number.


Be careful of spam texts or emails that might come from people posing as a health or care organisation. Your health and care organisation will always make it clear that the email or text message is from them and will provide information in advance about what you may be texted or emailed about.

If you are unable to receive email/text messages or choose not to, then you can continue to use other communication methods e.g. phone calls.


Guidance for healthcare workers

We are supportive of text and emails being used where they can support the delivery of care. Benefits include:

  • The use of your time is maximised, e.g. reduction in ‘did not attend’ appointments 

  • Patients/service users are sent information quicker i.e. compared to posting letters

  • Admin time is freed up e.g. from making/receiving calls

  • Patients have a better experience e.g. reminders of appointments

  • Helping you meet the Accessible Information Standard by communicating with disabled patients in a way which is accessible to them

  • Cost savings for the NHS

The case studies at the end of the guidance give examples of some of the benefits. There are also many benefits to patients and service users by communicating with them in this way. These are detailed above in the ‘Patients/Service Users - what do you need to know?’ section.  

The following sections provide guidance to support the safe use of emails and text messages to communicate with patients and services users.

Transparency information 

It is important to be clear and upfront with patients/service users about the scope and purpose of the service being offered, how their personal data will be used and accessed and individual rights. Information should be made available explaining to the patient or service user how their information will be used and what information will be texted/emailed (e.g. appointment reminders). It should also be clear that text messages and emails will not be read during non-working hours and therefore should not be used for urgent queries. 

Health and care organisations should make this information readily available to their patients and service users:

  • During the registration process

  • When a mobile phone or email address is recorded/updated

  • Through online applications, e.g. Patient Online

  • During contacts with the patient or service user, either in person or on the phone. This doesn’t need to be with the clinician and could be with reception staff.

  • Through information in a waiting area which highlights the benefits to patients and service users 

Patient preferences

It is important that any preferences are recorded in their record and respected. Patients and service users should be able to change their preferences about how they are contacted at any time. For children and adults lacking in capacity, someone with parental responsibility or who has power of attorney for that person can make this preference on their behalf. (See below for further information on children).

Children

The age at which a child becomes competent to make certain decisions about their health and care and information sharing will vary depending on the child and the particular decision. 

A child with competency and understanding is able to make choices about how health and care providers use their information. As such they should be able to make preferences about who receives emails and messages about their care. 

Confidentiality

It is important to consider the possibility that someone else may read a text message or email that you send to a patient or service user, e.g. a family member accessing their unlocked mobile phone, or the phone being passed on, sold or stolen and ending up in the possession of someone else. With this in mind, consider what information it is appropriate to include and whether clinical information, e.g. test results, should be shared via a portal requiring user verification, such as Patient Online or the NHS App. Only the minimum amount of personal data for the purpose should be communicated via email/text.

Recording information

Emails and text messages in the health and care setting are a professional communication. Any message together with any response received with the time and dates should be noted on the patient/service user record.


Guidance for IG professionals

It is important that organisations can use emails and text messages to support the delivery of care, where appropriate. Below is a series of recommended actions to support this.

  • Have a policy relating to the use of text messages and email to communicate with patients and service users which is regularly reviewed. A template policy is provided should you wish to use it

  • Use an established text message service for communications, rather than a personal phone

  • Undertake a Data Protection Impact Assessment (DPIA) for the email and text message service offered to patients/service users by your health or care organisation. Take reasonable steps to make sure the communication methods used are secure and ensure they are meeting their transparency responsibilities by providing information about how they use the email addresses and mobile telephone numbers

  • Consider how to inform patients/service users that text messaging/email is available e.g. website, notice board, poster

  • Be transparent with patients/service users about how information is being used including:

    1. What information you need about them, e.g. mobile number

    2. For what purpose, e.g. to send appointment reminders

    3. Who the information may be shared with, e.g. it will not be shared

    4. What you will do with the information, e.g. it will be stored on the patient record

    5. Consider how to inform patients and service users that text messaging/email is available. This could be done through posters, noticeboards and websites

    6. How patient/service users can make or change their preferences to be contacted in this way

  • It is appropriate to rely on implied consent for confidentiality purposes when contacting individual patients and service users about their individual care or requesting they complete a friends and family test survey

  • Respect patients’ objections/preferences to receiving communications in this way

  • Have processes in place to remind patients and service users to update their email address and mobile number when needed. Explain to the patient or service user that it is their responsibility to keep and provide an up to date email address and/or mobile phone number, and to be clear that the service is not responsible for onwards use or transmission of email or text message once it has been received by the patient /service user.

Case Studies

Text reminders and digital annual review communications

GP practices in East Lancashire estimate that text reminders have reduced ‘did not attends’ with an annual saving of £767,844. By using SMS, email and voice calls to invite patients for annual reviews, there has been a reduction in postage costs which has resulted in practices saving £813,495. Find out more here.

Digital letters to patients

East Lancashire Hospital Trust has cut the cost of appointment letters by 51 per cent, as part of a trust-wide initiative to drive digital efficiency. The patient portal sends a secure digital invite for the patient to view appointment letters, pre-assessments and supporting information on their smartphone, tablet or desktop. Patients can click to immediately confirm, cancel or rebook their appointment, as well as adding the appointment in their digital calendar, and accessing real-time travel maps. They can also save the letter or print it, and access text-to-speech functionality and 99 language translation options. Read more about this here.

Did Not Attend (DNA)

In January 2019 NHS England reported that more than 15 million general practice appointments were being wasted each year because patients DNA and failed to cancel their appointment. Research has found that these ‘did not attends’ can be reduced by up to 25% by sending text message reminders to patients. Discover more about this here.

Mobiles.jpg