“We have technology that is increasingly capable of addressing real operational pressures. The task now is to translate that potential into practical, scalable change.”
That quote from Dr. Alec Price-Forbes, national chief clinical information officer at NHS England, is unequivocal. The Service is leaving the old stereotype of lacking modern technology behind, embracing the challenge of leveraging it to deliver new levels of productivity and patient care.
This strategy revolves around the NHS App. Many trusts already use digital channels for structured messages such as appointment reminders, but clinically important correspondence often remains dispersed across legacy systems and unstructured formats.
Digital first does not mean digital only. Bringing this content into a consistent, channel-ready workflow will be essential if NHS Notify is to support the full patient journey.
New standards for patient comms
That ambition is now being embedded into the way trusts communicate with patients.
The NHS App is increasingly being positioned as the first point of contact, with NHS Notify providing a route for messages via app, SMS, email and post. This should allow trusts much stronger control over and understanding of their outbound comms, as well as a stronger basis for reducing delay and duplication.
However, it also raises the standard for underlying communications infrastructure across the Service. NHS Notify must be able to identify each piece of correspondence, apply the relevant patient preferences and accessibility requirements, and route it through the most appropriate channel.
In some cases, this is a simple task. Appointment reminders and confirmations are usually generated from predictable data fields, making them relatively straightforward to understand and automate.
But there are many, many types of communications — consultant letters, discharge summaries, care plan updates and so on — that are far less predictable. Not only is the information within much more dependent on wider context, but such documents can also be created in free text, stored in different departmental systems, and/or formatted according to local processes.
The systems that feed NHS Notify can’t simply be left to interpret these sources in a vacuum. Without a way to consistently capture, classify, and prepare them, it’s impossible for the App to fully understand their significance.
Legacy systems create blind spots
The operational consequences are as significant as they are difficult to trace. Apogee’s Time Back, Care Forward research, based on direct FOI data from NHS trusts, found that they recorded around five million missed or unattended appointments over the past 12 months — yet fewer than 5% could confirm whether communication failures had contributed.
Closing that visibility gap requires trusts to look beyond individual channels and examine how communications move across the wider technology estate.
Most organisations are working with a mix of EPRs, departmental applications, patient engagement platforms and legacy document systems. Each produces data in different formats: one communication may arrive through the App, another through a separate patient portal, while a third is printed and posted because the system that generated it cannot connect to the same digital workflow.
These additional routes can create further confusion and inconsistency. It becomes even harder for trusts to maintain a clear view of what has been sent, when it was received and whether further action is needed.
The priority is to connect those sources into a common workflow that can recognise the content, apply the right rules and direct it to the appropriate channel without forcing trusts into wholesale system replacement. It’s this non-negotiable foundation that the success of the NHS App and NHS Notify both rest upon.
Designing NHS communications around patients
Any such workflow must also preserve patient choice. App-first communication needs to account for people who do not use the NHS App, who require accessible formats, or who are better served by SMS, email, or post. For example, 19% of the UK population is aged 65 or older, and so less likely to use a smart phone to access their data.
Patient preferences, consent and delivery status should therefore shape routing from the outset. Trusts need to be allowed to prioritise digital delivery while still being able to move seamlessly to another channel when circumstances demand it.
The practical starting point is a clear audit of how patient correspondence is currently created and delivered. Trusts need to understand which systems generate each communication, where manual intervention occurs, which messages still depend on print, and where accessibility or channel preferences are being lost.
That baseline gives operational and digital teams the evidence to prioritise the highest-friction workflows, measure improvement and build a communications model that can scale across the organisation. From there, trusts can establish a consistent operating model for every communication.
Content should be captured from the originating system, classified according to its purpose and sensitivity, matched against the patient’s preferences and accessibility needs, and then routed through the most suitable channel. Delivery status and any fallback activity should be recorded within the same workflow, giving teams a clearer view of whether information has reached the patient and where intervention may be required.
Making app-first a reality
Making that model work will require shared ownership across clinical, digital, operational and patient-experience teams. Each group influences how communications are created, approved, delivered and acted upon, so progress should be measured against a common set of outcomes.
If those groups can work together, the NHS has an opportunity to turn its app-first ambition into a more coherent communications model across the full patient journey. Success will depend on trusts connecting the systems they already use, bringing structured and unstructured correspondence into the same workflow, and preserving a reliable path across digital and physical channels.
With that foundation in place, NHS Notify can give staff greater visibility, reduce avoidable duplication and help patients receive information in the format that best supports their care. That is the practical, scalable change the Service now needs: every communication reaching the right person, through the right channel, at the right time.
By Mark Statton, Director of Strategy, Public Sector & Industry, Quadient