Summary

600 million... it is a massive amount.   

Yet this is the number of patient contacts that NHS England (NHSE) recorded with GPs, community clinics, hospitals, NHS 111 and ambulance services across 2023-24 – the equivalent of 1.7 million interactions with patients every day.  

On top of engagement around appointments, much of this communication involves calling patients for health screenings, vaccinations or healthcare referrals.   

But the rising costs associated with patient messaging – particularly the distribution of physical letters – is unsustainable.   

To mitigate this, NHSE actively sought to create a service that would simplify message delivery and reduce costs but could also provide a fast and reliable patient communications method that could be easily extended as the need arose – for example around urgent vaccination programmes.   

What resulted was NHS Notify – a platform which has unified patient messaging and allowed a broad range of NHSE organisations and services to easily adopt the same process using a single integration.   

Wayne Shirt, Programme Manager at NHS England said, “At the height of the pandemic, we saw how agile the NHS could be when launching a new communication channel at pace. This inspired the concept of the NHS Notify programme.”  

By enabling a more effective communication process, to date over 257 million patient messages have been processed from various services using NHS Notify including 88 million to the NHS App, 87 million via SMS messages, 59 million emails, and 22 million letters.   


Challenge

Every NHS organisation operates with its own integrations, commercial strategies and communications methods, often resulting in patients not receiving information in the right way at the right time. Missing or incorrect mobile phone numbers result in around 20% of messages being undeliverable in some cases.   

The sheer number of methods for communication used means that NHSE hasn't gained value for money on its messaging investments. It has also resulted in inconsistencies in connecting with patients, leading to an increasing number of complaints.    

A survey and report “I love the NHS, but ..."  found that communication was the second largest driver of complaints across the NHS, with 55% of people experiencing poor communication from the health service in the past five years.  

 

Solution

NHSE, BJSS and Hippo (BJSS’ digital partner) formed a specialist team across strategy, customer experience, product design, and engineering. From this, NHS Notify was conceived as a scalable and reusable service with an Application Programming Interface (API), which would streamline the distribution of NHS App messages, emails, texts, and letters to patients and the public, enabling adoption across all NHSE organisations. 

Data quality  

BJSS established data guardrails to ensure message consistency. NHS strategy mandates that only data from its Personal Demographics Service (PDS) – the national electronic database of NHS patient demographic data – should feed into the messaging platform as the single source of truth.  

BJSS worked with colleagues in the NHS PDS team to increase data quality by analysing failed communications with a view to resolving these; for example, amongst other aspects, it corrected email addresses that had been mistyped such as hotmil.com and updated it to hotmail.com  

Scaling in the cloud  

A key requirement of the NHS Notify platform was that it must be able to scale to meet the combined messaging needs of the NHS across its many services and trusts.  

BJSS built a unified messaging system on an Amazon Web Services (AWS) platform, utilising services like Lambda, SQS, DynamoDB, S3, and others. These were selected for their scalability, ability to meet NHS delivery needs, and ease of maintenance for future adopters.   

The AWS solution also addressed cost and consistency goals while providing users with detailed performance insights, including message volumes per channel and the shift from physical to digital communication.   

Additionally, BJSS integrated with NHS England’s Apigee API Management tool, creating an internet-facing API which allows integrators like the national vaccination and screening programmes, e-Referral Service, external GP Suppliers, and more the ability to send messages through NHS App, SMS, Email and Letter formats to recipients. To do this, BJSS worked closely with NHSE’s API Management team, and the API was deployed to production and completed both the Discovery and Alpha Phases in just two months.   

This provided a public-facing sandbox and integration test environment for future partners to onboard to the service. Subsequently the API was deployed to production and now supports several live national services. 

Accessible messaging  

The success of the messaging platform wasn’t just assessed on its technical prowess though, the format of messages was an important marker for success.   

BJSS and Hippo worked together to ensure the solution was accessible by embedding features such as compatibility with screen readers, large print, braille, and translation of messages into 28 languages.   

Outcome

In the 18 months since it launched, NHS Notify is already seeing incredible results.   

Initially engaged in January 2023, the first service to use NHS Notify started six months later in July 2023 supporting GP registrations. There quickly followed a succession of other programmes going live using the product including the Autumn/Winter Flu and Covid Vaccination Programme in late 2023, NHS e-Referral Service in April 2024 and the National Breast Screening Programme in December 2024.   

12 further programmes are set to go live in early 2025, with an additional 80 programmes identified to be added in the coming years.    

Streamlining communications  

Those using the service can now send messages to different audiences in bulk or individually, write messages by creating reusable message templates, plan messages to be sent using multiple channels in a specific order, as well as prevent sending messages to people who cannot be contacted and reach recipients with additional needs.   

Many organisations using the service have seen increased engagement. For example, for the MMR vaccination programme – which issued messages through the NHS App for the first time – saw vaccination rates increase from the same period in 2023. Additionally, NHS Notify also helped over 4 million people receive the Covid booster in just 10 weeks.  

Reducing messaging costs  

NHSE is on track to achieve millions of pounds in cost reductions, all through enabling digital-first communications and lowering the cost of sending messages. This has primarily been as a result on reducing the volume of physical letters and failed communication attempts.   

Boosting sustainability  

NHS Notify has delivered significant carbon savings, supporting NHS organisations to meet Carbon Reduction Plan obligations. These savings equate to over 300 tonnes of reduced tCO2e – the equivalent to approximately 11 double-crewed ambulances staffed full time, 24/7, 365 days of the year.  

Maintaining impact and improving inclusivity  

The platform has dramatically improved both staff experience and patient outcomes. Streamlined communication processes freed staff from administrative tasks, allowing them to dedicate more time to direct patient care – boosting job satisfaction and efficiency. Meanwhile, standardised communication ensures patients receive timely and accurate information. Furthermore, 9,261 people have received vital health information in their preferred format including braille when requested.   

Wayne Shirt added, "NHS Notify has revolutionised patient engagement by demonstrating how teamwork and innovation can solve challenges. BJSS was instrumental in achieving these rapid results by delivering a solution that simplified and reduced communication costs all while improving accessibility for all. This translates to better patient outcomes and smarter resource utilisation, ushering in a new era for patient communication in the NHS."