The DTOS Primary Care Digital Support Hub collaborated with GP Practices, PCNs and NENC ICB to develop a suite of SMS (short message service) best practice tools, guidance documents, short videos and checklists to support the optimisation of SMS messaging and reduce costs to the NHS. The project has helped GP Practices and PCNs access and utilise a wide number of digital tools and techniques to increase their free of charge messages through the NHS App and email, reduce waste and their monthly messaging costs.
The challenge
SMS is a convenient, quick, and effective way for GP Practices to communicate with their patients. Practices can save significant time by reducing the number of phone calls they make and save money by reducing postage and printing costs.
Although NENC ICB meet the cost of practice SMS activity, they do not receive a national allocation to support SMS usage. The 2024/25 cost to NENC ICB was circa £2 million across North East and North Cumbria ICB area, which
is financially unsustainable and unaffordable.
The DTOS Project Team were asked to support GP practices and PCNs by developing SMS best practice guidance and help enable practices to adopt better ways of working i.e. the use of free digital channels. A good example of this is the messaging capability of the NHS App.
The solution
Resources – An SMS GP TeamNet page was developed which contained the approved SMS best practice guidance, checklists, and fragment efficiency tools to help practices use SMS more efficiently and reduce monthly costs.
Data insight – Monthly SMS usage reports, including spend, fragment lengths, NHS App data and free messaging were created by the NECS Applications Team and shared with all GP Practices, PCNs and Local Delivery Teams. This helped practices and PCNs monitor the impact of any changes made and identify areas where best practice could be shared across areas.
Support – 1:1 support was also provided to GP Practices with higher usage costs per 1000 patients and bespoke action plans were created based on SMS data usage reports and messaging activity. Webinars were hosted and led by the NECS Project Team to provide an overview of how SMS best practice could be applied together with separate supplier webinars. A Primary Care Digital Support hub generic inbox was created for any ad hoc SMS queries or support requests following receipt of the monthly usage reports.
The results
- All 335 GP practices within NENC ICB have been provided with SMS monthly usage reports, access to support and invited to webinar sessions. There have been 183 practices directly supported to date, resulting in the number of practices spending > £60 per 1000 patients per month reducing by 51% across NENC ICB.
- The percentage of patients across the ICB who downloaded the NHS App and enabled notifications rose by 33%, leading to a significant increase in free messages sent through the app. Between April and December 2025, 2,506,315 messages were sent – an 85% year-on-year increase – saving the NHS around £160,000.
- The percentage of patients with the NHS App downloaded across NENC ICB has increased to 53% as at December 2025, with the highest practice at 69%.
- The project also supports the wider NHS ambition to increase patient engagement through the NHS App and reduce reliance on paid communication channels.
West Quay Medical Practice were able to make the following reductions and savings by application of SMS best practice:
- Cost per 1000 patients per month – Cost reduction of 62% per 1000 patients per month saving £2358.54 compared to same period last year
- Average Fragment length – 9.3% reduction in average fragment length resulting in a lower cost per message
- % NHS App Free of Charge Messages sent – 101% increase resulting in 7513 free of charge messages successfully sent through the NHS App
- % of Patients with NHS App and Notifications enabled – 31% increase in the number of patients with the ability to receive free of charge messages, which is now above the NENC ICB average
West Quay Medical Practice were one of the higher usage practices supported. Their feedback following the NECS support received is outlined below:
“When we first saw our SMS figures and fragment usage, the whole Practice was taken aback. We assumed the review process would be lengthy and complex, involving every template and the whole team. In reality, once we approached it together, it was far more achievable than expected.
In team meetings, we encouraged staff to keep messages concise and avoid unnecessary padding. Many were initially worried that shorter messages might sound abrupt, but we quickly found that clear, factual communication actually saved time and still felt professional.
The Practice Management Team divided the templates between us and streamlined the content. Removing unnecessary characters and spacing alone made a big difference. Each of us spent about an hour reviewing our templates, and this significantly reduced fragment usage. We also looked at how we share general practice information such as staff changes, clinic availability, and patient resources and agreed to strengthen our website FAQs so we could send shorter texts with links to our practice website with more detailed information. And for those messages with length links, we began using on Online URL shortener to reduce the links which impacted the character/fragment count. We’ve also introduced a Facebook page for quick updates to patients too.
During our review, we also discovered that our system was sending two appointment reminders (seven days and 24 hours before). We have now reduced this to a single reminder at 24 hours to reduce the overall number of messages sent by the Practice.
One of our biggest tools was the inclusion of our Admin Team. With their support, we began to ensure mobile numbers were verified, consent was recorded and patients were reminded to enable notifications on their NHS app.”