How to use email in General Practice

After Matt Hancock announced that email should be used over faxe and even post for communication with patients, some practices may be struggling to understand how to make these changes. This video post will highlight some of the areas to consider and tips on how to do this. Click on the image to play the video


Set up

  • What system will you use- currently approved are nhs.net and office365. Criteria for other providers can be found here. https://digital.nhs.uk/services/nhsmail/the-secure-email-standard
  • It is worth having a patient facing inbox/address and a practice-based one for different communication routes. Consider different ones for results/ prescribing etc.
  • Suggest a generic email address for each to manage with a clear description as part of the email address ie prescriptionspracticeX@nhs.net or appointmentsSurgeryY@office365.com as examples.
  • Consider who and how often you will  monitor the inboxes
  • Establish as a practice how the additional time needed to run emails will be used, especially if clinically based
  • If this is a system change, make this public. Use waiting room displays, footers on letters, social media platforms and patient participation groups (PPG) to advocate the use. Even consider a link on the prescription counterfoil.
  • Test wording of standard letters to make sure the practice is happy, even agree with indemnity provider or PPG if appropriate.
  • Email communication is part of the clinical record. Look at how this will be stored or transferred. If standard letters are used these may not need adding directly, but a clear system for recording contact like templates or autoconsultations/macros should be used.
  • Consider using mailing list providers to help make this process easier, however, discuss with your local IT department on governance of providers.

Sign up

  • Abide the data protection guidelines like GDPR, collecting information for what you need. Use either sign up sheet or confirmation via sms/email with a link to your rules. Key tip is make this public ie on your website and use the link to share- easy via email, sms or other. Make this the central governance hub for all your documents so you only have to update one place.
  • I would recommend adding a box that the patient agrees to all disclaimers as per below. This should be repeated in the confirmation message.
  • In this sheet/link be clear about how the practice will use the communication ie – sharing results, clinic letters, appointment information etc. If unsure or starting, try areas you are comfortable with and progress from there.
  • Use a template or autoconsultation/ macro to make this process easier for staff to support patients.
  • On sign up, instill a test email or sms is sent at that time to confirm the identity and accuracy of the information given.
  • In this test email or message include a link to whitelisting emails. This is where a user confirms this is an email they want to receive. Include this in the footer of your emails as well which will help to ensure the messages do not end up in the junk folder. The following is an excellent link which shows this information
  • An additional option to help patients is to guide them to use folders to sort their emails from the practice.

Disclaimers:

  • Also include a disclaimer about patients protecting their data once they have received it. A practice is not responsible for onwards use or transmission of email or text message once it has been received by the patient / service user
  • Include also that maintaining the integrity of the contact method ie correct number is the responsibility of the patient.
  • Commercial email providers are not as secure as those systems used in the NHS so include a line about being aware (and accept) that there is a risk (however small) of the email being intercepted or ‘hacked’.  
  • Also include a line about which staff will access this data, ie admin, reception etc. This may help to prevent complaints at a later stage.
  • Recommend that the email or mobile number used is a personal one, not business or family one to support confidentiality. This is still the patient’s choice but an added disclaimer on the above would be prudent.

No-reply inboxes

One concern many clinicians have is being emailed about a critical symptom which may not be picked up till later and a negative impact. This also includes inappropriate clinical contact ie sending a prescription request but also asking a clinical question. One method to tackle this is with an automated no-reply message from the designated inbox.

  • Consider using a name rather than ‘donotreplypracticeX@nhs.net’ This may help engagement ie PracticeXresponse@nhs.net or DrYatPracticeZsays@nhs.net
  • Have a standard automated response. This may need tailoring for time of day. Software exists to support this.
  • Use appropriate wording. Some examples are:
    • Thank you for getting in touch, unfortunately, this email is an automated notification, which is unable to receive replies. We’re happy to help you with any questions or concerns you may have. Please contact us directly at…..
    • If you wish to contact us, please do not reply to this message but instead contact the practice. For services like requesting your medications, booking appointments or viewing your records it may be easier to sign up to online access here. Replies to this message will not be read or responded to.
    • Please do not reply to this message. Replies to this message are sent to an unmonitored mailbox. If you have any questions or health concerns contact the practice at:

Clinical use of emails:

  • As above look at your processes.
  • Remember that email can be effective for service information sharing, review of patients already seen and delivery of resources but may not be effective for new problem consultations.
  • Ensure an auto-response email is sent outlining the timeframe clinical emails will be reviewed in. NHS England recommend 24 hours. I would further clarify this to include a standard working day ie not including weekends or bank holidays.
  • This receipt email should also have a disclaimer about clinical direction ie this service is not regularly monitored. Any urgent health issues contact the practice at: or contact 111 if between these times…..
  • Ensure all reply emails have standard footers with disclaimer information and contact information.

For any comments or feedback contact me directly below or @drgandalf52 or @egplearning.