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  Text message communication in general practice policy

Text messages are a low-cost and low-effort way for GPs to keep patients updated, particularly for large-scale communications such as flu jab reminders.

Patients may prefer to be contacted in this way, and they may be more likely to read a text message than an email - and less likely to miss their appointment with a text reminder.

However, when communicating with patients via text message, bear in mind that a simple oversight could risk breaching confidentiality or data protection law.

What constitutes text messaging?

Text messaging' covers a variety of systems and apps, including SMS, Whatsapp, Facebook Messenger and related formats.

All of these are covered by the Data Protection Act and the General Data Protection Regulation (GDPR), and overseen by the Information Commissioner.

Legal basis

The Information Commissioner's Office (ICO) defines a data controller as "a person who (either alone or jointly or in common with other persons) determines the purposes for which and the manner in which any personal data are, or are to be processed."

The data controller, for example a GP practice, is responsible for ensuring that patients' personal information is used appropriately. The General Data Protection Regulation (GDPR) says you must have a lawful basis to use personal information to send messages via text.

Contacting patients by texting their mobile number in order to provide direct care is certainly convenient and can be permitted under data protection law. However, there must be 'fair processing' to support this. This means patients should understand why they may be contacted, and how they may be contacted. They should also be given the opportunity to participate or opt out of this method of contact.

GMC advice

The GMC expects doctors, wherever possible, to communicate with patients in a format that suits them and acknowledges that most communication methods pose some risk of interception.( See *1.132  1.133)  The GMC recognises text messaging is convenient and can be effective, but warns doctors to take reasonable steps to make sure whichever communication they use is secure.

1. *Communicating with patients

132

Wherever possible, you should communicate with patients in a format that suits them. For example, electronic communications – such as email or text messaging – can be convenient and can support effective communication between doctors and patients, with appropriate safeguards.⁵⁵ 

133

Most communication methods pose some risk of interception – for example, messages left on answering machines can be heard by others and emails can be insecure. You should take reasonable steps to make sure the communication methods you use are secure.

Patient permissions

Make sure patients know what kind of information they can expect to receive (for example, appointment confirmations, repeat prescription reminders, communicating investigation results or other clinical matters). You can only send them information which they expect to receive and which they have agreed to be sent. For example, a patient may agree to receive appointment reminders via text, but they may not wish to be sent test results via text.

Providing the practice with a mobile phone number is not deemed consent for this purpose; a patient will have had to actively agree to receive texts, with this clearly documented in their records.

It is unlikely a patient will be able to pre-emptively agree to all of the possible investigation results or other clinical matters, which may need to be discussed with them at any particular point, prior to the particular investigation or clinical matter actually arising. For this reason, specific consent may need to be sought for each contact. In many cases, it will be better to communicate this information face to face, during a phone call or 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 a text.

• Patients should be able to opt out of receiving texts at any time.

Confidentiality concerns

Keep in mind the potential pitfalls of communicating via text message - for example, a family member accessing the patient's unlocked mobile phone, or the phone being passed on, sold or stolen and ending up in the possession of someone else.

Stress the importance of the patient keeping you updated of any changes to their contact details.

Some patients may have their phone linked to other devices, such as their tablets. When structuring your text message, keep in mind that it could pop up as a notification on another device.

Children

A Gillick-competent child may wish to have some aspects of their care managed confidentially, but might want their parents to be involved in certain communications about their health.

Take care to update the contact details of all competent young patients so their parent or guardian doesn't receive confidential information, if parental contact numbers are also stored in the child's records.

Professionalism

Text messages are considered professional communications and should be noted on the patient's record, as well as any responses received and the time and date.

Use similar terms to those you would use in emails or letters. Avoid abbreviations or 'text speak'.

It's useful to have a system in place for reviewing and approving standard messages. If you're unsure whether a more complicated message may cause a misunderstanding, run it by a colleague before you send it.

Use an established clinical text message service for your communications, rather than a personal phone.

Make clear to patients if the text service is 'non-reply'; and what other channels are available to them for clinical enquiries or conversations.

Information sourced from https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/confidentiality/managing-and-protecting-personal-information#paragraph-132

Created 16.06.2021 JB