Managing SMS Messaging in General Practice (Reducing Fragment Costs)

Practical guidance for GP practices on managing SMS messaging, reducing fragment costs, and using alternative communication channels without compromising patient care.

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Why this matters

SMS messaging is now a core part of modern general practice, particularly with the move towards digital access, total triage, and online consultation models, as reflected in recent GP contract changes. It supports timely communication, reduces telephone demand, and improves patient access.

However, SMS messages are charged in “fragments” based on message length, and this creates a real cost pressure across systems. Increasingly, practices are being asked to be mindful of their usage and to use the most appropriate communication channel.

SMS should be used appropriately and does not replace clinical judgement about safe communication.

This guidance is intended to help practices use SMS effectively and efficiently, without compromising patient care.

What practices need to know

  • Messages are charged in “fragments” based on character count
  • 160 characters = 1 fragment
  • Longer messages are split into multiple fragments and charged accordingly

Even small increases in message length can significantly increase cost.

  • Messages sent via the NHS App or email are not charged in the same way
  • Many systems will automatically fall back to SMS if other routes fail
  • Many systems default to SMS based on patient preferences, and practices may wish to review and optimise these settings

Using a mix of channels is key to managing usage.

Some systems are introducing:

  • Practice-level SMS fragment allocations
  • Monitoring dashboards and usage reports
  • Support to help practices reduce usage

In some areas, excess usage may be chargeable, although this is not yet consistently applied nationally and the regulatory position remains unclear. Practices should be aware of wider system changes and funding pressures linked to the evolving GP contract arrangements for 2026/27.

SMS is commonly used for:

  • Triage responses
  • Appointment confirmations and reminders
  • Links to online forms or consultations
  • Follow-up communication

Reducing SMS use should not compromise safe or timely patient care.

What practices can do

  • Aim to stay within 160 characters where possible
  • Review templates to remove unnecessary wording
  • Use shorter links where appropriate
  • Use system preview functions to check message length before sending, particularly for batch communications

Reducing a message from 2 fragments to 1 can halve the cost.

  • Ensure preferred contact methods are recorded and accurate
  • Configure systems to prioritise NHS App or email where appropriate
  • Review fallback behaviour (e.g. when SMS is triggered automatically)

Where appropriate:

  • Use NHS App messaging for routine communication
  • Use email where a longer message is needed
  • Reserve SMS for time-sensitive or essential messages
  • Where possible, configure systems so this happens automatically
  • Where two-way messaging is enabled, ensure there is a clear workflow for managing incoming replies

Batch messaging tools can often prioritise email or NHS App before SMS. Practices should always consider whether SMS is the appropriate channel, particularly for urgent or sensitive communication.

  • Keep mobile numbers up to date
  • Remove invalid or unused numbers
  • Encourage patients to provide email addresses

Undelivered messages still contribute to workload and inefficiency.

Messages sent via the NHS App may avoid SMS use entirely or reduce fallback messaging.

  • Limit appointment reminders to one message where possible
  • Avoid sending the same message via multiple channels unless clinically necessary
  • Review automated workflows that generate multiple texts
  • Target communications to relevant patient groups only
  • Use email or NHS App for batch communications where possible
  • Ensure any externally requested campaigns include appropriate funding where required
  • When sending bulk messages, consider staggering where possible and reviewing system limitations around scheduling and visibility
  • Review messaging dashboards where available
  • Understand how many fragments are being used and by whom
  • Identify high-volume workflows or templates
  • Overly long or duplicated messages
  • Defaulting to SMS when another channel would be appropriate
  • Sending blanket messages to entire patient lists unnecessarily
  • Reducing communication in a way that risks patient safety or access

Key principles

  • Use SMS where it adds value, not by default
  • Keep communication clear, concise, and appropriate to the task
  • Make use of alternative channels where suitable
  • Monitor usage, but avoid creating unnecessary administrative burden
  • Ensure cost awareness does not compromise safe patient care

The LMC view

SMS messaging is now an integral part of modern general practice and digital access models. Practices should not feel pressured to reduce communication in a way that risks patient care.

At the same time, given the financial pressures across the system, it is reasonable for practices to take a proportionate and pragmatic approach to managing usage, making best use of available communication channels.