For the NHS App Messaging Service in England, “delivered” means a message reached the inbox, “notified” records a push notification successfully sent to the device, and “read” means the message was first opened. These receipts do not establish comprehension or action. NHS receipt definitions
The app also presents several messaging services. GP-system messages, online consultations, personal health record services and the NHS App Messaging Service have different arrangements. Some messages allow replies; access through the app does not establish a universal two-way conversation. NHS messaging privacy notice
What the message receipts establish
NHS England’s integrating-partner guidance defines these receipts for the NHS App Messaging Service. They are technical events; an interface may not display all of them to staff. Receipt definitions
| Receipt | What the guidance records | Limit of that evidence |
|---|---|---|
| Rejected | The send request was rejected | The app message has not succeeded |
| Delivered | The message was added to the inbox | No proof of notification or reading |
| Notified | A push notification was successfully sent to the device | No proof the person noticed it or acted |
| Unnotified | The push-notification attempt was unsuccessful | No evidence that another channel succeeded |
| Read | The message was opened for the first time | No proof of comprehension, reply or task completion |
These definitions describe different events. A supplier interface’s “sent” or “delivered” label does not by itself establish that the person read the message.
NHS App notifications depend on device settings
NHS help directs users through Profile → Notifications → device settings. Changes can take up to 24 hours, and permission is needed on each device. Using NHS App services through the website does not provide native app notifications; Android private-space installation and hiding the app on iOS are also listed exceptions. On shared devices, another person may see a notification. Managing notifications
For staff, that separates access to an inbox from the alert intended to prompt a visit. An account holder’s ability to log in does not by itself establish that push notifications reach them.
Fallback rules differ by supplier and message type
The examples below compare published product guidance checked on 8 October 2026. They do not verify any practice’s configuration or describe every NHS messaging supplier.
| Published service or feature | Stated trigger and timing | Boundary to preserve |
|---|---|---|
| Accurx Desktop individual messages | SMS fallback when unread after the workspace-selected 15, 30, 45 or 60 minutes; also when push notification cannot be delivered | Administrator-selectable timing is documented for the individual-message feature |
| PATCHS individual outbound messages | Fallback if no delivery receipt arrives within 4 hours | Its page does not define the underlying receipt status |
| PATCHS bulk messages | Fallback if no delivery receipt arrives within 24 hours | This is a different timer from individual messages |
| PATCHS appointment reminders and post-appointment messages | The page describes a 4-hour no-delivery-receipt rule | These types retain pilot-rollout labels; local availability needs confirmation |
Sources: Accurx individual-message guidance, PATCHS sending guidance.
There is a material difference between general and product-specific documentation. NHS staff guidance describes supplier-set fallback, often after a few hours, and says staff cannot change the timeframe. Accurx’s individual-message page now documents administrator choices. The general statement should therefore not be presented as a rule for every product and permission level. NHS staff guidance
Accurx also says its conversation thread does not update once an app message has been delivered or read, although its fallback mechanism uses real-time read information. Its listed SMS-only types include questionnaire reminders, confirmation messages and two-factor authentication. A basic questionnaire and a reminder about one should not be assumed to follow the same route. Accurx display and message-type limits
PATCHS allows primary-channel selection and fallback-channel editing for the described messages. Its guidance distinguishes individual and bulk availability from appointment-related pilot features, while retaining a broader pilot warning. A receipt-based timer is not automatically an unread-message timer. PATCHS channel and rollout guidance
Referral updates are not appointment confirmations
For referrals through the NHS e-Referral Service (e-RS), NHS guidance describes messages when the referral is sent for review and when it is accepted. The stated updates do not cover other referral routes, directly booked hospital appointments or rejected referrals. If the app is unavailable or notifications are disabled, the described route uses email; an unsuccessful email delivery leads to SMS after a further 48 hours. Where neither the app nor an email address is available, the guidance describes SMS. People unable to access digital channels should receive the information through existing communication methods. e-RS message routes
For NHS e-Referral Service (e-RS) referral updates, the 48-hour SMS step follows an unsuccessful email delivery. It is not a fallback deadline for every unread NHS App message. e-RS message-route guidance
Acceptance of a referral does not mean an appointment has been booked. The receiving provider contacts the patient separately about appointments and next steps. Hospital-portal features also vary: a request to change an appointment can remain pending until the provider processes it. Hospital and specialist appointment guidance
These distinctions matter when staff answer a status query: an inbox receipt, an accepted referral and a booked appointment are separate records.
What the published guidance does not verify
The published examples do not establish which features, fallback settings or channels a particular organisation has enabled, or how it handles failures and replies. No local configuration or live message delivery was tested for this article.
The NHS privacy notice assigns the sending organisation responsibility for message content, onward services, action on replies and processing requests to stop app messages. Device notification settings are separate from a person’s communication preference with that provider. Sender responsibilities
NHS England’s partner requirements advise against time-critical content and do not guarantee API processing speed. Its broader messaging guidance calls for clinical-safety and information-governance oversight of care-related communications. These are the NHS’s stated requirements; this article does not assess a service’s compliance or safety. Partner requirements, messaging governance
Our health-technology coverage follows the evidence and documented boundaries of these systems.