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Appointments, Referrals, and Waiting Lists

Timely, accessible appointment information would give Defence Primary Healthcare (DPHC)-registered patients a simpler journey and reduce reliance on separate letters, SMS messages, portals, and administrative contact. A project-owner-validated Defence Medical Services (DMS) Regulator (DMSR) finding identified Defence-related causes in 84% of the external-referral delay cases reviewed, including inaccurate contact details and delays passing appointment information to patients. It adds an important patient-safety and administrative reason to prioritise appointment communication, while remaining supporting evidence scoped to the reviewed cases.

The implementation logic should keep three appointment outcomes separate:

  1. NHS secondary-care and specialist appointment visibility and messages through existing NHS routes;
  2. DPHC Firmbase primary healthcare (PHC) appointment reminders through a new one-way source and messaging route; and
  3. DPHC Primary healthcare (PHC) appointment inventory and management, which require materially more source-system and write-back capability.
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flowchart LR
  SHC["NHS secondary care<br/>existing provider route"] --> PCA["e-RS + Patient Care Aggregator<br/>+ connected trust PEP"]
  PCA --> App["NHS App<br/>summary, detail, messages"]
  DMICP["DMICP Firmbase<br/>appointment event/feed"] --> Adapter["Controlled adapter<br/>CORTISONE / Health Connect candidate"]
  Adapter --> Notify["NHS Notify<br/>App message + fallback"]
  Adapter -. "separate visibility route" .-> PCA

NHS Secondary-Care Priority

The Patient Care Aggregator / Wayfinder route is the main NHS App architecture for secondary-care referrals and bookings. It aggregates e-Referral Service (e-RS) and participating booking-system data, returns a summary list to the NHS App, and deep-links the patient into e-RS or a Patient Engagement Portal (PEP) for details or supported booking changes.

NHS England reported in April 2026 that every acute trust in England was connected, 64% of hospital appointments were visible through the NHS App, and around half of trusts could send appointment reminders by push notification. These figures make appointment information from participating NHS providers in England the critical initial provider-connected capability to test where relevant to a DPHC patient's care. They do not prove that every booking, trust pathway, age group, proxy user or DPHC patient is visible. The IRTB(P) should therefore prioritise end-to-end tests using real DPHC referral and booking paths rather than propose an unnecessary Defence Medical Information Capability Programme (DMICP) change for NHS-originated secondary-care data.

DPHC Firmbase Reminders

A reminder is not the same as appointment visibility or management. The reviewed national NHS catalogue has no product named Appointments Reminder API. The proposed Defence provision is a DMICP appointment event or reminder feed. That event could pass through Programme Cortisone / Health Connect or another assured adapter and submit a message through the NHS Notify API. NHS Notify can deliver an NHS App message and route to configured email, SMS or letter fallback channels; it does not hold the appointment book, return an appointment list or write changes to DMICP.

The minimum route requires:

  • an authoritative DMICP appointment identifier, event/status, NHS number, time and time zone, service, location or modality, update/cancellation rules and patient-safe wording;
  • patient and organisation matching, suppression and restricted-record rules, duplicate control and source reconciliation;
  • NHS Notify sender eligibility, Organisation Data Service (ODS) identity, onboarding, routing plan, template, callbacks, fallback, support and assurance; and
  • a funded owner for delivery, clinical safety, data protection, security, accessibility, service support and benefits.

Initial App delivery should run alongside current DMICP SMS reminders. A later move to App-first delivery or replacement of routine SMS for defined cohorts requires evidence of delivery and failure behaviour, reconciliation, accessibility, support, safety, cost, exception handling, fallback completion, patient outcomes and administrative effect, followed by a recorded service decision. SMS or another channel remains available where the App is unavailable, unsuitable, not enabled, or fails.

No reviewed public MOD source defines the DMICP event/feed or confirms Defence Medical Command (DMedC) NHS Notify onboarding. Project-owner direction records the current GOV.UK Notify workflow and proposed parallel-to-App-first decision model, but neither the implementation artefact nor the replacement case is retained. These are implementation gates, not reasons to dilute the value case.

DPHC Firmbase Visibility and Management

If the intended outcome includes a visible appointment summary and detailed appointment page, a separate Patient Care Aggregator / PEP route is needed. The public onboarding model requires a Record Service integration, Get Appointments API, NHS login, a standardised PEP with deep links, testing and assurance. Current eligibility is written for secondary-care booking systems representing eligible trusts. DMedC therefore needs NHS England agreement before treating the technically analogous Firmbase route as accepted or available.

Appointment management is a later and more complex capability. Booking, cancellation, rescheduling, slot search and appointment-change requests require bidirectional write-back to the authoritative DMICP appointment book, schedule and slot state, conflict handling, patient/proxy permissions, audit, supplier enablement, failure recovery and clinical safety. NHS Notify cannot provide these functions, and a PEP link does not make an action authoritative unless the source appointment book is updated.

GP appointment booking is a separate interface problem. NHS England Digital guidance records registered-GP service discovery through Personal Demographics Service (PDS), endpoint lookup through Spine Directory Service (SDS), GP Connect Appointment Management for established consumers, and Interface Mechanism 1 (IM1) Pairing for the relevant NHS App GP-system route. These interfaces cannot be assumed for DMICP. MOD Total Triage evidence describes an online/telephone request and triage route, not NHS App booking or a DMICP interface.

Use NHS App Adoption and Implementation for the wider implementation sequence and Patient Care Aggregator and PEPs for the existing NHS secondary-care route.

DPHC Appointment Boundary

Detailed annual-report evidence is maintained in Armed Forces Covenant Reports. For this appointments page, the report series is a cross-reference only: it contains a direct but narrow NHS App appointment-booking access signal for a DMS / DPHC cohort, so appointment behaviour for other DPHC patients remains an open evidence question. The 2025 annual-report recheck found no direct resolution signal, and the 2025 MOD Total Triage source adds DPHC PHC access-route context without proving NHS App booking.

Needed Evidence