10 actions the government and NHS leaders should take on NHS admin

Introduction

NHS admin – how the NHS communicates with people about their appointments and care – is a fundamental aspect of a patient’s access to and experience of health care. This briefing sets out 10 actions the government and health care leaders should take to improve patients’ experiences of NHS admin. Although some of these actions involve changes to national policy, many can be taken forward by local leaders to make admin work better for patients in the services they manage. 

How does admin affect people’s views of the NHS and experiences of care? 

New polling by Ipsos for The King’s Fund, Healthwatch England and National Voices has found that admin is a widespread issue that impacts on people’s access to care and affects people’s trust in NHS care and efficiency. The results show there has been no improvement in people’s experiences of admin compared to the previous year’s polling, and people’s perceptions of how well the NHS communicates with patients have actually worsened.

The British Social Attitudes survey also shows public dissatisfaction with how efficiently the NHS spends its money. More than half of respondents (55%) in the 2025 survey disagreed or strongly disagreed with the statement ‘the NHS spends the money it has efficiently’, compared with 13% who agreed or strongly agreed. In a system that is perceived as wasteful, with poor admin being a factor in this perception for many people, there is a significant opportunity here for the government and NHS leaders to improve admin and, by doing so, improve people’s experiences and perceptions of the NHS overall. 

Prioritising and improving patients’ experiences of admin will require a significant shift in focus, from a system designed from the organisation’s perspective to one designed from the patient’s perspective, necessitating changes at all levels. 

The 10 actions presented below are linked to a number of areas that require focus to make admin better for patients: making admin a national priority; the digital shift; patient feedback and involvement; the admin workforce; sharing learning and best practice; and elective care.  

Making admin a national priority 

There is a need for action at the national level to prioritise patients’ experiences of admin. Our polling shows that issues around NHS admin are widespread and impacting people’s trust in the NHS and confidence to seek NHS care. The 10 Year Health Plan mentions admin numerous times but largely in the context of making admin processes more efficient for staff, and freeing up clinicians’ time for patient care.  

As the 10 Year Plan states, health care as we know it is changing, with new and expanded neighbourhood health services joining up care from across the NHS and local authorities, and care moving to new locations such as neighbourhood health centres and surgical hubs. The Plan positions the NHS App as the best way for people to manage their appointments and communicate with the NHS about their care effectively in the future. In the meantime, though, admin must work for everyone whether or not they are using the app; there is also a need to improve digital skills and health literacy to make sure nobody will be left behind in this shift.  

In this changing landscape, it’s more important than ever that people can access and communicate about their care. Improving admin shouldn’t be seen as a positive side effect of the changes laid out in the 10 Year Health Plan, but rather as a core foundation for the success of these changes. This will require making admin a priority for the NHS, through the new Director for Patient Experience, as well as via national strategies and guidance. Patients, people involved in managing care on patients’ behalf, clinical staff, and admin staff should all be included in the development of standards to bring about the changes people want to see on NHS admin. Our organisations are able and ready to support with the development of guidance and standards. 

The digital shift holds huge promise for improving NHS admin 

The next three actions focus on the digital shift. Our polling has shown that people are currently finding it difficult to contact their care teams, to access test results, and to book or amend appointments. The 10 Year Health Plan describes the NHS App as becoming the ‘front door to the NHS’, a portal to booking and changing appointments and communicating with clinical staff. The NHS App is also positioned to increase accessibility options such as screen readers and different languages. These changes hold a lot of promise for improving patients’ experiences of NHS admin.  

However, currently, the NHS App is just one of many apps, platforms and websites that patients may need to use, creating a confusing web of different log ins and routes to care. Digital access should be simple, and people should be able to access the same level of experience regardless of where they live, their expertise and confidence in using new technology, or their access to a smartphone and the internet. Digital inclusion can be supported through local collaborations between the NHS, local authorities and the voluntary, community and social enterprise (VCSE) sector to develop the public’s capabilities in using NHS digital tools. However, being able to reach a real person will remain important as admin processes are increasingly automated and use of artificial intelligence (AI) is expanded; admin staff are often hugely valued by patients, especially those who need support to navigate the NHS. 

The NHS App will house the Single Patient Record (SPR), which the 10 Year Health Plan states will be made accessible to people by default, though changes to legislation are required to set it up. Having access to their own records is an important aspect of empowering people to understand and take action on their health and be involved in shared decision-making about their care. 

Patient feedback and involvement are key to improving admin processes 

Each organisation should consider how well they understand NHS admin and communications from a patient perspective. More data on patients’ experiences of admin, collected at local and national levels, will be required to understand where things are working well and where they are not, to monitor impacts when changes are made, to measure improvement, and to understand variation between groups and areas. As the adage goes, what gets measured gets done. 

As our research has shown, it is important to understand the experiences and needs of different groups of patients and service users. To make experiences of NHS admin and access to care more equal, there should be efforts to understand the experiences and needs of people with multiple conditions, carers (who are managing care for someone else), and people from ethnic minority backgrounds.

Recognising the value of the admin workforce 

Making admin a national priority means valuing the workforce that delivers admin and communications processes, as well as the processes themselves. Admin staff are an under-recognised part of the health care workforce, who often work with difficult processes and under a great deal of pressure. Their experience and insights into the work they do is valuable for understanding where improvements can be made. Giving them a stronger voice in decisions that affect their work can also improve their job satisfaction as well as improving admin processes and outcomes for patients.  

Workforce planning and development for staff working in patient admin roles is essential – particularly as the NHS seeks to radically improve its use of digital technology. More thought should be given to where the skills and knowledge of admin staff can add value to patient care, and to make sure there are the right number of staff in the right places and settings, with the right skills (including digital skills as well as interpersonal or ‘customer care’ skills) to deliver both a high-performing admin service and a satisfying career for staff.  

Sharing learning and best practice 

There are some great examples of organisations improving admin processes, but these are not currently widely shared or promoted, which makes it hard for organisations to learn from each other. Sharing what works (and, in some cases, what doesn’t work) helps accelerate improvements across the system. It is commonplace within clinical practice, with various NHS networks established to enable sharing. A similar focus should be expanded to NHS admin, with regional teams taking a supporting role in setting these processes up and scaling what works.  

The King’s Fund is interested to hear about examples of good practice in admin from across the sector, which we can promote through our channels, with our partners, in meetings and presentations, and at our events. Get in touch via [email protected]

Improving communications around elective care 

The tenth action focuses on improving people’s experiences of waiting for care. Around 1 in 10 people in England are currently waiting for consultant-led elective treatment. With the average (median) ongoing waiting time currently at 13.4 weeks, this represents a group of patients who may have to wait several months or even longer for care. Waiting for treatment can be stressful for people and those close to them. Healthwatch England undertook research with people who had been referred by their GP for specialist care in the previous 12 months. They found that those who quickly received confirmation that their referral had been received, the correct information about their care, how to manage their condition and seek advice for any concerns in the meantime, and were offered choice around booking appointments at a convenient time and location, were more likely to be satisfied with the referral process. Compliance with the Accessible Information Standard is essential to make sure that everyone can understand the information they are sent about their appointments and care.