Digital first primary care and how the NHS Long Term Plan set a clear direction to mainstream digitally enabled care across the NHS

Tara Donnelly, Interim Chief Digital Officer at NHS England, discusses the case for future integration of digital tools into the NHS App.

I’m excited to be part of the team working to improve the daily experiences of both patients and clinicians by using digital technology differently. Digital technology has the potential to enhance the precision, personalisation and efficient delivery of care. So, it shouldn’t be surprising that the pursuit of digital-first primary care plays a prominent role in the NHS Long Term Plan.

Digital-first primary care is already enhancing people’s experience through the online ability to manage appointments, order repeat prescriptions and view their medical record. Over the coming months and years, as the NHS continues to roll out increasingly sophisticated technology and digital programmes, people will gain online access to check their symptoms, as well as receive timely and trusted advice, support and care from the most appropriate clinician connected to their own GP practice. This will be supported by a wide range of NHS approved health and wellbeing apps and when needed, help from urgent care professionals that can access their medical records appropriately too.

Online consultations

Over 300 million appointments take place in general practice every year, some of these appointments could be carried out online. A national programme of work started in 2017/18 to support practices (with their CCGs) to offer digital solutions to patients alongside face-to-face services.

Digital solutions such as video consultations and triage, email, web chat and web-form based models can provide a quick, convenient and secure alternative way to visit your GP practice, and the GP contract is clear; ‘every patient will have the right to online and video consultation by April 2021’. Since 2017/18, we have been supporting digitally mature practices to become early adopters, implementing the online consultation solution that best suits their local community.

These different digital options can make better use of clinician time as patients are triaged, with the clinician using their professional judgement to diagnose an issue or arrange a follow-up appointment, further tests or other specialists’ opinions. It is also known that some of the consultations can be quickly and easily resolved by other members of the practice team without the need to see a clinician – such as finding out about progress of a referral to hospital or requesting repeat medication.

Independent evidence of patient appetite for online consultations

Healthwatch Enfield, in their recent report, Using technology to ease the burden on Primary Care, found that in terms of the potential solutions that could ease the burden on primary care two thirds of responders (66%) said being able to email their GP to seek medical advice would be an option. Almost two-thirds (63%) said a trusted NHS website or an app to check symptoms before seeking advice from their GP and 60% said having a GP appointment via video calling services such as Facetime, Skype or WhatsApp.

The results of this small, single location study are promising. However, this same report highlighted that when it comes to accessing NHS services online, respondents want a simplified registration process and a user-friendly interface among other things such as a wider range of appointment types being available.

The future of the NHS App and simplified, safe access to NHS services online

One solution which will meet the need for safe, secure and simplified access to NHS services online, is the NHS App. The NHS App is an important step in enabling the public to interact with the NHS digitally, and will indeed be the new “front door”. It is going down well with both the public and primary care staff where it is already live. But we are also alive to the many innovative digital products it can link to, both in the market today and in the future.

While we are developing further features within the NHS App itself, we don’t seek to build solutions in this space ourselves but it is our role to set clear standards and work through the best ways to link-up such that this exciting potential can be realised. The team at NHS Digital are currently exploring the different options available to integrate the NHS App with other digital tools and work out which is the best approach. This includes investigating the technical requirements needed to enable the meaningful integration of online consultations within the NHS App. Our clear focus of integration, is to ensure the delivery of a consistent and good patient experience.

Following work with all the suppliers on the Dynamic Purchasing System (DPS) framework through questionnaires, meetings and the construction of multiple proofs of concept, it has been agreed to be through an Application Programming Interface (API). We are committed to the publication of this once developed in the spirit of transparency and openness to the market.

What next?

We are excited as there is a real appetite for digital-first primary care, and that meaningful integration between the NHS App and online consultations is a real possibility through API. The NHS App team will now take the integration of online consultations beyond the proof of concept.

We will also look to the work underway in London, which as the initial accelerator site, will test the integration of a range of digital products within the NHS App during 2019.

Tara Donnelly

Tara Donnelly is the interim Chief Digital Officer at NHS England.

She oversees a portfolio of citizen facing digital services, including the NHS website, NHS App and the development of digital services which meet people’s needs, target prevention and offer a personalised experience.

Tara is on secondment from her role as Chief Executive of the Health Innovation Network. She has led the Health Innovation Network for over three years and is also a non-executive director at the Nuffield Trust.

She has an extensive background in leadership roles within the NHS and the voluntary and community sector and has spent the past 18 years at board level. She has worked in the NHS for 30 years, with her first role being as a Ward Housekeeper when she was 18.

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  1. Dan Bayley says:

    Healthcare is increasingly complex & patients are mobile. My health & condition does not constrain itself to traditional boundaries.

    If we are to truly empower patients we need to focus on giving them choice & control.

    Some have started to realise that enabling eco-systems is key to the future of health, with the likes of Iceland & the Netherlands leading the way.

    Meanwhile in the US regulation is requiring organisations to give data back to individuals & we are starting to see this & the innovation around this emerge.

    The EU has a bold ambition to enable an EU digital health market place with sharing of data to further underpin EU cross border care rights.

    Meanwhile, consumer health is experiencing explosive growth & the NHS is starting to look out of date & out of touch by comparison.

    Enabling everything to work together as part of a harmonious eco-system is going to yeild greater benefits & a healthier society than the NHS trying to be all things to all people & failing.

  2. Chris Frith says:

    The app I trust out-of-hours is NHS111 will their symptom checker be linked to the NHSapp?
    AskmyGP is useful too but this will need my practice to alter its working practice to accept emails of their triage questionnaires.

    • daniel bayley says:

      This is a critical issue.

      We’re trying to modernise services which have yet to adopt *basic* technology (such as email) from the 90s and in many parts continue to resist it.

      The reason Babylon / GPAH are so successful is because they are listening to consumer needs, responding and providing choice where previously where there was no choice.

  3. Pete Deakin says:

    Will this be a free service? e.g. no consultation fee. Will it be run by a private company? I am concerned about data protection and that some private company/individuals will see as a way to make money

    • daniel bayley says:

      GPs are already private companies.

      Most are partnerships / Ltds operating under contract to the NHS.

      Some are more transparent about this than others.

      Your data will also already be processed by private companies who host services for the NHS not least Microsoft.

      If you are worrying about public vs private you are worrying about the wrong thing. The NHS has astronomical issues with data protection, not least unlawfully gifting records to google deep mind.

  4. Mike Higgins says:

    I have many concerns about these proposals. Let’s be honest, this is not about improving patient care, it is about saving money as part of the ongoing government underfunding of the NHS and about facilitating privatisation. On the latter point I note that the Secretary of State has already made it obvious that digitisation of NHS services is to be a beanfeast for private IT companies. Many people do not have access to the internet, either through personal choice or through lack of funding, the latter a particular issue in these times of low-paid employment and cuts in welfare benefits. How will the homeless be able to use these digital services – they don’t all possess i-phones, contrary to popular myth. Do you think that the well-being of patients with mental health problems is going to be improved by speaking to a screen about their issues rather than a human being? You say that there is “a real appetite for digital-first primary care”. I doubt that the public shares that appetite.