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The health of Welsh coal miners is the cornerstone of Archie Cochrane’s research, the foundation of evidence-based medicine. This work with Welsh miners deepened his commitment to the use of randomized controlled trials to evaluate medical interventions, as he observed firsthand the limitations of unproven treatments offered to miners (Cochrane, 1972).
After considerable thought I wrote out my slogan: “All effective treatment must be free”.
Country’s healthcare system in a nutshell
Healthcare in Wales is mainly provided by the Welsh public health service, NHS Wales. NHS Wales provides healthcare to all permanent residents which is free at the point of need and paid for from general taxation. Health is a matter that is devolved, and considerable differences are now developing between the public healthcare systems in the different countries of the United Kingdom, collectively Residents of Wales, like all UK residents, have access to public healthcare, which is primarily funded through taxation. In the UK, responsibility for healthcare is transferred from the central government to each of the devolved nations, meaning that the National Health Service (NHS). Though the public system dominates healthcare provision, private healthcare and a wide variety of alternative and complementary treatments are available.Initially administered by the UK Government, since 1999 NHS Wales has been funded and managed by the Welsh Government) in Wales is managed by the Welsh Government (Chang et al., 2011).
The latter establishes the strategic framework and health and social care policies that NHS Wales and its partners follow. The NHS in Wales operates through seven Local Health Boards, three NHS Trusts, and two Special Health Authorities. In particular, the Local Health Boards are tasked with planning and ensuring the delivery of a range of services, including primary, community, and secondary care, as well as specialist services such as dentistry, optometry, pharmacy, and mental health. They work to improve health outcomes, promote wellbeing, and reduce health inequalities across their populations (NHS Confederation, 2021).
Public vs private
Unfortunately, we couldn’t find any statistics about healthcare spending in Wales, but only for the UK. If you have access to this information or can put us in touch with someone who has, please contact us at book@patientsknowbestbook@phr4gov.comorg
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The national PHR
History
In recent years, NHS Wales' Digital Services for Patients and the Public (DSPP) programme - led by Stephen Frith - has undertaken has embarked on a significant endeavorproject: the creation of Wales' own version of the England’s NHS App. This initiative followed the realisation that the NHS App in England did not align with Welsh requirements, particularly as the app needed to be bilingual, but also because of different functionality requirements, including giving wider access to health and care services across Wales.
The contract for the app development was awarded to Kainos, which worked with the DSPP programme to build the app. Towards the end of 2022, the app went into private beta with a thousand patients from 10 different GP surgeries trialing the app.
The beta testing was originally due to run until Christmas 2022 but had been extended until the end of March 2023, as it became evident that the intricate network of diverse systems and suppliers within the NHS presented a complex support model.
Nevertheless, the DSPP programme has chosen not to do a public campaign about the app, but rather prioritizse support for GP practices, gradually and consistently introducing the app. This strategy, distinct from England's approach, is designed to ensure GPs comprehend Welsh requirements included adding the Welsh language, and different functionality.
DSPP programme awarded the app development to Kainos, a software company which was also involved in the development of the NHS app in England.
Private beta with a thousand patients at 10 GP surgeries started in November 2022. At that stage, DSPP priority was to ensure GPs comprehended the app's implications for their patients and take ownership of its integration into their practice. There will be a national publicity campaign about the app in the Spring of 2024.
In terms of technical maintenance, the supplier, Kainos, will oversee the app's operation and support for the initial 12 months. Thereafter, the operational system support may pass to Digital Health and Care Wales (DHCW).
On April 17thof 2023, the app started public beta testing: it
Public beta testing started in April 2023: the App was published on Apple and Google app stores for download, and it also started to be available at NHS Wales App website (English) and Ap GIG Cymru (Cymraeg). This wasn’t the final version of the app, as new functionalities are being released as soon as they are developed.
Features
At the release date, some app functions, such as in-app access to 111 and organ donation online services, were available to all. Other functions are due to be available later, once a person’s GP practice has enabled the functionality, this is the case of appointment booking, repeat prescription re-ordering(Welsh Government, 2023)
Features
For a patient to be able to use the following features, the GP practice must enable them: booking appointments, re-ordering repeat prescriptions, and viewing a summary of a patient’s GP health record. It is important to note also that many of the features that the app will display will be provided by a third-party provider, namely Patients Know Best (PKB), which will be integrated with the NHS Wales app from December 2023. These functionalities are: test results, library, symptoms, measurements, journal, care plans and messages, and a direct link to PKB to access all other features. While the NHS Wales App allows patients to access GP records, thanks to the integration with PKB, patients will be able to also view their data from other healthcare providers.The app also provides access to national information services, such as NHS 111 and organ donation services, where available.
Appointments:
patients can ask for request an appointment with the their GP (the GP practice decides what which appointment types are available).
patients can cancel appointments with the their GP through the app.
GP Prescriptions:
patients can order a prescription
patients can view your their existing repeat prescriptions
patients can view both current and past medicines
Depending on the health board or GP practice, patients may also be able to see:
medicines the GP has prescribed prescribed by their GP.
any allergies or allergic reactions patients have told recorded by their GP about.
test results from their GP.
"My health timeline", which is a collection of all the patient’s health records and events that is , searchable by date and record type
"About me and my care", which is a form that helps where patients can describe their healthcare needs, wishespreferences, and plans.
the app also provides information on organ and blood donation services information
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services.
Patients Know Best
Similar to the NHS App in England, the NHS Wales App integrates services and features developed by various private companies. Notably, it relies on Patients Know Best (PKB) to provide patients with access to their test results, a library of health resources, symptom tracking, measurements, journal entries, care planning, and messaging. Additionally, the app includes a direct link to PKB, allowing users to access all other PKB features from within the platform. While the core functionality of the NHS Wales App enables patients to access their GP records, the integration with PKB allows them to also view data from other healthcare providers.
This integration is still in progress and is currently available only in regions where PKB has been designated as the Patient Held Record (PHR) provider. In these regions, patients can access parts of their PKB record within the NHS Wales App and use the NHS login’s encrypted single sign-on for secure access.
Challenges and areas for improvement
The budget allocated by the Welsh government for the development of the NHS Wales App is smaller than the budget provided for the NHS App in England. As a result, there will be fewer features, and the development process has been and will continue to be slower by comparison.
The government's special health authority Digital Health and Care Wales (DHCW) has locked down both the use of NHS Login and access to the NHS Wales App.
Agreements will be between Health Boards and DHCW on behalf of apps or private sector providers rather than those providers getting single approval for use across Wales which means that integration rollout will be slowed and will lead to less private sector collaboration.
While the NHS Wales App should function as a single entry point for digital health and care services for all patients, this will result in unequal access across health boards during these slow rollouts
Published outcomes - statistics
At the beginning of December 2023, the NHS Wales app had:
202 GP practices onboarded (52% of all practices in Wales), with a plan to
onboard the remaining 48% within March 2024Over 50.,000 app downloads by patients via App Store or google play store
3169 3,169 appointments have been booked through the app
15855 15,855 repeat prescriptions have been ordered
48519 48,519 GP health records have been viewed
Screenshots
PKB inside the NHS Wales app
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NHS Wales App screenshots
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Bibliography
Chang, J., Peysakhovich, F., Wang, W. and Zhu, J., 2011. The UK health care system. The United Kingdom, 30, p.2019. Available at: link (accessed 2 August 2024).
Cochrane, A. L. (1972). Effectiveness and Efficiency: Random Reflections on Health Services. London: Nuffield Provincial Hospitals Trust. Available at: https://www.
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nuffieldtrust.org.uk/sites/default/files/2017-01/effectiveness-and-efficiency-web-final.pdf (accessed: 2 November 2024).
Evenstad, L. (30 Mar 2023). Wales is building a dragon of an NHS app. Computerweekly . Available at: https://www.computerweekly.com/news/365534184/The-Welsh-are-building-a-dragon-of-an-NHS-app (accessed: 18 December 2023).
NHS Confederation, 2021. About the NHS in Wales. (online) 12 May. Available at: https://
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articles/about-nhs-wales (accessed 2 August 2024).
Welsh Government. (17 April 2023). Cabinet Statement: Written Statement - The new NHS Wales App, by Eluned Morgan MS, Minister for Health and Social Services. Available at: https://www.gov.wales/written-statement-new-nhs-wales-app (accessed: 18 December 2023).