Country’s healthcare system in a nutshell

In the United Kingdom, the National Health Service (NHS) provides publicly-funded universal coverage as well as publicly-funded care providers. Every person must register with a primary care general practitioner. GP appointments are free of charge and access to secondary care requires a GP referral

Health care is a governed by each of the four nations of the United Kingdom, with NHS England covering the largest population of 57 million people. The main difference from Scotland, Wales and Northern Ireland is that England traditionally separated government-owned providers from government-funded payers.

Despite the dominance of the public system, private healthcare options and various alternative and complementary treatments are accessible for individuals with the means to afford them. (European Observatory on Health Systems and Policies, 2022)

According to the most recent data from 2010, health insurance covered the entire population of the United Kingdom. This coverage encompasses both those who are members of health insurance schemes and those who have free access to state-provided healthcare services (Our World in Data, n.p.)

Public vs private

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Source: The World Bank.
The pink column refers to the public expenditure as a % of the country’s total healthcare expenditure. The blue dot is the country’s expenditure on health per capita, expressed in international dollars at purchasing power parity.

The national portal

History

NHS England’s NHS App’s 2019 launch was a significant milestone in the modernisation of the National Health Service. Developed collaboratively by NHSX, NHS Digital and NHS England, the project got support from Health Ministers Jeremy Hunt and Matt Hancock, who both saw the app as a pivotal force driving technological advancement within the NHS.

Development

In September 2017, Jeremy Hunt (at that time Secretary of State for Health and Social Care) set forth eight fundamental challenges for the app's development. These encompassed critical aspects of patient care, from symptom checking and triage to facilitating end-of-life care choices. Additionally, the app aimed to facilitate administrative tasks such as booking GP appointments, ordering repeat prescriptions, and managing data sharing and organ donation preferences.

The app's pilot phase commenced in October 2018, with plans to roll it out nationwide by December of the same year. Initial testing covered various regions, including Liverpool, Staffordshire, Redditch, Bromsgrove, and several others. During this early stage, the app provided essential functions like symptom checking, appointment booking, prescription orders, and access to patient records.

From 2019, it was planned to support GP video consultations and integration with wearable devices like Apple Watch and FitBit (note: consultation features weren’t developed, and put on the roadmap again in 2022). Future developments promised connectivity with the NHS e-Referral Service, enabling patients to book hospital or clinic appointments.

By January 2019, the app was available for download, but GP practices needed to adjust their system settings before it could go live. The NHS login provided a robust identity verification system for users, ensuring secure access to the platform. At the go live, the NHS App included GP record access, a GP prescription renewals feature, and a GP appointment booking feature. This was possible because NHS England contracts directly with GP providers and GP software companies, and that’s how the app’s delivery focus was set (Bostock, 2019).

After the establishment in early 2019 of NHSX as a central IT department for the NHS, chief executive Matthew Gould stated that the app should not have any more features, but should be a platform allowing "other people innovate on top of it” (Duffy, 2020).

In 2020, Patients Know Best (PKB) became the first Personal Health Record (PHR) integrated with the application and extending the NHS App’s current features to include PKB’s full health and care record and functionality.

COVID-19

From May 17, 2021, the app began displaying COVID-19 vaccination records, initially to facilitate international travel. Over subsequent months, this feature evolved into the ‘NHS COVID Pass’.

The Covid passport during lock-downs led to an explosion of the NHS App’s usage and mandate, as shown in the graph below.

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Monthly new NHS App downloads and registrations. Kc et al. (2023) 'Uptake and adoption of the NHS App in England', British Journal of General Practice, 73(737), pp. e932–e940.

PEPs vs PHRs

In 2022, NHS England introduced the term Patient Engagement Platform (PEP). As NHS England’s starting focus was administrative, the first PEPs focused on sharing letters and questionnaires with patients and having appointment management capabilities.

PEPs are expanding focus on clinical usage, releasing clinical data to deliver clinical transformation. This functionality relies on PHRs.

Features

England is the only country in this research that has successfully created a marketplace for healthcare innovation through the NHS App. This has been achieved by integrating services developed by various private companies into its platform. The marketplace model operates as follows: NHS Digital developed the foundational structure of the NHS App, while most of the features have been developed by private companies and then integrated into the app. This has created a competitive environment where private developers are incentivized to create high-quality, innovative solutions that meet the needs of NHS patients (Al-Ubaydli, 2024).

NHS England’s NHS App has therefore three sets of functionality:

1. National functionality, paid for and built through central government funding. This was the starting point of the NHS App in 2019.

2. Early on, GP-commissioned functionality determined extra features each patient sees, ie. functionality their GP surgery had chosen for all the patients in that surgery. This was the initial marketplace of electronic consultation systems and personal health records.

3. Later on, with the Wayfinder programme, NHS England added a secondary care health care providers as a commissioning unit for PEPs. Each patient sees additional functionality that their hospital has bought for the patients treated at that hospital. This marketplace focused on appointments, starting with administration and expanding to clinical features.

This page shows all the organisations, their corresponding product and their functionality which has integrated with the NHS App: https://digital.nhs.uk/services/nhs-app/how-to-integrate-with-the-nhs-app/nhs-app-integrated-partners-and-services

Core national functionality

The core national functionality allows a patient to work with their GP’s electronic health record system, including:

• order repeat prescriptions

• nominate a pharmacy where they would like to collect them

• book and manage appointments

• view their GP health record to see information like allergies and medicines

• book and manage (COVID-19) vaccinations

• get their NHS COVID Pass

• register their organ donation decision

• choose how the NHS uses their GP data

• view their NHS number

[Put core NHS App screenshots here]

The NHS App is increasingly integrating informational resources including:

• use NHS 111 online to answer questions and get instant advice or medical help near them

• search trusted NHS information and advice on hundreds of conditions and treatments

• find NHS services near them

Appointment booking

Suppliers include: DrDoctor, Netcall, Patients Know Best, Zesty

[DrDoctor inside the NHS App screenshot]

Electronic consultations

Suppliers include: eConsult, accuRx, TPP (Airmid), engage health (mostly in primary care)

Allow triage

Below you can find the screenshots of eConsult inside the NHS app

Personal health records

Patients Know Best (PKB) integrated with the NHS app in 2020. PKB gives the NHS App user full PKB functionality which is much deeper than the standard NHS App functionality limited to just the GP.

Below you can find the screenshots of PKB within the NHS app.

Challenges and areas for improvement

The main area for improvement is that the NHS App shows the features to patients based on NHS organisation, so either all the patients in a hospital can use it or none.

The hospital can only choose one supplier for each feature, for example, for appointments, they can only choose one supplier.

Published outcomes - statistics

In April 2024:

• 1/6 of users log into app every month 

• Repeat prescription every second 

  • Saves 3 minutes for the GP

• 85% of GP records are open:

  • 15% that haven’t are against the contract

  • In April 2023, 6 million patients have looked at their GP record in a month;

  • In April 2024, 17 million patients have looked at their GP record in a month;

  • 111 on front of NHS App is 9x cheaper 4x faster than calling.

(PKB interviews)

Older stats from the 31st of December 2022:

• In 2022, with over 30 million sign-ups across England. This includes 7 million new sign-ups in 2022.

• During 2022 the NHS App has facilitated 1.7 million GP appointments and processed over 22 million repeat prescriptions, contributing to significant time-saving for clinicians.

• The NHS app has seen over 65 million views of GP records

• Over 21 million repeat prescriptions were ordered through the NHS App in 2022 (these were 9 million in 2021

• Approximately 128,000 individuals registered their organ donation decision using the NHS App.

• New features have been added to the app, enabling users to receive notifications from their GPs and manage hospital appointments. These features have been utilized over 800,000 times.

• Over 28,000 COVID-19 vaccine appointments were booked through the NHS App within four weeks of adding this feature, constituting 9% of all bookings.

(Department of Health and Social Care et al., 2022)

Screenshots

Bibliography

Al-Ubaydli, M., 2024. What makes the NHS app successful? Digital Health. Available at: https://www.digitalhealth.net/2024/07/what-makes-the-nhs-app-successful/ (Accessed: 25 July 2024).

Barclay, S., Lord Markham, C., Department of Health and Social Care, NHS Digital, NHS England, 2022. NHS App hits over 30 million sign-ups. Available at: https://www.gov.uk/government/news/nhs-app-hits-over-30-million-sign-ups (Accessed: 12 October 2023).

Department of Health and Social Care, NHS England, NHS Digital, The Rt Hon Steve Barclay MP, Lord Markham CBE. (31 December 2022). NHS App hits over 30 million sign-ups. Available at:. Accessed 12 October 2023)

Duffy, D., 2020. Matthew Gould outlines the digital mission of NHSX. Hospital Times. Available at: (Accessed: 25 July 2024).

European Observatory on Health Systems and Policies, 2022. United Kingdom: health system summary 2022. Available at: (Accessed: 12 October 2023).

Kc, S., Tewolde, S., Laverty, A. A., Costelloe, C., Papoutsi, C., Reidy, C., Gudgin, B., Shenton, C., Majeed, A., Powell, J. & Greaves, F., 2023. Uptake and adoption of the NHS App in England: an observational study. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 73(737), pp. e932–e940. doi: 10.3399/BJGP.2022.0150.

NHS app goes live with full rollout to GP practices promised by July. GP Online. Available at: (Accessed: 25 July 2024).

NHS, 2023. About the NHS App. Available at: (Accessed: 12 October 2023).

NHS Digital, 2024. NHS Digital Transformation: The Road Ahead [video]. Available at: https://www.youtube.com/watch?v=90foL7lKn-Y ,(Accessed: 25 July 2024).

NHS Digital, 2024. The Future of NHS Technology [video]. Available at: https://www.youtube.com/watch?v=Zpf3wnJvw20&t=28s , (Accessed: 25 July 2024).