Wales
Evidence-based medicine’s founder, Archie Cochrane, started with the health of Welsh coal miners. Working with Welsh miners deepened his commitment to the use of randomized controlled trials to evaluate medical interventions. 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
Residents of Wales, like all UK residents, have access to public healthcare funded through taxation. Responsibility for healthcare is transferred from the UK central government to each of the devolved nations. The Welsh Government manages the National Health Service (NHS) in Wales (Chang et al., 2011).
The Welsh Government 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. 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 well-being, and reduce health inequalities across their populations (NHS Confederation, 2021).
Public vs private
The national PHR
History
The Digital Services for Patients and the Public (DSPP) of NHS Wales creates Wales' version of England’s NHS App. Welsh requirements included adding the Welsh language and different functionality. DSPP programme awarded the app development to Kainos, a software company that 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's priority was to ensure GPs understand the app's implications for their patients and take ownership of its integration into their practice.
Public beta testing started in April 2023. The app was available via the Apple and Google app stores. A web version is at app.nhs.wales in English and ap.gig.cymru in Welsh (Welsh Government, 2023).
Features
The GP practice must enable these for a patient to use: booking appointments, re-ordering repeat prescriptions, and seeing a summary of a patient’s GP health record (NHS Wales App, 2024). The app also provides access to national information services, such as NHS 111 and organ donation services, where available.
Appointments (the GP practice decides which appointment types are available):
Patients can request an appointment with their GP
Patients can cancel appointments with their GP through the app
GP Prescriptions:
Patients can order a prescription
Patients can view 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 prescribed by their GP
Any allergies or allergic reactions recorded by their GP
Test results from their GP
"My health timeline", which is a collection of all the patient’s health records and events, searchable by date and record type
"About me and my care", which is a form where patients can describe their healthcare needs, preferences, and plans
The app also provides information on organ and blood donation services
Patients Know Best
Similar to the NHS App in England, the NHS Wales App integrates services and features developed by 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, screens include a direct link to PKB, allowing users to access all other PKB features from within the app. While the core functionality of the NHS Wales App enables patients to access their GP records, the integration with PKB allows them also to see data from other healthcare providers, including hospitals in Wales and providers in the rest of the UK.
This integration is still in progress and is currently available only in regions choosing PKB as the 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 that for the NHS App in England. As a result, there will be fewer features, and development will be slower.
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.
Therefore, the integration rollout will be slowed, which 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 (PKB research, 2024).
Published outcomes - statistics
At the beginning of December 2023, the NHS Wales App had (Digital Services for Patients and Public, 2023):
202 GP practices onboarded (52% of all practices in Wales), with a plan to onboard the remaining 48% within March 2024
Over 50,000 app downloads by patients via App Store or Google Play Store
3,169 appointments have been booked through the app
15,855 repeat prescriptions have been ordered
48,519 GP health records have been viewed
Screenshots
Core NHS Wales App
 Patients can view their messages, search for medical advice through NHS 111 Wales, and review, update, or register their organ donation decisions. They also have the option to register as blood donors. |  On the messages page, patients can access consultations, events, and messages, a service provided by Patients Know Best (PKB), as shown in the previous screenshots. Additionally, they can view health information and updates. |  In the Health Information and Updates section, patients can see messages from the NHS Wales app. |
 NHS Wales App shows a welcome message for patients.
|  . Within ‘My Health,’ patients can determine whether their GP practice is connected to the App. If their practice is connected, they will have access to view appointments, prescriptions, and their health data. |
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Patients Know Best within the NHS Wales App
 On the Messages Page, patients have two options for managing their communications. They can either click to view more details about their visits, treatments, and clinical documents, as well as send messages to their healthcare professionals, or they can select the option to view messages received from health services and the NHS Wales App. |  Upon clicking on ‘Consultations, Events, and Messages,’ patients are notified that this service is provided by the company Patients Know Best (PKB). |  When opening messages for the first time, patients are required to register with Patients Know Best (PKB). |  Once registered, patients can review their sharing settings and begin utilising all the services available through the NHS Wales app, as provided by Patients Know Best (PKB). |
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 Once registered, patients are directed to the specific area of Patients Know Best (PKB) they selected from the NHS App, in this instance, the Events & Messages section. Here, they can view and send messages to their healthcare professionals, as well as access their letters. |  In the ‘My Health’ menu, patients can click to access their GP health record or explore additional options under ‘More health records, results, and tools.’ |  Upon clicking on ‘More health records, results, and tools,’ patients can select to view their test results or access a library of resources provided by their health team. |  When clicking on ‘Shared health links,’ patients are presented with a library of links and files added by their healthcare professionals, as well as the option to add their own. |
 Patients have the option to click on ‘Track your health’ to record their symptoms, measurements, and journal entries. They can also select ‘Plans’ to view their health management plans. |  ‘Plans’ can outline the patient’s condition, track their progress, and suggest actionable steps for management. Both healthcare professionals and patients can contribute to these plans. |  The menu within ‘Track your health’ features options for ‘symptoms,’ ‘measurements,’ and ‘journal,’ allowing patients to monitor and document their health. |  On the ‘Symptoms’ page, patients can input their symptoms along with an indication of their intensity. |
 On the ‘Measurements’ page, patients have the option to manually enter their measurements or connect a device to track and record their data automatically. |  In the ‘Journal’ page, patients can create new journal entries by typing in a free text box, allowing them to express their thoughts and observations about their health. |  In the ‘Test Results’ page, patients can view results from past tests or manually add new ones. The results are displayed as a list and in graphs, enabling patients to track trends. |
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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.nuffieldtrust.org.uk/sites/default/files/2017-01/effectiveness-and-efficiency-web-final.pdf (accessed: 2 November 2024).
Digital Services for Patients and Public (2023) DSPP – Cynnydd ar App GIG Cymru // DSPP Webinar - Progress on the NHS Wales App. Available at: DSPP – Cynnydd ar App GIG Cymru // DSPP Webinar - Progress on the NHS Wales App December 5 2023 (accessed: 8 December 2023).
Evenstad, L. (30 Mar 2023). Wales is building a dragon of an NHS app. Computerweekly . Available at: Wales is building a dragon of an NHS app | Computer Weekly (accessed: 18 December 2023).
NHS Wales App (2024) NHS Wales App: Help and support. Available at: https://apphelp.nhs.wales/ (accessed: 19 November 2024).
NHS Confederation, 2021. About the NHS in Wales. (online) 12 May. Available at: About the NHS in 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).
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