England

Owned by Federica Andreoni
Last updated: yesterday at 4:03 pm by Mohammad Al-Ubaydli
12 min read

Welfare more than offset the deaths from warfare in England. The biggest improvements in life expectancy happened during the decades of WWI and WWII because of the government’s increase in welfare (Preston 1972). And in 1948, the UK created the National Health Service.

Improvements in life expectancy in England and Wales, 1901-1960.png
Preston, 1972

Country’s healthcare system in a nutshell

In the United Kingdom, the National Health Service (NHS) provides publicly funded universal healthcare coverage (Our World in Data, n.p.), along with publicly funded care providers. Every individual is required to register with a primary care general practitioner (GP). GP appointments are free of charge, and access to secondary care typically requires a GP referral.

Healthcare is devolved to each of the four nations of the United Kingdom, with NHS England serving the largest population of 58 million people. England separated government-owned providers from government-funded payers, while Scotland (5.5 million), Wales (3 million), and Northern Ireland (2 million) did not.

Despite the dominance of the public system, private healthcare options, as well as various alternative and complementary treatments, are available to those who can afford them. (European Observatory on Health Systems and Policies, 2022)

Public vs private

 

Health care spending by country in 2021.svg
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 force driving technological advancement within the NHS.

Launch

Eight fundamental patient care challenges in 2017 drove the Secretary of State’s investment in the NHS App, 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 pilot phase began in October 2018, in regions including Liverpool, Staffordshire, Redditch, Bromsgrove, and others. During this phase, the app provided essential functions such as symptom checking, appointment booking, prescription orders, and access to patient records.

From 2019, it was planned that the app would support GP video consultations and integrate with wearable devices like the Apple Watch and Fitbit. These have not yet developed and are in future roadmaps. So is future integration with the NHS e-Referral Service, allowing patients to book hospital or clinic appointments.

By January 2019, the app was available for download, though each GP practice needed to release data and appointment slots. This functionality was enabled through direct contracts between NHS England, GP providers and GP software companies, so shaping the app’s delivery focus (Bostock, 2019).

The NHS login provided a robust identity verification system. Patients could do this remotely without taking up clinical time or waiting.

Expansion

The app should not have additional features but instead serve as a platform for others to innovate on top of. NHSX CEO stated this in 2019 (Duffy, 2020). NHSX was established as the central IT department for the NHS.

In 2020, Patients Know Best (PKB) became the first Personal Health Record (PHR) to integrate with the NHS App. It included PKB’s full health and care records and functionality.

COVID-19 Pass

Starting on 17 May 2021, the NHS App began displaying COVID-19 vaccination records, initially to support international travel. Over the following months, this feature evolved into the “NHS COVID Pass”. Lockdowns significantly increased the use and adoption of the NHS App.

PEPs vs PHRs

In 2022, NHS England introduced the term Patient Engagement Platform (PEP). As NHS England’s starting focus was administrative, the first PEP procurements focused on hospital appointment management features. Next were letter display and questionnaire completion features.

NHS England is expanding focus to clinical usage, releasing clinical data to deliver clinical transformation. This functionality relies on PHRs.

Features

England is the only country identified in this research that has successfully created a marketplace for healthcare innovation through the NHS App.

NHS England achieved this by integrating private companies’ features into its public platform. 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).

The 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. GP-commissioned functionality determined extra features each patient sees, i.e. 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. Secondary care-commissioned PEP features. Each patient sees additional functionality that their hospital has bought for the patients treated at that hospital. This use interface organised around appointments, starting with administration features and expanding to clinical features.

This page shows all the organisations, their corresponding product and their functionality which have 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 patients to interact with their GP’s electronic health record system, including the ability to:

  • Order repeat prescriptions.

  • Nominate a pharmacy for prescription collection.

  • Book and manage appointments.

  • View their GP health record, including information such as allergies and medications.

  • Book and manage COVID-19 vaccinations.

  • Access their NHS COVID Pass.

  • Register their organ donation decision.

  • Choose how the NHS uses their GP data.

  • View their NHS number

Screenshots of core NHS App functionality

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The NHS App increasingly integrates informational resources, allowing patients to:

  • Use NHS 111 online to answer questions and get instant advice or medical help nearby.

  • 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

Electronic consultations

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

These apps allow patient-initiated triage, i.e the patient answer the software’s questions so the software assesses and recommends the urgency for clinicians.

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, beyond the GP-only the standard NHS App functionality.

Screenshots of Patients Know Best within the NHS app

 

 

They should then click on 'Your hospital and specialist doctors'.

 

 

 

 

 

 

 



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Challenges and areas for improvement

The main area for improvement is that the NHS App shows the features to patients based on NHS organisation, not by patient. So either all the patients in a hospital can use a particular functionality or none.

Additionally, organisations must choose one supplier for each feature. For example, when it comes to appointment management, a hospital can only work with one appointment booking supplier for all appointments.

Statistics

April 2024

Based on PKB interviews:

  • One in six users logs into the NHS App each month.

  • A repeat prescription is processed every second, saving saves GPs an average of three minutes per interaction.

  • 85% of GP records are accessible to patients. The remaining 15% are in breach of contractual obligations.

  • In April 2023, 6 million patients accessed their GP records within a month. By April 2024, this number had increased to 17 million.

  • The NHS 111 service via the app is nine times cheaper and four times faster than traditional phone calls.

December 2022

Older statistics showed cumulative sign-ups of over 30 million (Department of Health and Social Care et al., 2022). Over the year:

  • 7 million new users registered.

  • The app facilitated 1.7 million GP appointments and processed more than 22 million repeat prescriptions.

  • GP records were viewed over 65 million times throughout the year.

  • More than 21 million repeat prescriptions were ordered via the app, a significant increase from 9 million in 2021.

  • Approximately 128,000 individuals registered their organ donation decision through the app.

  • New features allowed users to receive GP notifications and manage hospital appointments, used over 800,000 times.

  • Within four weeks of enabling the COVID-19 vaccine appointment feature, over 28,000 bookings were made through the app, representing 9% of all vaccine appointments.

 

Bibliography

 

 

 

 

 

 

 

 

 

 

 

 

 

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