nhs app case study

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Case studies and webinars from health care professionals

Read about how people across the NHS are implementing, using and benefiting from providing online access to patient records. Choose from our selection of case studies, blogs, webinars and articles of interest about enabling patients to view their GP health record information through the NHS App and other online services.

Case studies

Watch a recording of the  accelerating patient online access Safeguarding webinar  presented by Dr James Higgins and Dr Devin Grey, which focuses on reducing harm and safeguarding risk reduction, including the reporting mechanism for safeguarding incidents and improving efficacy.

Read how one practice successfully launched online access to new record information and supported patients whose first language is not English. 

Westbourne Medical Centre switched on patient access to records on 1 March 2022 and was one of our 16 early adopter sites that have worked with us to share their learning, lessons, and the benefits of general practice record access.

Boughton Health Centre have been providing detailed coded access to patient records since 2015.

They are now supporting even more patients to access their records as part of the Accelerated Citizen Access to GP Data programme, as an early adopter pilot site.

Paxton Green (EMIS) is a large practice in London, serving approximately 19,000 patients. In May 2022, it became one of 16 practices to enable online access to prospective record entries as an early adopter (pilot site).  

It had previously offered historic access to all patients upon request but since switching on access 97% of its patients with online accounts now benefit from automatic access to their prospective records. Aeira Marsh, IT Operations Manager, was heavily involved in work to ensure that patients who might be at risk or harm or distress from being given automatic access to their online records were safeguarded.

A selection of webinar recordings which include primary care colleagues who have shared their experiences of giving patients online access to their new health record information, enabling online record access and safeguarding patients. 

Watch a recording of the 5 October General Practice webinar  which included a presentation by Dr Muhammad Akhtar a GP in Morecambe.  The time stamp is 22.50 for the programme update and 26.47 for Dr Akhtar's presentation (requires NHS Future account). 

Watch a recording of the  accelerating patient online access Safeguarding webinar  presented by Dr James Higgins and Dr Devin Grey, which focuses on reducing harm and safeguarding risk reduction, including the reporting mechanism for safeguarding incidents and improving efficacy.  You will require a NHS Futures account to view. 

A TPP-focused webinar on enabling online record access and safeguarding patients.

The session included a discussion between Helen Crowther, National Digital Primary Care Nurse Lead for NHS England, and Dr Tim Caroe, NHS England South East Medical Director Primary Care Transformation and GP at The Lighthouse Medical Practice. This was followed by a presentation from Richard Bowron, business manager, and Jemma Atkinson, practice manager, at Pelton and Fellrose Medical Group. 

The questions from the webinar were collated and have been added to the existing  FAQ document . You can also  watch the recording ,  view the presentation slides  (requires FutureNHS login) and find  further guidance on safeguarding . 

Dr Shammy Noor, GP Partner at Darwin Medical Practice, shares his practice’s experience of offering automatic online health record access, as well as his own experiences as a patient, at the General Practice Webinar in May 2023. Requires an NHS Future account to view.  (10.53 is our programme update and 17.10 for Shammy Noor)

View the early adopter experience webinar  23 March 2023 (requires NHS Future account) and find out how early adopter practices prepared, with top tips for making the process run smoothly. Learn about their different approaches to safeguarding at-risk patients and how improved record access has made a difference to staff and patients.

Patient case studies

Meet some of the patients who access their GP health record through the NHS App and learn more about their stories and why they recommend you use the app yourself. 

Further information

Explore some of the benefits of giving people online access to their health record information via the NHS App.

Our full archive of NHS App blogs.

Last edited: 26 March 2024 2:41 pm

Transformation Directorate

Using digital, data and technology to improve the outcomes of patient care in North West London

Imperial College Healthcare NHS Trust provides acute and specialist healthcare in North West London for around a million people every year. It has five hospitals and over 13,000 staff. The Trust is part of the Imperial College Academic Health Science Centre and the Health Informatics Collaborative, and hosts a biomedical research centre with Imperial College London for the National Institute for Health Research. Imperial is one of the four acute trusts in the North West London Integrated Care System.

The EPR system at Imperial

The critical step of replacing the patient administration system happened in 2014 and clinical modules were introduced in stages between 2013 and 2019. This staged implementation was possible because we were largely replacing paper and not an existing electronic patient record (EPR) system. In contrast in 2019 we collaborated with our neighbouring Trust to switch them to our EPR during one weekend. We use the Cerner Millennium system.

The EPR system in the digital strategy

The North West London Integrated Care uses a seven steps framework to inform its digital and data strategy. The second step is digitising the patient record and, combined with resilient infrastructure, it provides the essential foundation for everything else For example, data from our EPR system goes into:

• the London Care Record for staff for direct care (data sharing)
• the Care Information Exchange portal for patients (patient empowerment)
• the Whole Systems Integrated Care system (population health).

We have been continuously developing the EPR to improve patient safety and care, and clinician and patient experience. This process accelerated when Chelsea and Westminster joined us on the system and will expand again when it becomes a four trust collaboration at the end of 2023.

What the EPR has helped us deliver

Paper free outpatients.

Introducing the EPR took away 80% of the paper in outpatients, and the paper-free project tackled the remaining 20%. Now when adult patients visit our hospitals for outpatient appointments, all of the records held by the Trust relating to the patient are available to clinicians from their computers. Clinical decision making can always be supported by all the information available to the Trust, and the reliance on having the right paper records in the right place at the right time is removed. This has delivered a £1.2m net reduction in the annual budget for health records rising to £2m recurrent by 2023, and has released 1680m2 of hospital space for operational use.

Wireless entry of patient vital signs

Nursing staff routinely take observations like blood pressure, heart rate, temperature and oxygen saturation using mobile bedside monitoring devices. Previously these observations had to be entered manually into the electronic patient record. Now the information goes directly into the patient record over WiFi. This reduces the risk of error, increases patient safety by triggering alerts for deteriorating patients, and saves time. It’s available on wards across the Trust and releases 23,000 hours of nursing time for care every year.

Digital monitoring of foetal and maternal vital signs

Around 10,000 babies are born at Imperial College Healthcare every year. Contractions and foetal and maternal heart rates from cardiotocograph (CTG) devices were previously printed out on rolls of paper and midwives added handwritten clinical observations. These records were hard to share quickly for a second opinion.

The solution was to connect the CTG machines to the EPR system. Maternity staff can now view electronic, graphical displays of heart rates and contractions for all mums and babies on Trust labour wards. They can spot signs of distress and take action quickly, improving patient safety. The data is recorded in the electronic patient record.

Using data to improve care

Clinical data analytics is enabling improvements in clinical practice and better outcomes for patients. Digital sepsis alerts, test bundles and treatment plans were central to an improvement initiative that led to: 

• 71% increase in the likelihood of patients receiving timely antibiotics
• 7% reduction in the chances of a patient experiencing a long hospital stay
• 24% reduction in the risk of death from sepsis.

Analysis of the effectiveness of risk assessments for venous thromboembolism (VTE) demonstrated a clear benefit to patient care from timely risk assessments and preventive treatment where needed.

Care Information Exchange

More than 400,000 patients have access to parts of the hospital health records including appointments, test results and letters via the web or via the NHS app. This helps give patients the information they need more quickly and gives them more of a sense of control over their health and care. All of the data comes from our EPR system.

London Care Record

This gives access to data from North West London GP practices and from the nine acute trusts across London that use Cerner. It is also the way that clinicians access the Urgent Care Plan system. This is invaluable for clinical staff particularly when treating patients who are new to the Trust. One of our consultants reported that she uses the London Care Record for every single patient. The system is available primary and secondary care clinicians from the EPR systems they use every day.

Whole Systems Integrated Care

Whole Systems Integrated Care provides a single integrated care record for clinical analytics, case finding, population health management, research and innovation. The system has coded data from primary, acute, mental health, community and social care providers across NW London. It provides capability to identify cohorts of patients for intervention through interactive dashboards.

By the end of 2023, the 12 hospitals from all four North West London acute trusts will be using the same Cerner digital patient record system. This will deliver significant benefits for the individual trusts:

• reduced payments to the supplier
• improved staff experience for those who work at both trusts
• patient safety benefits with information available to clinicians regardless of which hospital administered the treatment.

And it will support the accelerating collaborative work across the ICS and the transformation of clinical pathways.

Testimonials

Imperial College Healthcare completed its Cerner EPR implementation journey in a series of go-lives over eight years between 2011 and 2019. The global digital exemplar programme allowed us to work in partnership with our fast follower to launch the same system at Chelsea and Westminster in one weekend in 2019. And the journey has not stopped there. By 2024 we will have four acute trusts sharing a single EPR system in North West London.

Kevin Jarrold , Joint Chief Information Officer, North West London Health and Care Partnership, Imperial College Healthcare NHS Trust and Chelsea and Westminster Hospital NHS Foundation Trust

Our Digital by Design programme is supporting the Trust and the wider ICS to exploit Digital Data and Technology and embed a digital culture to deliver better health for life. Our EPR system is absolutely fundamental to that work.

Linda Watts Associate Director of Digital Transformation & General Manager Outpatients & Patient Access, Imperial College Healthcare NHS Trust  

Digital, data and technology are allowing the nursing community to drive improvements in practice and increase patient safety. One of the keys to success is making sure that new digital solutions are always within the context of the EPR system that nurses are using every day.

James Bird Chief Nursing Information Officer, Imperial College Healthcare NHS Trust  

The digital patient record and real-time operational data are now as essential to the front-line clinician and operational teams as the oxygen supply. They are mission critical systems. One example of this is the role of digital and data in our work to improve the speed and effectiveness of our response to suspected sepsis when a digital sepsis alert is triggered. This led to a 24% reduction in the risk of death from sepsis.

Dr Anne Kinderlerer , Consultant rheumatologist and Acute Physician Associate Medical Director

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Medical Centre

• Primary Care

Evaluating the Uptake of the NHS App in England

Azeem Majeed , Professor of Primary Care and Public Health

4 October 2023

Our new study published in the British Journal of General Practice  examines uptake of the NHS App in England. The NHS App was launched in January 2019 as a “front door” to digitally enabled health services, allowing patients to access their personal health information online. With the advent of the COVID-19 pandemic, the app saw a significant increase in downloads, especially with the introduction of the COVID Pass feature. However, the uptake of the app has revealed some important trends and inequalities that need to be addressed.

A comprehensive observational study used monthly NHS App user data at general-practice level in England from January 2019 to May 2021. Different statistical models were applied to assess changes in the level and trend of use of various functionalities of the app, particularly before and after the first COVID-19 lockdown.

Key Findings

Between January 2019 and May 2021, the NHS App was downloaded 8,524,882 times and registered 4,449,869 users. Intriguingly, the app experienced a 4-fold increase in downloads after the introduction of the COVID Pass feature, which allows users to prove their COVID-19 vaccination status. However, the data also revealed disparities in app registration based on sociodemographic factors:

• There were 25% fewer registrations in the most deprived practices.
• Largest-sized practices had 44% more registrations.
• Registration rates were 36% higher in practices with the highest proportion of registered White patients.
• Practices with a larger proportion of 15–34-year-olds saw 23% more registrations.
• Surprisingly, practices with the highest proportion of people with long-term care needs saw 2% fewer registrations.

What This Means

The findings indicate that while the NHS App has proven to be an useful tool, especially in the times of the Covid-19 pandemic, its usage is not uniform across various sociodemographic groups. This raises questions about accessibility and the digital divide, which could ultimately impact the quality of patient care and health outcomes.

Further Steps

While the app has clearly benefited a significant number of people, it’s crucial to understand the reasons behind these patterns of inequalities. Further research is essential to delve deeper into these trends and how they may affect the patient experience.

Understanding these dynamics can guide improvements to the app, making it more inclusive and effective for all users. Policymakers, developers, and healthcare providers need to work together to ensure that digital health services like the NHS App are accessible and beneficial to everyone, regardless of their socio-economic status or demographic background.

The NHS App has seen a considerable increase in usage since the onset of the Covid-19 pandemic, highlighting its essential role in modern healthcare. However, the unequal patterns in its uptake call for a focused approach to ensure it serves as an inclusive platform for all. Further research is crucial to uncover the underlying reasons for these disparities and to work towards a more equitable healthcare system.

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How the introduction of a 'happy app' helped us improve staff wellbeing and patient care

University Hospitals Bristol is one of the largest teaching trusts in England, with seven hospitals in central Bristol and some additional community services. It has 11,500 staff and a significant research programme. When Robert Woolley joined the board in 2002 the trust was in a challenging place, clinically, financially and culturally. Robert took over as chief executive in 2010. Although a 2014 CQC report rated the trust as 'requires improvement', in both 2016 and August 2019 it was judged 'outstanding'. The inspectors in 2016 said there was "a clear statement of vision and values within the trust which was driven by quality and safety". The most recent inspection report notes that "there was compassionate, inclusive and effective leadership at all levels of the organisation." Robert says it was important to change the culture within the trust: "When I took over my role was very much about performance against waiting times and dealing with sensitive inter-trust relationships. "The big change we made that led to the outstanding rating was we started demonstrating a genuine commitment to our staff, their wellbeing, development, and engaging them in improvement." A key priority has been to ensure that when staff do record concerns about care, they receive feedback on the outcomes of that inquiry. "It's that team endeavour that matters to me personally. We are well away from the model of heroic leadership. It’s a team enterprise. "CQC asked me in 2016 if we’d adopted policies from other centres or from America. The answer is 'no'. We’ve just grown it ourselves. We’ve made mistakes, but we own it. It’s ours."

Because I'm happy

It's been nearly four years since two doctors – Anne Frampton and Andrew Hollowood – came up with the idea of measuring staff satisfaction in order to improve patient care. "We realised if we could unpick staff frustrations – the issues affecting staff on a daily basis – the likelihood was that we would improve the care of the patients, simply by improving staff wellbeing," says Andrew.

We realised if we could unpick staff frustrations – the issues affecting staff on a daily basis – the likelihood was that we would improve the care of the patients, simply by improving staff wellbeing. Dr Andrew Hollowood    

Supported by the trust management team, they devised a spreadsheet which they tested on the children's ward, where Anne was a consultant, and on a surgical ward. Andrew is a consultant surgeon specialising in oesophageal cancer, but was also a clinical lead in the trust. "We had a hunch people might use it but we didn’t know, so we started small rather than a big bang approach" says Anne. Staff could input anonymously about their feelings and concerns that day, then she would download the comments daily and respond on a chart on the ward. The concept was backed by the Academic Health Science Network, which helped to set up and evaluate the project. It soon proved a success with staff, and the approach has now transferred to an app on an iPad, used by 180 teams across the trust. The Happy App has emojis of a sad, neutral or happy face. Staff responses are anonymised, with free-text comments to explain the mood. "It rapidly spread across the whole organisation," says Andrew. "We saw benefit in engagement scores year-on-year. Individuals' voices were being heard. It became a smoke detector for the organisation."

It rapidly spread across the whole organisation. We saw benefit in engagement scores year-on-year. Individuals' voices were being heard. It became a smoke detector for the organisation. Dr Andrew Hollowood    

One change it brought about was the way porters in theatres are regarded, following comments about how they supported the team. They have now taken on expanded roles at a higher banding. Another change was in the children's A&E. It was often overcrowded, but little had been done about it because there had been no discernible patient harm. The feedback from the Happy App showed the impact on staff, who felt overwhelmed and unhappy. These staff comments led to changes, such as a snack trolley in the evening for patients, a bigger waiting area, and additional nursing assistants. It is not possible to draw a direct correlation between the success of the app and staff engagement statistics. However, the trust’s staff engagement score has increased each year in the annual national NHS staff survey over the last five years. This rose from 6.7 out of 10 in 2014 to 7.2 in 2018. Patient satisfaction has also improved over that period. The trust received the best overall hospital experience score of all general acute trusts in CQC's national adult inpatient survey 2018. The score rose from 8.1 out of 10 in 2014 to 8.5 in 2018.

The feedback from the Happy App showed the impact on staff, who felt overwhelmed and unhappy. These staff comments led to changes, such as a snack trolley in the evening for patients, a bigger waiting area, and additional nursing assistants.    

While this can't necessarily be attributed to improved staff satisfaction, research has shown that staff and patient satisfaction are closely correlated. The Happy App has now spread to other trusts in the area. "The support for the project has been phenomenal," says Andrew. "You are heard, listened to and encouraged." This case study demonstrates the way that trusts can use technology innovatively to listen to their workforce, really hear what they have to say, and act on their feedback to make improvements to the staff experience which in turn, drives quality improvement for patients. The use of technology will play an essential part in helping to address workforce challenges across the sector by helping to improve staff retention and make the NHS a more modern, flexible and innovative place to work. Technology offers leaders another route to connect directly with staff on the frontline and remain in touch with their concerns and ideas to improve the way care is delivered. We are seeing examples of this innovation across the provider sector such as e-rostering, digital staff banks, sharing and accessing data across teams and professions and reducing administration. 

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Educating the next generation around health apps

Educating the next generation around health apps. We live in a digital world and none are more digitally savvy than our young people.

Ambiguous advice, questionable quality: How a lack of development & evaluation standards is preventing the potential of health-apps

If you can think of an ailment, concern, or...

COVID-19 Quarterly Digital Health Trends

We share our data insights from the first quarter...

Apps for Remote Physiotherapy

Apps for Remote Physiotherapy. Learn more about apps for remote physiotherapy that have scored well in ORCHA's Review.

Digital Health for Winter Pressures

Our latest insights on how digital health can help...

GP Demonstrates 3 Apps for Managing Heart Health at Home

GP Dr Tom Micklewright discusses his views on three apps for managing heart health that have scored well in ORCHA's Review.

Important Standards and Regulations for App Developers

Important standards and regulations for app developers. Making staying up to date with the latest app regulations and standards easier for you so that your apps can provide the best customer experience, whilst also meeting the standards required for safe, ethical and high-quality apps.

App Regulation: Care Quality Commission

App Regulation: Care Quality Commission. Staying up to date with the latest app regulations and standards is essential for app developers.

App Regulation: GDPR

App Regulation: GDPR. As a developer, staying up to date with the latest app regulations and standards is essential.

Top Tips for App Developers: Goal Setting

How to use goals to increase engagement

Top Tips for App Developers: Navigation

Top Tips for App Developers: Navigation. To help app developers produce the best apps, we’re sharing tips to help to set your app apart from the rest!

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News and Events

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Raising Awareness of Self Harm

Over the last week colleagues at ORCHA have been looking at the impact digital health solutions have had in this sadly growing area of need.

Humber and North Yorkshire Swap and Stop Campaign

The Swap and Stop Case Studies evidences the impact of the recent campaign across Humber and North Yorkshire to encourage Quit attempts during the month of January.

Introducing the OIDPM Badge

ORCHA, in collaboration with Alpha MD, is delighted to unveil the ORCHA India Data Protection Mark (OIDPM). This innovative badge marks a significant milestone in the response to the Indian Digital Personal Data Protection Act 2023.

Elevate Cancer Care through Digital Transformation

ORCHA is on the lookout for visionary partners who want to lead the charge in crafting ground breaking digital models for cancer care using health apps.

ORCHA and Alpha MD Forge Strategic Partnership to Revolutionise Digital Health Delivery in India 

ORCHA, the Organisation for the Review of Health and Care Apps, and Alpha MD, a leading player in healthcare innovation, are proud to announce a strategic partnership aimed at shaping and supporting digital health delivery in India.

 We hope the Government reconsiders its decision

We are surprised by the Government's decision to reject a straightforward recommendation – an accreditation scheme for third-party healthcare apps verified by the NHS.

 PainDrainer™ wins first Nordic Best Health App Award

The Swedish health app PainDrainer™, a digital self-management device designed for individuals suffering from chronic pain, has won the inaugural Nordic Health App Award.

Top 5 FAQs – Clinical safety standards NHS Digital Technology Assessment Criteria (DTAC) 

Your questions answered: clinical safety requirements to pass the NHS Digital Technology Assessment Criteria (DTAC), Clinical Safety Officers and DCB0129.

MedConnect North

Dr Tom Micklewright, Medical Director, ORCHA, will be speaking at MedConnect North

ORCHA are exhibiting at HETT 2023

ORCHA launches SAFE APPS campaign to help consumers choose safe digital health apps

Guidelines to choosing safe, high-quality health apps from the Organisation for the Review of Care and Health Apps (ORCHA).

Health and Social Care Committee Calls for Central Systems to Ensure Safe Third-Party Health Apps 

Following the inquiry into digital transformation in the NHS, the cross-party Health and Social Care Committee has now published its recommendations. Read our response.

Digital health attitudes and behaviour report 2023

To better understand the nation’s true opinions on digital mental health support, ORCHA commissioned independent research to ask 2,000 UK residents what they think.

Revolutionising Healthcare: Clinical Leads Discuss the Future of the NHS and Digital Health 

Find out what our clinical leads think about digital health and the crucial role it has to play to help alleviate pressures on the NHS.

Mental Health Commission of Canada Launches Digital Mental Health Framework

Our partner, The Mental Health Commission of Canada has launched its digital mental health app assessment framework.

ORCHA Welcomes Pete Rowse as New chairman

It is our great pleasure to announce that Pete Rowse has been appointed as our new Chairman. On behalf of the entire ORCHA team, we extend a warm welcome and are thrilled to have him on board.

Digital Health in the UK Attitudes and Behaviours Report 2023

A new ‘Patient and Public Involvement and Engagement’ Digital Health Academy learning module has been created to support the development and delivery of patient-centric technologies

Liz Ashall-Payne, founding CEO, will be moderating a session at HIMSS 2023.

HealthTech Integrates

Paul Weston, Reviews and Accreditations Director, will be speaking at HealthTech Integrates.

World Heart Summit

Alison Johnson, SVP of Customer Success and Projects, will be speaking at the World Heart Summit on 21st May.

HFMA North West Conference

Liz Ashall-Payne, Founding CEO, will be speaking at HFMA North West Branch 2 day Annual Conference 2023.

NHS ConfedExpo

ORCHA will be exhibiting at ConfedExpo, stand A21.

Med Tech Innovation Expo

Ryan Palmer, ORCHA VP of Developer Sales, will be speaking at Med Tech Innovation Expo on 7th June at 2:30-3pm.

We’re bridging the gap between health innovators and patients

The budget: a spring forward for digital health.

Following the rapid growth of the digital health sector, healthcare professionals and citizens now have distinct and different needs from their health app libraries – and so ORCHA has created products exactly tailored for each of these two audiences.

The UK’s first Digital Health Formulary and a Health App Library just for citizens

International summit on public health and preventative medicine.

Liz Ashall-Payne, Founding CEO at ORCHA, will be a keynote speaker at the International Summit on Public Health and Preventative Medicine

LSX World Congress

Liz Ashall-Payne, Founding CEO at ORCHA, will be speaking for the Closing Keynote Panel: How do we build trust in Digital Technology, AI and Data Use

Maydens Digital Showcase 2023: Tech solutions for CYPMH services

Paul Weston, Review and Accreditations Director at ORCHA, will be speaking at Mayden's Digital Showcase 2023: Tech solutions for CYPMH services

Bridging the Gap – South West Academic Health Science Network

ORCHA will be exhibiting at Bridging the Gap - South West Academic Health Science Network

Digital Health Rewired

Liz Ashall-Payne, Founding CEO at ORCHA, will speak at Digital Health Rewired.  ORCHA will be exhibiting at Stand Number: A15

600,000 A&E Admissions Could be Prevented with a Nationwide Deployment of Key Digital Health Products in Primary Care

Researchers at ORCHA and the University of Warwick have identified that digital health products such as health apps could make a substantial contribution to tackling NHS urgent care pressures, by keeping patients out of hospital in the first place. 

ORCHA at the Health and Social Care Select Committee

ORCHA was invited to the Health and Social Care Select Committee to discuss the steps that will help the NHS accelerate its digital transformation. 

Digital health sector will take advantage of landmark new UK-Australia Free Trade Agreement 

Digital health companies ORCHA and Cogniss have announced a global partnership that will benefit from the new UK-Australian Free Trade Agreement (FTA) which has just passed through the UK House of Commons and is anticipated to come into effect in 2023.

First thousand frontline workers complete ORCHA training academy

One thousand delegates from across the NHS and care sectors have logged onto the new ORCHA Digital Health Academy and completed foundation training modules.

New research shows diabetes health apps can help patients reduce blood sugar levels

New published research finds that diabetes-specific health apps reduce long-term blood sugar levels in patients with Type 1 diabetes, Type 2 diabetes, and prediabetes.

His Majesty The King invites ORCHA to Buckingham Palace

The event, initiated by King Charles, will recognise and celebrate the contribution of small businesses to the UK economy.

New study into liver disease shows doctors recognise the potential of digital health interventions

Healthcare professionals involved in a new research project believe that digital health interventions can help patient care management.  

Digital for mental health attitudes and behaviour report 2022

Digital health attitudes and behaviours report 2022.

ORCHA has commissioned independent research to ask 2,000 UK residents what they think of digital health.

Data security of period tracking apps

The assessment team at ORCHA has examined the privacy policies of 25 period tracker apps and revealed significant flaws.

Liverpool Metro Mayor opens ORCHA’s new offices at Sci-Tech Daresbury

Metro Mayor of the Liverpool City Region, Steve Rotheram, visited ORCHA on 24 October, to meet the team and celebrate its extensive new premises.

ORCHA’s founding CEO presented at the United Nations yesterday

Liz Ashall-Payne, founding CEO of ORCHA, presented yesterday at a United Nations symposium on digital health, streamed by UNESCO to 150 countries.

Hull patients to benefit from collaboration between Patients Know Best and ORCHA

Patients using the Patients Know Best portal to access their medical records and interact with the professional teams will be offered several opportunities, via the platform itself, to get free access to an ORCHA digital health library containing hundreds of highly rated health apps.

How do you best measure the usability of a digital health product?

ORCHA's research team collaborated with Ulster University on a piece of research to discover whether the System Usability Scale can be used to reliably assess the usability of digital health products.

ORCHA celebrated as one of UK’s top 50 HealthTech companies

ORCHA celebrated as one of UK's top 50 HealthTech companies .

A Level and GCSE results are due – here are five apps to help teens cope

ORCHA has selected five mental health apps which could help anxious teenagers as they wait for their A Level and GCSE results (due on 18 August and 25 August).

Digital health products to help the NHS catch up with routine health checks

Public Health England commissioned ORCHA to produce a report that identifies a series of digital health products which can safely and effectively assist healthcare professionals and patients with the NHS Health Check.

84% of period tracker apps share data with third parties

Experts reveal an industry-wide issue with where and when users of period tracking apps are asked for their permission to share their data.

ORCHA’s response to the Government’s first ever Women’s Health Strategy, published today

Statement from Liz Ashall-Payne, founding CEO, ORCHA

ORCHA’s response to the Government’s first digital health and care plan, published today

‘tipping point’ reached as public say they prefer health apps to antidepressants to support mental health conditions.

Consumer research published on 9th May 2022 reveals that people aged from 18 to 44 years old would choose digital health to support a mental health condition over and above prescription medication, such as an antidepressant

The world’s first cross-border digital health accreditation system to be launched at HIMMS Europe

The Nordic region aims to be the most integrated health region in the world by 2030, according to the Nordic Council of Ministers. A shift towards digital health, and its focus on the self-management of health by Nordic populations, will be an important step on this journey, but it also brings new risks

Government: 75% of adults to be using NHS App by March 2024. But how is the nation responding to this health revolution at our fingertips?

As the government sets ambitious targets for the use of the NHS App, independent research into the nation’s use of health apps asks, for the first time, whether health apps are actually helping us self-manage our health – and the result is ‘striking’

ORCHA’s Founding CEO contributes to The Economist’s Technology Quarterly

Liz’s contribution discusses the appetite for digital health, and the quality of health and care apps that are available

New Digital Health Assessment Framework Launches in the US

ORCHA collaborate with major U.S. Bodies in delivery of a new U.S. framework for assessing digital health technologies.

ORCHA expands Clinical Advisory Team

To ensure patient safety and professional fit and function remain at its forefront, ORCHA has appointed GP and digital health expert Tom Micklewright as Clinical Director

New website provides reliable health apps to Sefton

People in Sefton can now help themselves to live healthier, happier lives using accredited health applications included on sefton.orcha.co.uk. 

UK’s first digital health training programme for all NHS frontline staff

UK’s first digital health training programme for all NHS frontline staff: the Digital Health Academy, with support from Health Education England, brings a massive boost of digital health skills

Cwm Taf Morgannwg University Health Board to partner with leading digital health app review and distribution company

Patients who are supported by the Wellness Improvement Service (WISE) at Cwm Taf Morgannwg University Health Board will soon have personal access to a Digital Healthcare Library.

ORCHA’s Liz Ashall-Payne named Entrepreneur of the Year at Women in IT Awards

The founding CEO of ORCHA, Liz Ashall-Payne, has been named Entrepreneur of the Year at the Women in IT awards

ORCHA insights inform Policy Exchange report

ORCHA insights inform Policy Exchange report. The report proposes the need to reform general practice and enable digital healthcare at scale

Public Sector Insight Week

Alison Johnson, Head of Programmes and Projects at ORCHA, will present on: Upskilling the workforce for efficient digital health transformation.

Get in touch to meet with ORCHA at VIVE.

HIMSS Global Conference

Get in touch to meet with ORCHA at HIMSS Global Conference 2022

Two ICSs set to pilot a new digital health Elective Care Toolkit

Two NHS Integrated Care Systems (ICSs) are piloting a new digital health Elective Care Toolkit designed to support overstretched NHS staff

Loneliness: Praise for health apps which offer social interaction

We need to give loneliness the attention it deserves, particularly at this time of year when those sufferers can experience it even more. Try digital health to beat loneliness this year.

ORCHA partners with Best For You – transformative mental health care for children and young people

ORCHA is very proud to announce a partnership with Best For You: a new initiative from leading NHS organisations that will transform mental health services for children and young people.

Web-based internet searches for digital health products in the United Kingdom before and during the COVID-19 pandemic: a time-series analysis using app libraries from ORCHA

We explored if consumer interest in digital health products (DHPs) changed following the COVID-19 pandemic and the lockdown measures that ensued

Barriers and Facilitators to the Adoption of Mobile Health Among Health Care Professionals From the United Kingdom: Discrete Choice Experiment

Despite the increasing availability of mobile health services, clinical engagement and use of health-apps remains minimal. This study aimed to identify and prioritise barriers to and drivers of health app use among health care professionals (HCPs) from the United Kingdom

The role of health-care providers in mHealth adoption

We interviewed groups of digital health experts, practice nurses, allied health professionals, secondary care doctors, and general practitioners to determine the factors important to health-care providers for considering the recommendation of DHTs to patients

Effective? Engaging? Secure? Applying the ORCHA-24 framework to evaluate apps for chronic insomnia disorder

In this study we assessed the quality of apps for chronic insomnia disorder, available on the Android Google Play Store, and determine whether a novel approach to app assessment could identify high-quality and low-risk health apps in the absence of indicators such as National Health Service (NHS) approval

Comparing applets and oranges: barriers to evidence-based practice for app-based psychological interventions

Published in: BMJ Evidence-based mental health: Comparing applets and oranges: barriers to evidence-based practice for app-based psychological interventions. Poor-quality pharmaceuticals and medical devices rarely make it to market; however, the same cannot be said for app-based interventions

App-based psychological interventions: friend or foe?

Health-apps are one solution the NHS has recommended to fill the gap between patient need and he capacity of incumbent NHS psychological services

The Daily Telegraph features ORCHA research

During the summer we surveyed 2000 consumers to find out more about how they were using health apps

BMJ Open study shows significant & sustained interest in digital health products throughout lockdown

Research scientists led by Simon Leigh, head of research at ORCHA, have examined web-based internet searches for digital health products before and during the COVID-19 pandemic

On World Mental Health Day, ORCHA reports that the use of mental health apps is still on the rise

Since the start of the COVID-19 pandemic, ORCHA’s researchers have been watching trends in the use of digital health for mental health support

ORCHA reconfigures its services to support developers from start to finish

Developers of digital health products can now have a partner to lead them through every step of the planning, accreditation, certification and distribution process for their innovation

Get DTAC ready at HETT…and save 10%

To accelerate the adoption of the DTAC across NHS and Social Services, we are offering a 10% discount on ORCHA DTAC reviews booked at HETT

The Pharma Industry Highlights the Potential for digital apps

'App development is a golden opportunity - but pharma companies need to be wary'. Pharma industry highlights potential for digital apps

Join Us at HETT21: You’re invited to the ORCHA Digital Patient Zone – Register Today!

Get DTAC ready, meet top scoring digital health suppliers, hear about our new products and so much more...

Get Active and win a FitBit with our ORCHA Digital Health App Finder

ORCHA is holding a competition for AHPs who are ORCHA Pro License holders, to run alongside the yearly Twitter We Active Challenge

Clear Mind Project: Teen boys help other teens find mental health support

A group of teenage boys are working together to figure out how technology, in the form of health apps, can support their peers through tough times

ORCHA speaks at European mHealth Hub’s Hub Talks 2021: Digital Health Assessment Frameworks

Discussing European digital health assessment frameworks, including projects that ORCHA has worked on in the Nordics, Netherlands and Israel

How do Digital Health Standards Assess Evidence?

An international snapshot of how evidence is defined around the world

Patients Seek Digital Health to Reduce Pressure on the NHS

ORCHA commissioned research to ask people in the UK what they think of digital health

Digital Health and Care Alliance Webinar: ORCHA, app assessment, and the future

Join ORCHA CEO, Liz Ashall-Payne, and MD, Lloyd Humphreys, for this Digital Health and Care Alliance Webinar: ORCHA, app assessment, and the future.

Dubai Health Centre to spearhead growth of digital health in UAE

Citizens and expats based in Dubai will have access to the Middle East’s first digital health library, thanks to a ground-breaking partnership between the Osteopathic Health Centre, Dubai, and ORCHA.

Feeling Good passes the new NHS DTAC

Feeling Good is amongst the first products to become compliant with the new NHS DTAC

SilverCloud Head of Europe joins ORCHA as MD

Dr Humphreys joins the ORCHA team following a period of accelerated growth for the organisation

ORCHA’s digital health insights featured in national newspapers

Only around 20% of health and care apps are safe, secure, and meet clinical standards

ORCHA featured in the DIT’s ‘First 100’ Digital Health Playbook

The campaign, launched by the Department for International Trade (DIT), articulates the exportable strengths that the UK has in healthtech.

Digital Medicine Technologies for Mental Health & Stress Management: Video

ORCHA's Business Development Manager George Kowalski discusses digital health solutions for mental health and stress management.

Derbyshire Public Health spearheads digital revolution in wellbeing services

Derbyshire County Council has joined forces with ORCHA on an ambitious long-term project to embed the use of health apps and online tools into its services.

Which digital for mental health recovery action plans?

Our mental health report lists 5 top quality apps to help with: anxiety, depression, teen mental health and self-harm.

Digital health for cancer services: Report

Find out how digital health can help in cancer services

365 days since lockdown

Exploring the milestones in digital health since 16 March 2020.

WeAreTechWomen 2021

Join us on May 11-13 for what will no doubt be one of the most exciting events for women in tech this year. 

Health apps for long COVID self-management: Report

Discover the impact of long COVID in services today

ORCHA features in BBC News article: ‘Most healthcare apps are not up to NHS standards’

Under which criteria do many apps fall down?

Check your app against the NHS DTAC

What does the DTAC mean for digital health reviews?

New ORCHA V6 Review Incorporates the Latest Standards

New ORCHA V6 Review incorporates the latest standards. From today, ORCHA Libraries only display Reviews using this new criteria

ORCHA Co-Authors Mental Health Research Paper with the University of Cambridge

'Early warning signs of a mental health tsunami: A coordinated response'

Join ORCHA at HETT Reset 2021

Join ORCHA at HETT Reset 2021. The UK’s Leading Healthtech and Digital Health Event. Live and Online.

Digital in Weight Management Services: BDA and ORCHA Report

Report, developed with The Association of UK Dietitians (BDA), shares best practice on digital health in weight management services.

Can you help ORCHA recruit its exec team and 100 new positions?

ORCHA is looking to grow its team by more than 100, starting with a number of board-level executive positions, to find the brightest talent in its next phase of growth.

COVID-19: Digital Health Trends & 2021 Opportunities Report

What digital health trends emerged in 2020 and what is predicted for 2021?

MindTech 2020: The changing appetite for psychological mHealth solutions

Health Economist Simon Leigh presents his research and findings into the appetite for psychological mHealth solutions.

Open call for products capable of delivering NHS Digital Health Checks

If you have a product that can help with NHS Digital Health Checks, we want to hear from you!

ORCHA Published in Healthcare Enablers 2020

We are proud to have contributed to Healthcare Enablers 2020. The book explores how we can work together to make healthcare technology an integral part of our healthcare system.

Behaviour change: digital health interventions

Our latest news roundup.

ORCHA CEO features in UK-Japan Symposium on Data-Driven Health

Read the full write-up of the key messages to emerge from the conference, featuring Liz Ashall-Payne’s insights.

Join us at Virtual HPN Expo 2020

Join us at Virtual HPN Expo 2020. We are delighted to be a media partner for Virtual HPN Expo 2020. Register to join us at the event.

On-demand CPD webinar: Augment mental health services with digital health

On-demand CPD webinar: Augment mental health services with digital health.

ORCHA works with Nordic Innovation to launch Nordic Digital Health & Medication Platform

ORCHA works with Nordic Innovation to launch Nordic Digital Health & Medication Platform for health app accreditation and distribution.

ORCHA features in Waitrose Weekend Newspaper: Get fit with your phone

American telemedicine association partners with orcha to launch review process in the u.s..

American Telemedicine Association partners with ORCHA to launch digital health review process in the U.S.

ORCHA approved as a digital marketplace supplier on the government’s G-Cloud 12

ORCHA’s platforms and services have now been approved on the Government’s Digital Marketplace G-Cloud 12 framework.

ORCHA CEO featured in OBI Property’s HealthTech Roundtable

How can HealthTech power the North in a post-COVID...

Digital Healthy Schools: welcome back!

Digital Healthy Schools: welcome back! Help to support your students with their return to school, focusing on their mental health.

ORCHA partners with NHS London Procurement Partnership

Developed in partnership with ORCHA, NHS London Procurement Programme’s Dynamic Procurement System allows NHS organisations to rapidly procure digital health solutions at scale.

Task group driving digital health readiness

A new group has been formed to drive forward...

British Lung Foundation launch technology hub to support people with lung conditions

British Lung Foundation launch technology hub, supporting people with lung conditions to use technology to help manage their condition better at home.

The Association of UK Dietitians Launches App Library

The Association of UK Dietitians launches App Library to help people to access wellbeing help during COVID-19.

NeLL & ORCHA to optimize App Checking Process

NeLL & ORCHA to optimize app checking process. The organisations are planning to bring together their expertise to provide guidance on the digitalisation of care pathways.

Is Digital Health in your Return to School Plan?

Is Digital Health in your Return to School Plan? An increasing number of schools are using digital health as a proactive measure to support their students' mental and physical health.

How to access your Digital Healthy Schools app library

How to access your Digital Healthy Schools app library. Empower young people to embrace and responsibly use apps to support their own health and wellbeing. 

COVID-19 App Developers Discover Loophole in App Store Regulations

How have app developers been bypassing app store security?

Northern Ireland Health Minister Announces New Health App Library Launch

We are proud to support Northern Ireland’s new Health...

A rise in UK health and care services introducing an App Library

As the NHS, social care organisations, and local authorities, continue responding to the COVID-19 crisis, ORCHA is seeing a growing number introducing bespoke App Libraries to help their patients, professionals and service users find the best health and care apps at this time.

ORCHA Launches COVID-19 Health App Formulary

ORCHA today launches a COVID-19 health app formulary to help healthcare professionals and consumers know which health apps they can trust.

GP Demonstrates 3 Apps for Remote Asthma Management

Dr Tom Micklewright discusses his views on three apps...

Apps to help the vulnerable

Apps to help the vulnerable. We are running a series of webinars to help health and care workers learn about which apps can provide the best support to their vulnerable communities

Coronavirus: Apps to help the elderly

How can health and care apps keep pressure off...

Coronavirus: Apps to help children and young people

Coronavirus: Apps to help children and young people. As schools across the UK close to most children, 8.2 million young people will now be kept at home. 

Digital Healthy Schools: Your Questions, Answered

Saira Arif answers our most frequently asked questions for the Digital Healthy Schools programme.

5 minutes with… Ms Claire Parkinson

5 minutes with Ms Claire Parkinson, Associate Assistant Headteacher at Ashton Community Science College, about how her school has found the Digital Healthy School programme.

Coronavirus: Apps to help self-management

Apps to support self-care for all during COVID-19

NHS LPP adds 5 new categories to Dynamic Purchasing System

Best health apps for sleep.

Top-scoring apps to help patients improve sleeping patterns

February/March News Digest

February/March ORCHA News Digest. The most significant digital health market developments from the past month.

March 2020 Digital Health Events

March 2020 digital health events. If you want to attend an event to stay abreast of the market, here are the events we recommend attending.

How is ORCHA Unlocking the Power of Digital Health?

Want to know more about ORCHA? Watch this two minute video to find out more about how we work with organisations and health bodies worldwide to unlock the power of digital health!

Webinar Catch-up: Building an App Library for People Living with Dementia

Webinar catch-up: Building an App Library for People Living with Dementia. Watch again and download the slides.

Workshops: Beyond Algorithmic Systems and Trust

Workshops: Beyond algorithmic systems and trust. Join our workshop with commissioners of mental health services.

ORCHA to Sponsor SEHTA’s International MedTech Expo

ORCHA to sponsor SEHTA's International MedTech Expo. Come and join us to meet other like-minded SMEs in digital.

Global Health App Evaluator, ORCHA, Exhibits Apps Library at Arab Health 2020

Global health app evaluator, ORCHA, exhibits apps library at Arab Health 2020, as part of the Academic Health Science Networks (AHSN).

January 2020 Digital Health Events

January 2020 digital health events. If you want to stay abreast of the market, here are the events we recommend attending.

New Year News

ORCHA New Year News. Keep up to date with the most significant digital health market developments. Accurate, impartial and up to date advice on finding the best health apps.

3 apps for New Year’s Resolutions

ORCHA tests more apps than anyone else. Here are hree top-scoring apps that will help kick-start New Year's resolutions.

ORCHA in Top 20 North West ‘Companies to Watch out for in 2020’

We’ve been named one of the region’s most exciting...

Accessible Apps: Which Languages are Most Supported?

Accessible apps: Which languages are most supported? What are the top 5 most supported languages for apps on ORCHA’s App Library?

ORCHA CEO elected for techUK Health and Social Care Council

ORCHA CEO elected for techUK Health and Social Care Council to help techUK represent the healthtech industry in its totality.

Commonwealth Centre for Digital Health to Launch Safe mHealth Platform with ORCHA

A digital future in Uganda and across the Commonwealth

ORCHA Highly Commended in Business Culture Awards

ORCHA highly commended in Business Culture Awards. The Business Culture Awards recognise those companies who have taken notable steps to creating a stand-out business culture.

Diet and Weight Loss Apps Rating Map

Three key takeaways revealed

New EU Medical Device Regulations Seminar

New EU Medical Device Regulations seminar with ORCHA and SEHTA. Are you prepared for the changes coming into effect soon?

November Digital Health Events

November digital health events. If you want to attend an event to stay abreast of the digital health market, here are our recommendations.

Latest news from ORCHA!

Latest news from ORCHA! The most significant digital health market developments from the last month from our team of experts.

3 Top Apps for Women’s Health

Take a look at our videos

ORCHA a Partner for Digital Health Society Summit

ORCHA a partner for Digital Health Society Summit, held on the 11th and 12th December 2019 in Helsinki, Finland.

ORCHA App Zone showcases the ‘need to know’ health apps

ORCHA curated and hosted an App Zone at HETT19, a conference that unites NHS digital leaders with health technology suppliers.

Video: NHS London Procurement Partnership launches purchasing system for health apps

Watch the video with NHS LPP

ORCHA and NeLL: working together on the international development of reliable digital care

Optimally integrating digital healthcare applications into existing healthcare processes

Applying Solutions to the NHS: An Interview with Liz Ashall-Payne

What is ORCHA's solution to the digital health challenges of awareness, access, trust and governance? An Interview with CEO Liz Ashall-Payne

NHS London Procurement Partnership invites tenders for health and social care apps

NHS London Procurement Partnership introducing a Dynamic Purchasing System (DPS) for mHealth applications, enabling a streamlined and compliant route to market.

Mental Health Apps Rating Map

What are our three key takeaways?

Launching ORCHA Connect

Launching ORCHA Connect. Our ORCHA Connect service will introduce you to a suitable specialist supplier proven to deliver results to developers.

Top 3 Dementia Apps

Exploring the role health apps can play in managing...

ORCHA at NHS Expo 2019!

ORCHA at NHS Expo 2019! Find us in the AHSN Network Innovation Exchange Zone, where we will demonstrate ORCHA’s Solution for trusted mHealth adoption.

MIND appoints ORCHA to address the Dutch ‘jungle’ of health apps

MIND appoints ORCHA to address the Dutch ‘jungle’ of health apps. MIND wants to ensure people are better informed about the quality and functionality of apps so they can make a choice from the entire range more easily

ORCHA to host App Zone at HETT 2019

ORCHA to host App Zone at HETT 2019, with 12 app developers with top scoring apps on ORCHA’s extensive App Library.

Blood Pressure Apps Rating Map

Blood pressure apps rating map. ORCHA reviews more than 120 of the market’s most downloaded heart and blood vessels apps.

3 Apps to Tackle Summer Pressures

ORCHA tests more apps than anyone else. Here are three top-scoring apps that are designed to help people better manage their health in the summer months.

ORCHA Launches User Experience Project with App Developers

ORCHA has been awarded a grant by Innovate UK, enabling ORCHA to work with app developers and health bodies to develop a new, effective industry standard for measuring User Experience.

What are ORCHA’s Best Diabetes Apps?

Five top-scoring diabetes apps

Femtech Apps Rating Map

Results revealed in a 3D map

Dementia Apps Rating Map

Insights into the dementia apps landscape

ORCHA Approved as a Digital Marketplace Supplier on the Government’s G-Cloud 11

Find out what this means and how to engage

Our Chapter in SEHTA’s ‘2019 Accessing the NHS Guide’

Advice, understanding and knowledge for health technology SMEs wanting...

New ORCHA Health App Quality Mark

New ORCHA Health App Quality Mark. Look out for these badges and then read our review to get the full picture.

What are the best pregnancy apps?

What are the best pregnancy apps? Want to find the best pregnancy apps but don’t know where to start? ORCHA is your trusted health app guide.

CEO Liz Ashall-Payne Discusses ORCHA’s Review Accreditation Engine in HIMSS Interview

CEO Liz Ashall-Payne Discusses ORCHA’s Review Accreditation Engine in HIMSS Interview with consultant John Crawford.

Research in npj Digital Medicine journal parallels ORCHA’s vision for validated health apps

Featured in international journal, npj Digital Medicine, a study into digital health validation solutions by American research university, Johns Hopkins University and its affiliates, directly parallels ORCHA’s vision for validated health apps.

Brian O’Connor Appointed Chair at Health App Watchdog ORCHA

ORCHA, is delighted to announce the appointment of shareholder, director and investor Brian O’Connor as Non Executive Chairman.

eGP Learning Reviews ORCHA!

eGP Learning Reviews ORCHA! eGP Learning provides a range of services to help with technology-enhanced primary care and learning.

ORCHA Published in The Lancet Digital Health

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• Volume 13, Issue 5
• Benefits, challenges and sustainability of digital healthcare for NHS Wales: a qualitative study
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• http://orcid.org/0000-0001-9823-4822 Gemma Johns 1 ,
• Bethan Whistance 1 ,
• Anna Burhouse 2 ,
• Sara Khalil 1 ,
• Megan Whistance 1 ,
• Saiba Ahuja 1 ,
• Mike Ogonovsky 1 ,
• http://orcid.org/0000-0003-2658-2021 Alka Ahuja 1 , 3
• 1 Informatics, Technology Enabled Care Cymru , Aneurin Bevan Health Board , Gwent , UK
• 2 Director of Quality Development RUBIS. Qi Northumbria Healthcare NHS Foundation Trust , The Health Foundation , London , UK
• 3 Specialist Child and Adolescent Mental Health , Aneurin Bevan University Health Board , Newport , UK
• Correspondence to Gemma Johns; gemma.johns3{at}wales.nhs.uk

Introduction Digital healthcare in the UK was adopted out of necessity rather than choice during the COVID-19 pandemic. However, as we move forward, UK governments and healthcare services have acknowledged its evident benefits for patients, staff and the National Health Service (NHS), and are keen to sustain its improvements in the long term.

Objective To understand the benefits, challenges and sustainability of a future-proof digital healthcare.

Design A semi-structured interview study was conducted.

Setting In NHS services in Wales, UK.

Participants With clinical and non-clinical staff across a mix of clinical specialties.

Outcome measures Semi-structured interviews were conducted to address benefits, challenges and sustainability of a national video consulting (VC) service, and thematically coded using a quantification method of qualitative work.

Results A total of 203 interviews were conducted and 3 dominant domains emerged, with 7 themes and 26 categories.

Limitations It is important to acknowledge that these findings were captured during a pandemic.

Conclusions NHS Wales has demonstrated that currently there are an equal measure of benefits and challenges to a national digital healthcare. However, with ongoing government and service support, improvement and evaluation, it has potential for a sustainable digital future, in which the benefits can outweigh the challenges.

• QUALITATIVE RESEARCH
• Information technology
• Health informatics
• Telemedicine

Data availability statement

Data are available on reasonable request. The analysed data are published on the TEC Cymru website in the format of a full report of all data for the public to view. To access this report please see https://digitalhealth.wales/tec-cymru . Other data can be requested as a reasonable request to the corresponding author.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2022-069371

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STRENGTHS AND LIMITATIONS OF THIS STUDY

This is a national study, which is representative of Wales.

This study has a large sample size for qualitative research.

This study provides both narrative and quantification of narrative accounts.

Interviews were with clinical and non-clinical staff, therefore, benefits and challenges are perceived by them only, and not patients.

This study was conducted during the COVID-19 pandemic and update and satisfaction of digital healthcare may have been impacted.

Wales is a country that is part of the UK with a population of 3.1 million across a total area of 20 779 km 2 . Compared with other parts of the UK, Wales has a high rural environment, the oldest age population (21% over 65), the highest proportion of people with a disability (22%) and is the poorest UK country. 1 2 Based on Wales’ rurality and demographic profile, it may be assumed that digital healthcare may not be an equitable option for its general population. 3 4 However, there is currently little research and evaluation to support that there may be any health disparities in Wales.

Though, such assumptions have been challenged recently, and suggest otherwise. For example, Welsh data from more than 50 000 National Health Service (NHS) patients and staff demonstrates that regardless of what may be considered limiting factors, for example, age, gender, ethnicity, household income, location, health status and disability, digital healthcare, such as video consulting (VC) platforms, can provide equity of care across all patient and staff groups, appointment types and clinical specialties, which suggests that the same type of digital care can be offered and accepted by all people in Wales, regardless of status. 5

In support of this, the Welsh government has recently published a ministerial call for a new digital strategy in Wales, stating that ‘ digital change offers us a range of new tools for solving old and novel problems’ . 6 It is further argued that ‘ digital offers the potential to make our experience in the world better, enhancing people’s lives [and] strengthening the delivery of public services’ . 6 The digital strategy, and other Welsh government policies such as Prudent Healthcare and the Future Generations Act 7 8 look to support and enable a strong digital future for NHS Wales. Early research and evaluation have been conducted in Wales, which demonstrate the early successes of the government’s strategy. 9–11

The aim of this study was to identify the benefits, challenges and sustainability of a national digital healthcare service from a representative sample of NHS healthcare professionals (clinical and non-clinical). The NHS Wales VC Service was identified as an appropriate service to recruit. A VC platform called ‘Attend Anywhere’ was funded in 2020 by the Welsh Government for use across NHS Wales, to include all primary, secondary and community healthcare. The service included unlimited and free access to the VC platform, and additional training, evaluation and support by the national VC team. Thus, as researchers from the national VC team, the scope of the study is limited to understanding VC via the Attend Anywhere platform only.

We conducted semi-structured interviews with staff to identify the benefits, challenges and sustainability of VC across NHS Wales. An opportunity and convenience sampling approach was taken to recruit NHS staff using VC for an interview. First, sampling involved adding an additional question to the end of the NHS VC Service feedback survey, requesting VC users to take part in an interview (this feedback survey appears at the end of each VC appointment). Second, to ensure that we interviewed all types of VC users, emails were sent to all NHS Wales VC Service contacts. Furthermore, social media platforms and personal/professional networks were used to further recruit.

This process lasted for approximately 2 months (September–November 2020) until recruitment received at least a 1% representation of all Welsh VC users. Based on the total of 16 000 healthcare professionals registered and set up with VC in Wales, 10% were approached to take part in interviews (approximately=1600), and a total of 203 semistructured interviews were completed with participants across all health boards in Wales, across a range of specialties. This resulted in a 1.3% representation of all Attend Anywhere VC users in Wales.

The inclusion criteria for an interview were to have prior experience of using the NHS Wales VC service in the 1-year period (March 2020–March 2021). On initial contact, via an introductory email or phone call, all expressions of interest met the inclusion criteria, which was to confirm eligibility using a tick box exercise. Interested respondents were sent an email with study information and a consent form. In addition, a scheduled Microsoft Teams invite for a video interview was arranged, or a contact number was obtained for a telephone interview, or face-to-face interview if preferred. A total of 12 people did not attend the scheduled interview, and no follow-up arrangements were made. With each interview, consent was read out verbally, and this was obtained from all of those in this study.

Each interview lasted approximately 45 min. Interviews were audio recorded and transcribed verbatim. A semi-structured interview guide was constructed and included questions that asked about their experience and opinions of VC (topic guide shown in online supplemental appendix 1 ). A conversational style of interviewing was adopted to allow a more natural dialogue.

Supplemental material

Following Braun and Clarke’s approach, 12 thematic analysis was conducted, using original transcripts. Initial analysis involved listening to the recordings and reading of the transcripts and making notes, which then led into highlighting and coding emergent codes and areas of interest, about experience and opinions of VC, as well as flagging up of common domains, themes and categories. These were reviewed and refined until final conclusions could be drawn.

This process was predominately conducted by five researchers. These include a research officer (BW), a head of research (GJ), a national clinical research lead (AA) and two supporting research assistants (MW and SA). The interviews guide was developed by GJ, SK and AA. The interviews were conducted by GJ, BW, MW and SA. The coding was conducted by BW, MW, SA and consensus of coding by GJ, SK and AA. Analysis and development of domains, themes and categories was conducted by GJ, BW, MW, SA, AA and checked and confirmed by all authors.

To provide a clearer understanding of commonality across domains, themes and categories, and provide a more accurate indication of experience and response, using a quantification method of the qualitative work, the findings were thematically coded, analysed and presented as both quantifiable information based on the number of dominant and sub-dominant coded responses (referenced as n=), these were determined by the number of times an idea or theme emerged, using two full rounds of coding (initial and final). Qualitative data were analysed and presented as direct quotations, which are referenced by respondent’s occupation and health board. Qualitative guidelines, found online via EQUATOR, were used to assist with this process.

Patient and public involvement

No patient or public involvement in the development of this study. However, the interviews were guided by standard research principles.

A total of 203 participants were interviewed including clinical and non-clinical staff across primary, secondary and community care sectors, across all seven Welsh Health Boards in NHS Wales. Participant data collected, include clinical specialty, profession and associated health boards (shown in online supplemental appendix 2 ). Demographic data collected include age, gender and ethnicity (shown in online supplemental appendix 3 ).

From the thematic analysis of the 203 interviews, a quantification of qualitative work was conducted. In total, 1494 direct codes were identified, which resulted in 3 dominant domains emerging, with 7 themes and 26 categories. These are displayed in table 1 .

• View inline

Dominant domains, themes and categories

Domain 1: Benefits of VC

The dominant domain ‘benefits’ is themed into ‘service benefits’ (NHS Wales), ‘personal benefits’ (NHS staff member) and ‘patient benefits’ (patient, family or patient–clinician relationship). As a quantified total of coded benefits, there were 506 individual responses from the 203 interviews that indicate a defined benefit of VC. Of these, 81 responses (16%) were related to ‘personal benefits’, 157 responses (31%) to ‘service benefits’ and 268 responses (53%) to ‘patient benefits’, which were either direct benefits to the patient or family (n=164) or a benefit to the patient–clinician relationship (n=104).

Service benefits

At the NHS service level, VC was believed to have benefited the NHS service due to decreased appointment waiting times (n=26), fewer missed appointments/‘did not attends’ (DNAs) (n=14), monetary savings on reduced service expenses (n=14) and improved service delivery (n=103).

For example, staff narrative states that patients are now waiting less time for an appointment due to VC and its contribution to ease of access and reduced waiting lists.

If we continue with virtual clinics, it will improve, as we’re not constrained by the physical space anymore with them (Otolaryngologist, SBUHB) If we didn’t have VC, our waiting list would’ve increase significantly (Mental Health/ASD Nurse, ABUHB).

Furthermore, reductions in missed appointments/DNAs are believed to be associated with the increased use of VC.

There’s a massive decline in the DNA’s. With my clinics, because they are so in-depth, I book in one-hour slots. Usually, if there was a DNA then I would be waiting over an hour for the next patient, and if two DNA’d then that would be a massive waste of my time. Whereas now, I can carry on with other referrals or other phone calls (Stroke Nurse, SBUHB) It has drastically reduced DNAs because there’s less excuse now…so it has reduced that, and some people forget about appointments and you can now ring them, and they can quickly join whereas that wouldn’t happen if they had to physically get to the appointment (Psychological Therapist, SBUHB)

The NHS service also benefited from direct monetary savings in reduced service expenses such as staff or patient travel expenses being claimed back, or costs such as clinic room bookings.

It’s got to be saving the health board money, as the elderly patients always need transport (paid by the NHS) to get to hospital (Vascular Surgeon, ABUHB) Massive reduction in our travel, before I was averaging about £200 a month in expenses and now it’s barely £20 a monthly (Occupational Therapist, ABUHB) It must have saved us (the NHS) a fortune in booking rooms based in the community. The cost implications are massive (Physiotherapist, SBUHB)

VC has also improved service efficacies due to its avoidance of waste on clinical time and resource. This benefit highlights how VC is considered an extra tool in clinical ‘tool boxes’.

I work with nurses, radiographers, paramedics, and we’ve basically, innovated a new service, the VC has helped us to do that (Physiotherapist, SBUHB) The NHS spaces are so overloaded, and a lot of that is inappropriate… so as an alternative VC allows patients to access services (Mental Health Therapist, CTMUHB) …VC is another resource that people can use and it’s a tool (Learning Disabilities Therapist, ABUHB) It’s just another tool really isn’t it…the more tools you have and the more ability you have to offer alternatives, and the more likely you are to be able to absorb the patients that we have (Physiotherapist, SBUHB)

Personal benefits

As a direct personal benefit of VC, the NHS staff report a reduction in their own travel and parking (n=49) and improved flexibility in their working day (n=32), which is said to improve staff well-being.

It saves time in my travel time, because I can literally sit in the office do the appointment, write the notes up onto the next one. (Speech & Language Therapist, BCUHB) This is transformative for me in terms of travel and how I manage my diary and book people in (Speech & Language Therapist, CAVUHB) We have more flexibility as when we do our appointments, doesn’t have to be when a room is available, which I think has been good for staff wellbeing (Neuromuscular Carer, SBUHB)

Although these are personal benefits to NHS staff members, they ultimately feed into patient or service benefits as well, as less travel equals more time for other clinical work, and improved flexibility allows more flexible care for patients.

Patient benefits

From the perspective of the NHS staff, there are a wide range of direct patient and family benefits such as the reduction in travel and parking, and improved flexibility (n=113).

VC saves patients travelling. We used to get people in quite regularly just for a check, where now we might not necessarily have to (Podiatrist, CAVUHB) The parking really stresses people out in our hospital… so now it works really well that patients can have something offered to them like VC (Physiotherapist, SBUHB) It should have been like this before, we’re a really rural country so our area would have been ideal for VC as people have to travel so far (Counsellor, PTHB) Parents with children have busy lifestyles and a lot going on, so it’s easier for them… more flexibility (Speech & Language Therapist, PTHB) My patients who are working age, they are doing VC in their work, in a private room (Neurologist, CTMUHB)

Furthermore, the virtual environment within the patient’s home can encourage family involvement, and positively promote independence and improved patient-centred care (n=52).

It’s almost the next best thing they’re on their sofa their dog is on their lap and they’re chatting away… in their own home is actually quite nice (Speech & Language Therapist, CTMUHB) Since using VC, we've been working with the families a bit more and on modifying the home environment rather than working with the child specifically (Speech & Language Therapist, ABUHB) I don’t think in the majority of cases it has negatively affected anybody’s care. It has probably done the opposite in promoting self-management and self-efficacy and like the patients’ treatments. People take the control more and they actually do the exercises… (Physiotherapist, SBUHB)

VC is also seen to positively enhance communication and improve cues between clinicians and patients, ultimately balancing out the healthcare power dynamics (n=85). Participants suggested that this improvement may have been due to patients feeling more comfortable in their home environment.

It’s opened up communication for us…It’s never been so good…I always know everything that is going on, I’m always involved in all the decisions. (Learning Disabilities Nurse, ABUHB) It has been invaluable. You can actually see the patient, you’re looking for the subtle changes on them so you see if they’re being looked after (Neurologist, CTMUHB) You get the added thing that you’re seeing them in their home so you’re getting cues from what you see behind them (Primary Mental Health Assessor, SBUHB) VC is a real levelle3r. It’s not a power situation, it’s much more about you and I doing this piece of work… the therapeutic relationship has started off on a better foot. (Administrator, PTHB) When they come into the hospital, things are very structured and professional. That professionalism gets in the way…, but having contact through VC makes the patient seem a lot more relaxed. (Acute Adult Psychiatrist, ABUHB)

The narrative also suggests that there are specific types of patients and families that VC add an additional level of benefit to. For example, hard to reach families (n=18) whereby VC can remove many of the challenges associated to access of care.

With hard to reach families or families that don’t have transport… (Speech & Language Therapist, ABUHB) It’s enabled me to work with people I wouldn’t have been able to see face-to-face (Mental Health Therapist, ABUHB)

Domain 2: Challenges

As a quantified total of coded challenges, there were 584 individual responses from the 203 interviews that indicate a defined challenge of VC. The dominant domain ‘challenges’ (n=584) is themed into two sections: as ‘clinical decisions’ (n=451) and ‘technical restraints’ (n=133). The theme ‘clinical decisions’ is subcategorised as ‘risk and privacy’ (n=149), ‘confidence’ (n=60), ‘takes more time’ (n=57), ‘engagement and cues’ (n=64), ‘organisation’ (n=39) and ‘well-being and isolation’ (n=82). The theme ‘technical restraints’ is subcategorised as ‘audio and visuals’ (n=22), ‘Internet and bandwidth’ (n=72) and ‘platform incompatibility’ (n=39).

Clinical decisions

The narrative on challenges relating to clinical decisions were associated to concerns surrounding VC’s delivery of clinical care, particularly what participants felt may be clinically missed, may take more clinical time, or affect clinicians themselves.

Participants commented on the ‘risk’ surrounding VC as a cause for concern for some people in certain specialities, regarding missing certain aspects of an appointment that may be better seen or identified face to face, for example, being able to physically examine a patient.

VCs not a one-stop shop, sometimes you want to check blood and do blood pressure, so it doesn’t do that (Paediatric Consultant, ABUHB) You may miss things because you haven’t got that ‘hands on’, and that is a worry. But, if you think, right I couldn’t see everything that I needed to, but that’s where your clinical reasoning comes in, and you go out to see that child (Physiotherapist, CTMUHB)

In addition, the challenge around ‘privacy’ was predominately discussed by participants in mental health services, and generally associated to specific types of patients, such as those with a history of abuse or currently living in a domestic abuse household.

They might not be able to speak freely, on a laptop, you don’t know who else is going to be hidden in the room (Clinical Psychologist, ABUHB) For some clients it’s just not safe for them to do therapy in their own home, they may have children, they may have partners, they may have abusive partners and no privacy so that’s one side of it. The other side of it, some patients don’t want their childhood trauma beamed across their living room which is their safe space (Clinical Psychologist, PTHB)

Some of the participants discussed ‘confidence’ around VC and the required technology was portrayed as a challenge for some patients and clinicians. Interestingly, these findings suggested some participants shadow colleagues while learning to use VC, which impacts digital confidence. Some participants felt more comfortable with this ‘copying’ behaviour where this learnt culture helped participants move to VC with growing confidence. This 'copying' has the potential of positive or negative responses, but it is important to acknowledge its presence, particularly when exploring new digital innovations.

Sometimes patients are shy around VC. But are getting more familiar with it. Its personal choice, I guess (Mental Health Nurse, ABUHB) So, I was quite daunted by it at the beginning, but I feel really positive about it now. Often you feel the anticipation doing a new thing for the first time (Clinical Psychologist, BCUHB)

However, it was stated how it catches on more as the new culture embeds itself.

I think some colleagues think it’s more difficult than it is, they were scared of it, but I’ve shown them and it’s easy to use… It’s so easy to use and it’s a brilliant resource (Community Nurse, SBUHB) Some are more comfortable with it and others will avoid it, but with practice they’re getting better at it but perhaps more training, that’s more specific to how to do a video call (Physiotherapist, HDUHB)

Some participants felt extra ‘time’ was needed for VC uptake, as opposed to other consultation methods. This challenge was apparent when training was necessary to use the platform or where patients needed additional explanations and support during their VC. A small number of participants also commented on the additional ‘setting-up’ time needed to conduct a VC.

You’re doing a lot explaining of how to use the camera etc., which takes away from actually assessing them (GP, BCUHB) There’s a training element that’s taken a little bit of time out of my diary, workload overall (Counselling Psychologist, ABUHB) We just go into clinic a bit beforehand and make sure everything is set up (Paediatric Nurse, SBUHB)

For some participants, there were challenges surrounding ‘engagement’ with patients via VC, particularly with the lack of visible body language and trying to get ‘cues’. For example, several participants found it difficult to achieve the same level of engagement with new patients or younger patients. While facial cues can be picked up well during VC, a number of participants found this more demanding during their virtual consultations.

…The key thing is you have to know the patient. If you’re talking to new patients you haven’t met before you don’t know what to expect of them, or them of you, there’s no relationship there and it tends to go on and on. Whereas with patients you know it is a quick consultation, straight to the point …you both have confidence in what you’re saying to each other (Cardiologist, SBUHB) Video feels less personal, it’s difficult to strike up a rapport (Occupational Therapist, ABUHB) You don’t get to pick up on those cultural non-verbal cues from VC patients (Neurologist, SBUHB)

Some participants reported that VC appointments within their services have increased the amount of ‘organisation’ required surrounding appointment setup and consultation. For example, some services struggled to have a streamlined booking process in place, while others found it difficult to manage the sheer number of virtual waiting rooms for their patients.

It’s just managing the waiting room which is tricky for us. We have multiple doctors, multiple nurses running clinics at different times of the weeks. (Administrator, SBUHB) It’s going well—it works really well actually. The software works brilliantly, it’s the organisation around it that works less well—but that’s not the fault of the software (Infectious Disease Consultant, CAVUHB)

A further challenge that participants reported was the impact that VC had on their own well-being. Some participants reported a greater increase in workload due to the use of VC. This was often paired with feelings of isolation for some participants who were conducting VC from home and not seeing work colleagues as often as before.

My work load has definitely increased and I do feel a lot more tired at the end of the day, and I think that has a lot to do with just sitting in front of the screen (Speech & Language Therapist, PTHB) You just don’t have the contact with your colleagues or patients, that physical contact, communication (Physiotherapist, PTHB)

Technical restraints

The narrative on challenges relating to technological restraints were discussed predominately regarding ‘audio and visual’ difficulties when using the VC platform, ‘internet and bandwidth’ issues or ‘poor quality or incompatibility’ problems for participants to use as a consultation method.

For a number of participants, audio and visual impacted on the quality of their VC calls. For example, the audio at times could be robotic and the picture quality of the video could be blurred. This was a challenge for many participants as it could negatively impact appointments and damage rapport and conversations with patients if this arose mid-call, particularly when discussing sensitive or emotional information.

When the quality of the video is poor, it’s very unpleasant… It’s not that it impacts the session as such. It’s not as good as other face-to-face platforms so I don’t understand why that would be. It’s more comfortable when the picture is clear (Health Psychologist, SBUHB) A very minor gripe is that the quality is not as good as other formats. Although, this could be due to peoples phones or the laptops they are using. (Physiotherapist, SBUHB)

Linked with poor audio and visuals is the internet and bandwidth connections that participants had when using VC. For some, their internet allowed them to use VC as intended with no connectivity interruptions. However, for others with poorer connectivity caused issues. Participant narrative suggested that in some services, they were nervous to attempt to use VC following connectivity problems that disrupted the call with a patient.

If people’s internet isn’t stable, there’s a huge delay which makes it really hard (Clinical Psychologist, PTHB) One couple we tried, we had to give up because the technology wasn’t good enough. It causes huge amounts of stress. It has an impact on the assessment and the therapeutic relationship (Psychotherapist, ABUHB)

In some instances, the participant narrative suggests that at times, the quality of the VC platform is too poor for consultation use. For some, patients were unable to access the VC platform. Some participants found the technology aspect of VC incredibly stressful. For some services, this has had a negative impact on their views of VC and how this would fit in with their consultation methods.

There are some issues, but it’s been the technology stress that has actually put on me more than anything else… It’s nobody’s fault- it’s just the way it is… but technology is definitely the biggest stressor and that’s why I feel sorry for our patients (Physiotherapist, CAVUHB) For the most part it is very good, I think it’s on the side of the client sometimes they struggle to get on to the system but that could be due to them delaying their appointment as well, might not always be technology. (Administrator, PTHB)

Domain 3: Sustainability

The dominant domain ‘sustainability’ counted for 404 responses and is themed into two sections: ‘future use’ (n=244) and ‘future improvements’ (n=160). Having a blended approach (n=105), patient choice (n=71), favour for face to face (n=10) and VC as a useful tool (n=58) have been sub-categorised within ‘future use’ with their total of codes relating to sustainability. For ‘future improvements’, improved support, training and resource (n=88), awareness and digital champions (n=23) and technical advancements (n=49) are subcategorised.

Many participants reported that they would like VC embedded into NHS practice for the long term, but as a ‘blended approach’, with a mix of face to face and virtual appointments adopted where clinically appropriate. However, ‘patient choice’ was seen to be just as important.

I am definitely using VC the most, but quite a few people are on a blended approach… I think that blended approach is useful (Paediatric Consultant, ABUHB) In the future maybe clinic settings could have a mixture of everything (Neurology Nurse, CTMUHB) I would love to keep using VC. There’s always going to be a time for face-to-face in clinics, but I think together they will work really well (Occupational Therapist, CTMUHB)

It was felt that a combination would ensure the best possible care for the patient, and that clinicians are confident in making these clinical judgement calls. However, regardless of clinicians making these clinical calls, many participants expressed their awareness that decisions surrounding the future use of VC are made above them among managerial staff and specific to health boards.

…it just depends on what our Health Board says (Health Visitor, SBUHB) I think there is reluctance in other areas and it’s what the NHS is all about, the culture … the chain management. I [as a Manager] have sold it to my team and very much this is how you solve things (Manager, ABUHB)

But there was, however, a strong sense of ‘want’ for VC to continue being part of NHS Wales, with discussions within services on how VC will be best integrated.

Overall it has been really positive for clinicians and patients, and we are looking to take it forward and make it a bigger part of our service (Neuromuscular Doctor, SBUHB) …we’ve started having conversations about how we can integrate VC into the working diary (Speech & Language Therapist, SBUHB)

But a small few still wish to return to traditional means of face to face.

I hope it gets back to normal soon I’m not doing this job for another 20 years over the screen (Child Development Nurse, ABUHB) The gold star is face-to-face. (Child & Adolescent Mental Health Nurse, ABUHB)

When looking at the future of VC, participants expressed that they want to be able to give the patient a choice when deciding on their mode of consultation. This emphasises the focus participants put on patient-centred care.

At present, the majority of participants believe this choice to be a ‘service choice’ due to the demands of the service during the pandemic and the need to limit face-to-face contact. Similarly, it is the service choice for many participants to use face-to-face where they see that face-to-face contact is more appropriate.

Past the pandemic, VC will undoubtedly be something which will be incorporated into the system. It is definitely going to be some sort of hybrid system where patients are offered the choice (Physiotherapist, SBUHB) We wanted to keep choice for our clients… not everybody has the technology or doesn’t know how or use it, and it’s about client safety (Counsellor, CAVUHB)

A number of participants within the findings reported a preference for face to face; as time has gone on they have become ‘fed up’ of only using VC. This emphasises that at present, the use of VC depends on the need of the service and what that specific service and health board have decided, despite a number of participants focusing on patient involvement and choice with VC.

We’re getting fed up and want to be back face-to-face (Physiotherapist, SBUHB) I think for us front line hands on workers we very much want to get back to that hands on and seeing our patients face-to-face (Child Development Nurse, ABUHB)

A large proportion of the narrative involved the value of VC. Many participants could perceive VC becoming a valuable asset to take forward within their services and being added as a ‘tool’ for professionals to reach for with patients.

I definitely think it should stay and be added to our skills, definitely (Health Visitor, SBUHB) I would be very disappointed if this was withdrawn from us as a service (Renal Medicine Nurse, BCUHB)

Future improvements

Many of the participants expanded their thinking into future improvements for VC that were considered vital in moving forward with its use and ensuring its sustainability long term. These improvements include ‘increased support and training’, VC ‘awareness’ and digital champions’ and ‘technical advancements’.

While VC has been used across a large range of services, several participants commented on areas that needed further work such as improved levels of support and training which would enable participants to keep using VC. For example, having technical support would increase confidence using VC among participants as well as additional training sessions to consolidate learning and add to VC knowledge and skills. A number of participants also felt as though VC drop-in sessions for any questions would be beneficial and an opportunity to fit in around schedules.

I think drop-in sessions would be good for those sort of questions too (Health Visitor, SBUHB) I would really like another training session now I’ve used it for a few months, um, because I would really like a session to consolidate (Physiotherapist, CAVUHB) I would maybe need a bit more training, a refresher I suppose if I wanted to go into adding someone else into the call or go into a different call but for the moment just adding one patient and talking to them one-to-one, it is so easy (Physiotherapist, CTMUHB)

There were a number of participants who reported being ‘digital champions’ or ‘super users’ for VC and thus, took the lead role on the roll out of VC within their service. This was considered important for leading the way, especially in encouraging uptake among the less confident or motivated members of their team.

While digital champions are not deemed essential by participants to use VC, having colleagues who were available to go to for support and advice was incredibly useful for participants. Closely linked to participants having the support to use VC among their colleagues is also the needed improvement of raising awareness of VC. Without the support of making VC known within services, participants felt as though it was difficult for those (clinicians) using it to make contact with patients. Participants reported awareness is necessary among patients, clinicians and administrative staff alike.

We have a VC group, a task and finish group, and they’ve looked at some of them who are less confident or looking at a ‘buddying up system’ and how to support therapists who are less confident (Speech & Language Therapist, BCUHB) I’m a super user. So I’ve been training people up on VC (Psychologist, ABUHB) More options to share tech with people, borrowing something for a limited time, and have someone go into show them how to work it. Or liaise with other organisations like Age Cymru who have digital coaching (Psychotherapist, ABUHB) A bigger media presence with it on TV for something and for me it needs to not be medic-people… it needs to be the AHPs, the nurses saying we can do these things this way (Physiotherapist, SBUHB)

While a number of participants had these three levels of awareness in place throughout their service, other participants commented on the noticeable gaps and the need for improvement. A particular issue noted by participants was that if administrative staff are not as well informed about VC as participants hoped; if administrative staff do not offer VC, then patients do not know it is available and the awareness never increases. In turn, participants found this a struggle and emphasised that improvements to appointment setups were needed for a clear and seamless integration through the VC system, as without this, VC is less productive at both the individual level and also service level.

VC is here to stay, but it needs the organisation behind it… to ensure that they have had a practice run, so they come in my call and know what buttons to press (Cardiologist, SBUHB) I would really push for that seamless integration… but that improves all the time doesn’t it (GP, CAVUHB) The administrative team did not implement VC. They did not see it as important, they did not see it as a priority (GP-BCUHB) I’m trying to get my administrative staff to ask patients whether they’d like to be seen face-to-face or virtually. (Paediatric Neurologist, SBUHB)

Appropriate technology and available space to be able to conduct participant VC is considered a much needed future improvement. While the majority of participants felt as though they had been provided with the adequate technology to run VC, there were a small number of participants who felt there had not been a push for VC from their managers and health boards, and so they lacked the equipment and technology as VC was not seen as a priority. For example, many participants noted that they were without correct head sets and devices to run their VCs.

Have to treat them like a normal clinic in terms of needing a room to conduct those VCs privately so I still can’t do those from my shared office (Oncologist, BCUHB) We don’t really have the equipment, it would be great if we had laptops and better cameras and things (Occupational Therapist, CTMUHB) There isn’t enough infrastructure in the hospital to support the system. For example, they don’t have enough cameras, they don’t have enough speakers so we have to take our own equipment. (Infectious Disease Consultant, CAVUHB)

Conducting VC from the office and from home, some felt as though equipment was lacking. For the office environment, there is a needed improvement in ensuring there is adequate space to conduct the VCs that is private, to ensure confidentiality. Office environments also need to have the appropriate technology and WIFI connections to ensure VCs can be conducted without disruptions. For participants working from home, there was a consensus that more should be done to ensure they are able to work from home and be provided with equipment.

Equally important to improving the technology access and space is the technical improvements to the VC platform itself. There are noticeable improvements that participants felt would.

I would really push for is high-quality video (GP, CAVUHB) The expansion of the capacity of VC to do groups would be good (Physiotherapist, PTHB) The thing a lot of us are screaming out for is an interactive platform where we can get the person on the other side to show us what they are doing (Therapy Assistant, SBUHB)

It is important to view these results in their historical context. The period of March 2020−2021 involved the rapid adoption and spread of VC at the beginning of the COVID-19 pandemic across Wales. The use of VC enabled many healthcare services, especially community, mental health and outpatient teams to continue to offer a service to patients when there was limited or no access to face-to-face delivery in clinic or hospital settings. VC represented an immediate and very helpful tool to enable healthcare professionals to provide patient care and to social distance. While greater use of digital technologies and remote monitoring in healthcare have been longstanding NHS objectives, findings from across the UK suggest that ‘ The single biggest reported factor reported as enabling an increase in video consulting was the cancellation of non-essential face-to-face appointments. Changes in staff and patient attitudes were also considered important.’ 13

As such, it is not surprising to have found significant themes in this study about the benefits of using a VC platform for both patients, healthcare staff and services in these circumstances and to have captured some of the technical, organisational and capability issues that such a rapid deployment of a new way of working bring.

The three domains discussed in this study, and the related themes and categories are, however, of great importance to this area of work, and it provides understanding of the experience or opinions of NHS staff using VC, which for many, was the first time using digital healthcare. For future digital interventions, this evidence is crucial.

Many of the benefits discovered in this study, have potential to continue to bring long-term gains, especially the reduction in miles less travelled for healthcare, better utilisation of buildings and resources, flexible ways of working, reduction in missed appointments and increased patient choice. The challenge now, as we are in the recovery phase of the pandemic, is to reorientate utilisation away from VC being seen as an ‘emergency response’ and to ensure that it becomes a mainstream method of delivering healthcare. As blended delivery models of VC, telephone and face-to-face consultation become possible; this will require health and social care staff, in partnership with patients, to codesign what the ‘new normal’ pattern of consultations looks like for each clinical specialty and service. It is highly likely that differences will emerge between specialities based on clinical need for physical examinations and observations. Key ingredients in the success of this next co-design phase will be incorporating the patient’s choice of method of consultation (VC, telephone and face to face), while balancing service demand and effectiveness, the most appropriate medium for that moment in clinical care and clinician preference.

The challenges the study have highlighted align with wider findings from 'health systems research that disruptive technological innovation, especially in heavily institutionalised environments, is complex, uncertain, challenging and risky. Success is not just about new technologies but also about their clinical safety, how we make them work, and whether NHS infrastructure can accommodate them at speed and scale' 13 . This study highlights that while there were many benefits from the rapid deployment of VC across Wales, inevitably the speed of adoption will mean that there are issues to address and a need to continuously improve. 14 These include ‘skills and knowledge; motivation and attitudes; user-centred design; ways of working; safety and equity; resources and infrastructure; and culture and leadership…[and they add] It is not difficult to see how rolling out changes during a pandemic may have created challenges in each of these areas.’ 14 The thematic findings in this study correspond with these key factors, and so potentially illustrate the areas where the next phase of continuous improvement must focus.

It is now important to reflect on the learning we have gained from this period and the potential role for VC in a sustainable healthcare system. The findings from this study highlight the benefits to patients and staff of being able to access and deliver healthcare through VC and provide a helpful lens through which to see where continuous improvement should focus for greatest impact on patient and staff experience and outcomes.

Limitations

Due to this study being conducted during a pandemic, it may influence the update of digital healthcare, as many face-to-face services were unavailable. Furthermore, this study was conducted with NHS staff only, and therefore, patient voices were directly missed. Future research should seek to focus on these gaps.

Overall participant narrative highlights both benefits and challenges from VC use within NHS Wales’ services. Nevertheless, moving forward, the benefits are likely to outweigh the challenges, in that many of the challenges identified in this study are relatively simple fixes, which the Welsh government and TEC Cymru are currently working on, such as improvements in internet connectivity, data integration and VC platform issues. It is also important to consider the ongoing benefits, and sustainability of VC and continue to understand how participants see VC being used in their services, and what they deem necessary for its long-term benefits and success.

Ethics statements

Patient consent for publication.

Consent obtained directly from patient(s).

Ethics approval

This study involves human participants and was approved by prior to the start of the study, ethical approval was obtained (SA/1114/20) from the Aneurin Bevan University Health Board Ethics and Risk Committee. Participants gave informed consent to participate in the study before taking part.

• Welsh Government
• Williams E ,
• Ogonovsky M , et al
• Whistance B ,
• Khalil S , et al
• Ahuja A , et al
• Mahadeva S , et al

Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1
• Data supplement 2
• Data supplement 3

Twitter @teccymru

Contributors GJ contributed to the main design of the study and development of the research questions, the main structure and write-up of the paper, and final amendments to the manuscript. GJ, SK, BW, MW and SA conducted the data collection and analysis. GJ, AB, SK and AA discussed and interpreted the data once analysed. AB completed the discussion. SK, MO and AA helped structure the manuscript, and contributed to the programme and clinical understanding of the findings and shaped the conclusions. AA was responsible for overseeing the full development of the study design and data collection, the analysis and development and final sign-off of manuscript from a clinical and programme perspective. All authors contributed to proof-reading and amendments of the final manuscript. AA is the author acting as guarantor.

Funding Technology Enabled Care (TEC) Cymru and the NHS Wales Video Consultation (VC) Service is funded by the Welsh Government. Funding award number N/A.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Artificial intelligence (AI) and machine learning

Version1.1 14 June 2023

This guidance is part of the Working in a digitally transformed NHS section of the Good practice guidelines for GP electronic patient records .

For technical terms in this article please refer to the NHS AI Dictionary .

In the near future…

A patient is identified by an algorithm as being high risk of hospital admission.  They could easily have been lost to follow up after failing to attend for regular reviews.

They are offered support at home to manage their chronic lung disease including a smart watch that measures observations (oxygen levels, heart rate and ECG) and can detect movement patterns, including an unsteady gait.  It can be configured to send automatic alerts to the GP, hospital team or community respiratory nurse in response to worsening clinical indicators and can call emergency services in the event of a fall.

The wearable monitor detects an increased heart rate and unsteady gait and prompts the patient to make a GP consultation.  The patient chooses to have the consultation via video link due to the weather.  During the consultation, the GP is presented with onscreen observations, and a decision support algorithm processes the information and ranks the many possible differential diagnoses in real time. 

Speech-recognition software transcribes the conversation automatically.  At the end of the consultation, follow-up investigations are suggested such as the need for additional blood tests or an X-ray, based on the most up to date and relevant clinical guidelines.

Treatment options are suggested by the algorithm based on the patient, but the ultimate treatment decision is made by the GP and the patient through shared decision-making.  The patient chooses to continue to be treated at home and is added to a virtual ward with automated calls and scheduled visits from the community medical team.

The 24-hour monitoring has provided peace of mind to the patient and their relatives. The healthcare team has benefited from 24-hour home monitoring and automation of clinical pathways. Together it has allowed the patient to remain at home for longer than would have been otherwise possible maintaining independence.

  Inspired by a King’s fund blog post .

Artificial intelligence (AI) is at a critical point of being adopted by the NHS.  In other industries AI is already used widely, e.g. in facial recognition software on consumer devices, virtual assistants, and algorithms that provide results used in search engines and social media platforms.  It promises many benefits to healthcare, such as helping with the complex decision-making and analysing the huge amounts of data being generated by digital health devices (DHTs).

It is predicted in the NHS AI Lab roadmap that general practice will be one of the most affected workforce groups in the NHS.

AI has been used to help diagnose COVID-19 from chest imaging and used to help secondary care dermatology referrals, e.g. skin analytics .  Other examples from the NHS AI award winners help with retinal screening and stewardship of antimicrobials.  Symptom checkers such as NHS 111 online are also trialling AI to help with triage.

To achieve its potential, AI must be developed in a regulated way, and as a collaboration between clinicians, software engineers, data scientists and product designers.  The early challenges include gathering enough good-quality data to build models, understanding the information governance surrounding this and developing proof of concept of AI tools. As these initial challenges are overcome other factors will grow in importance such as workflow integration, demonstrating evidence of real-world clinical effectiveness and providing ongoing safety.

Algorithms in general practice

Algorithms are not something new to general practice having been used widely for many years, e.g., risk scores ( QRISK , FRAX ), prescription switching, and for searches and reporting such as for Quality and Outcomes Framework (QOF). These algorithms are generally well validated before being used in clinical practice and clinicians balance the risk of error with the reward of having convenient tools to use day to day and inform care.

Machine learning involves creating more complex algorithms that learn rules from data, rather than being written by experts. This typically relies on two key components:

• the development of an advanced algorithm
• training it with a large amount of data to increase its precision in predicting outcomes

There are many ways in which this can happen such as analysing data and finding patterns ( unsupervised machine learning ), finding the best way of predicting a specific outcome ( supervised machine learning ), or finding the best way of achieving a goal ( reinforcement learning ).

Potential benefits of AI in general practice

The NHS Long Term Plan sees AI as a key element in digital transformation ‘ to help clinicians in applying best practice, eliminate unwarranted variation across the whole pathway of care, and support patients in managing their health and condition ‘.

Some of the many ways in which AI is anticipated to touch on general practice are:

• Automation/service efficiency | Voice recognition software could transcribe consultations, freeing up more staff time to deliver care. Natural language processing could also automate some patient documentation workflows, to identify actions and help suggest and automate responses.
•   Diagnostic/decision support | Decision support can apply guidelines to the consultation data and suggest a diagnosis or suggest management to the clinician. An example of this is C The Signs , which uses AI to improve the diagnosis of cancer.
• Precision (P4) Medicine | Predictive, Preventive, Personalised and Participatory Medicine incorporates multiple data sources such as the patient record, biometric data and genomic data. This can be used to calculate patient risk more accurately and can use pharmacogenomics predict an individual patient’s response to medication.  This promises to move from the traditional ‘one-size-fits-all’ form of medicine to a personalised, data-driven disease prevention and treatment methodology.
• Image analysis | AI has been used to take the place of a second reader in radiology and histology. This can increase image processing capacity and may help identify lesions that had been overlooked.  This field is rapidly developing, and we may see new diagnostic tools to help interpret images taken in primary care such as photographs of skin.
• Continuous monitoring | Algorithms can be always on, which makes them well placed to provide continuous monitoring of patients and early recognition of deteriorating patients.  Examples of how this could work include the virtual wards used during the COVID 19 pandemic .
• Consumer technology | Results from smartphones and wearable devices may prompt a patient to make a consultation. For example, many smartwatches are able to detect atrial fibrillation and assess sleep quality. The latest smartphones can be used to detect respiration and heart rates.  Smart speakers similarly can detect coughs and snoring.
• Population/public health . | AI may be used to spot patterns in practice population data not previously identified.  Interventions could be used to reduce the risk level of individuals by given them targeted advice directly via an app or letter with lifestyle suggestions such as stopping smoking or reducing alcohol intake.

Tips when implementing AI

Understanding healthcare workers’ confidence in AI (2022) is an excellent report developed by Health Education England (HEE) and the NHS AI Lab.  It explores how to prepare the UK’s healthcare workforce to master digital technologies for patient benefit.  The report is essential reading to those using AI in the NHS to understand the barriers to adopting AI amongst healthcare providers. 

Staff may be reluctant to adopt AI technologies if they feel threatened, if they are worried about the risks, or if they do not see enough evidence of effectiveness.  They need to be brought onboard so that those who are worried feel empowered to shape how the technology can used to support them.

To this end, NHS and GP organisations are working to regulate and design standards that support developers in ensuring that they can deploy their technology, because they’ve met minimum standards that enable greater confidence in the use of the technology.  It will be important for GPs and other primary care leaders to be actively involved in this process to shape how technology is used.  

Ongoing research into the impact of algorithms on decisions is needed so that clinicians can be appropriately educated.

Evaluation and validation

As with other digital healthcare technologies implementation must only be carried out when there has been robust clinical validation.  The following is a summary taken from the ‘Understanding healthcare workers’ confidence’ report.

Evaluation of AI’s efficacy is a continual process as it passes through stages of development and deployment:

• Internal validation | Testing by the developer. This usually uses a validation data set, often split from the same source as the training data set. It generally uses retrospective data sets (data that has been collected in the past).
• External validation | Testing with data from a different source to the training data. It tests in clinically relevant situations to ensure the AI is effective.  This may be performed by the AI developer, or independently by a third party.
• Local validation | This may be done as part of deploying AI at a local setting, to ensure it performs well with local data, patient populations and clinical scenarios.
• Prospective clinical studies | Testing in a real-world clinical setting using data collected in real time to determine if the AI is effective and improves patient outcomes.
• Ongoing monitoring | This is essential to identify safety risks, or performance issues that may not have been apparent at earlier stages, and to monitor performance, as it may deteriorate over time due to changes in the population ‘population drift’ or changes in medical practice. Deterioration could also happen when moving from a training set to a live instance.

The Multi-Agency Advice Service

The MAAS (Multi-Agency Advice Service) is a collaboration between the National Institute for Health and Care Excellence (NICE) , the Medicines and Healthcare products Regulatory Agency (MHRA) , the Health Research Authority (HRA) , and the Care Quality Commission (CQC) .  It has been established to help ensure developers and procurers of AI have the information to confirm products are meeting regulatory requirements.

Medical device regulation

If an AI product is classed as a medical device, it will be regulated by the MHRA. Medical devices must be registered with the MHRA and are subject to Medical Device Regulations, the UK MDR 2002 .  There is another article in the Good Practice Guidelines about medical devices and digital tools .

The MHRA does not regulate AI products that are not classed as medical devices, such as products used to automate administrative processes.  These products must still conform with other regulations when used in healthcare, including the General Data Protection Regulation (GDPR) and the NHS Digital Technologies Assessment criteria (DTAC) framework .

Healthcare workers should be cautious and investigate carefully what the regulatory approval of an AI product means.  It can be easy to equate regulatory approval with proof that a product has been clinically validated and is safe and effective, but this may not always be the case.

Evidence standards for AI may not involve external validation.  Current MHRA guidelines for UK Conformity Assessed (UKCA) approval only require internal validation.  External validation may be implied from the UKCA clinical evaluation requirements, but this does not yet need to be done independently.  Prospective clinical studies are also not currently a requirement for regulatory approval.

Clinically valid algorithms depend on high-quality information from which to learn.  It is worth being cautious as many AI models perform well at the internal validation stage but perform significantly worse at the external validation stage due to flaws with internal validation or the model not working well when given data different to its original source, being insufficiently ‘generalisable’.

As a rule, if you want to implement or test an AI tool, check with MAAS.  If you want to recommend or prescribe an AI tool, check the NICE evidence standards framework (ESF). 

Evidence standards framework

NICE Evidence standards framework (ESF) for digital health technologies is likely to become an important tool for evaluating AI technology.  The standards include those needed to demonstrate value to the UK health and care system, including evidence of effectiveness, and evidence of being value for money. 

There have been high profile cases where healthcare providers have not communicated clearly with patients about how their data was to be used.  The lesson learned from this is that patient engagement and participation is crucial to the successful adoption of AI technologies in health.  A suitable legal basis must be found before any use is made of confidential patient data, and any appropriate opt-outs, if invoked, must be respected.

If the processing is for direct care, then the consent is implied. 

Personal data should be de-identified before processing or sharing either by being anonymised (removal of all identifying data) or pseudonymised (removal of identifiers in a way that means it can no longer be easily attributed to a specific person).

GDPR states that data should only be stored for as long as is required and processed in the ways agreed for the purpose.  Data protection impact assessments should be completed – along with an appropriate data processing and data sharing agreement if applicable.

Key considerations when planning AI in general practice

Patient engagement.

The patient must be at the centre when assessing and implementing any new technologies.  Care must be taken to ensure algorithms don’t exacerbate inequalities or introduce new discrimination.  An example of this is where an algorithm developed to detect melanoma was trained on publicly available images which are more prevalent in white skin.  As a result, it was more accurate in detecting melanoma in white skin than black.

Equality and health impacts assessment (EHIA) should be used to mitigate risks of discrimination and exacerbating heath inequalities.

Model cards

Information on the way AI algorithms are created and tested needs to be shared with healthcare teams.  Used for a different purpose or on a different population, AI will produce misleading and potentially harmful results.  There are various methods for evaluating algorithms and displaying key facts to users, e.g. a ‘ model cards ‘ or ‘model facts’ label has been proposed, showing key information, and explaining to users an algorithm’s capabilities and limitations including the characteristics of the training data set.

Risk management

Caution should be employed with new technology.  What are the risks with the real-life application of this software and how can they be minimised? 

Post-market surveillance is essential, as with any new medication or medical device.   Medical device incidents or near misses should be reported to the manufacturer and the MHRA via the Yellow Card reporting system.

Considering wider impacts

There will always be unanticipated effects on clinical workload, care pathways and payment mechanisms.  For example, if symptom checkers are too risk averse, workload may increase.  Similarly, indeterminate results thrown up by algorithms may increase the need for additional diagnostic investigations.  To mitigate against these effects on the health system the wider impact of new technology needs to be considered.

For more details see:

• Artificial Intelligence: How to get it right
• A Buyer’s Guide to AI in Health and Care

Wider context around AI

AI is not an off-the-shelf solution to healthcare’s problems and needs to be carefully evaluated before and as it is deployed.   AI solutions are likely to depend on well-functioning health systems rather than replacing the need for them.  Similarly, automation of processes within primary care and integration of new digital tools with existing systems will be essential for AI to bring the promised efficiency gains needed for users to adopt them.

There are some outstanding questions with AI that are yet to be answered such as accountability.  If harm happens because of care delivered jointly by physicians and algorithms, who is legally responsible?  The clinician, developer, the vendor, or the healthcare provider?  The NHS AI lab are exploring these issues along with NHS Resolution .

Explaining AI can be very difficult, even for those who have designed it.   Many work as ‘black boxes’ generating results without explaining how they reached them. This can make it difficult to assess for bias, error, reliability, or faults.  It can also be difficult to assess for reproducibility, as an algorithm continues to learn as it is used, so a result it gives on one day might not be the same as the result it gives on another day, even if all the inputs are the same.  The MHRA hopes to try to address this and ensure they are sufficiently transparent to be reliable, trustworthy, and testable.

There are many types of bias that can exist with AI.  Bias can be introduced to AI through the prejudices of the people developing the algorithm, or carelessness in the way training data is collected or processed.

One form of bias affecting AI is automation bias, which is when users favour suggestions from automated decision-making systems and ignore contradictory information, even when correct.  

Even with well-designed AI there is a risk of automation bias.  This is already seen as a cause of accidents with pilots using autopilots and drivers of self-driving cars.  This risk may even increase as algorithms get better, if too much confidence is given to the automated decision and if concentration on the task or skill of the workforce decreases over time.

Finally, temporal bias describes how an algorithm will eventually become obsolete due to changes in the population or to future events that were not factored into the model.  An example of this could be diagnostic models that are presented with new diseases such as Covid 19 or monkey pox.  Periodic evaluation of AI algorithms over time will help to ensure they remain relevant.

Primary care clinicians should be reassured that a safe operating environment is being worked on for artificial intelligence.  They should also be encouraged to get involved in its development and deployment to ensure primary care benefits from this burgeoning technology.

As with all new technology there will be compromises with AI, e.g. balancing the needs of individual privacy versus the needs of society to have good research data or the need to allow patients to benefit from a new technology versus the need to protect them from the new risks that it presents. 

Extensive collaboration between patients, clinicians, regulators, software engineers, data scientists, product designers and entrepreneurs will be needed to ensure AI improves healthcare in the way intended.

Many new roles will be needed in the data-driven health service that AI will bring, and the workforce needs to be trained for this.

Human subtleties and patient preferences will mean that clinicians will always be needed to provide empathy and psychological support to patients and agree a shared management plan with the patient.

The 2019 Topol review, preparing the healthcare workforce to deliver the digital future concluded that machines ‘ will not replace healthcare professionals but will enhance them (‘augment them’), giving them more time to care for patients’.  

AI in practice

Machine learning can be used to identify, and risk stratify a practice’s patients with, or at risk of, diabetes, as in the example below.

Machine learning can use objective data that a practice or primary care network (PCN) holds, and segment and risk stratify all patients, not just those for whom blood tests are up to date.  This means we can help clinicians learn more about all their patients, not just their regular visitors.

A GP surgery wanted to re-design its diabetes service to identify which patients were at risk of adverse outcomes.  Clinicians worked together with data scientists to identify markers for adverse outcomes.  This approach used clinically agreed risk markers, rather than an ‘out of the box’ risk model.  This made the output more transparent and helped describe why people were at high risk – which is not typically exposed in risk registers.

They pooled data sets from general practice and hospital patient records to create a risk model. The model was reviewed to ensure it had identified the right patients and risk stratified them in a way that matches the clinical judgement of the GPs.

In a population of 17,000 patients, the model helped to identify around 40 patients who were unregistered as having diabetes but who have the condition.

Related GPG guidance

• Health equalities and inclusion
• Interoperability
• Population health management
• Medical devices and digital tools
• Calculating Quality Reporting Service (CQRS) and Quality Outcomes Framework (QOF)

Other helpful resources

Learning/workspaces.

• Ada Lovelace Institute . An independent research institute with a mission to ensure data and AI work for people and society
• AnalystX workspace
• The NHS AI Lab , guidance, case studies and reports on how AI has been developed and implemented in NHS and care to find out about the challenges, lessons learned and best practice
• Digital, Artificial Intelligence and Robotics Technologies in Education (DART-Ed) . A programme delivered by Health Education England (HEE) that explores the educational needs of the health and care workforce to enable use of AI and Robotic technologies to improve healthcare
• FutureNHS, Analytics Learning Exchange (Alx) – to help those who work in health and care to become better skilled in the use of data, evidence, and analytical products (please note registration is required to access this site)
• Academy of Medical Royal Colleges (AMRC), Artificial Intelligence in Healthcare
• Royal College of General Practitioners (RCGP) British Journal of General Practice 2019, Artificial Intelligence and Primary Care
• RCGP, Technology manifesto
• The Reform Trust, Thinking on its own: AI in the NHS
• Explaining decisions made with AI by the Information Commissioner’s Office (ICO) and The Alan Turing Institute – practical advice to help explain the processes, services and decisions delivered or assisted by AI, to the individuals affected by them
• Hannah Fry, Hello world. How to be human in the age of the Machine, 2019 Publisher: Transworld Publishers Ltd, ISBN: 9781784163068
• Eric Topol, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, Publisher: Basic Books, ISBN: 9781541644632 
• Faculty of Clinical Informatics, Artificial Intelligence Special Interest Group , webinar sessions available:
• An introduction to machine learning and healthcare AI
• What is ‘computable biomedical knowledge’ and why is it important?
• NHS England, The vision for AI in healthcare
• Government Digital Service (GDS), A guide to using AI in the public sector
• NHS England case study, ‘C the signs’ app for referrals
• US Food and Drug Administration (FDA) and Department of Health, Digital and data driven health and care technology, 2018 updated 2021, Guiding Principles to AI

Case Study: NHS App – To Access a Range of National Health Services in the UK

If you are in the UK, you might have heard about NHS or National Health Service. Even, you might have used the services for NHS. Yes, it is a comprehensive public health service under government administration. The services are offered by NHS for the entire population in the UK for free. Indeed, you will have to bear some minor charges alone. It would be good to gather information about NHS Services right from your smartphone. This is where the NHS App can help you.

NHS App – Some Basic Details

The NHS App provides you with a secure and simple way to approach different Services of NHS on your tablet or smartphone. You are eligible to download the app in case, you are more than 13 years of age. To use this app, you must be a registered member of the Isle of Man in England or the NHS GP Surgery. Otherwise, the app also offers the option to log in through the NHS Website on your PC from where you can use the app services.

How Will NHS App Help You?

With NHS App on your Android or Apple Phone , you can:

• Find NHS Services near you
• Show other the details of your COVID-19 vaccination when you travel abroad
• Select whether the NHS uses your data for planning and research
• Select your organ donation preferences
• Spot what to do when others need help urgently with the help of NHS 111 Online
• Get health advice with the help of this app.

Further, if you register with the NHS App to prove your identity, you can:

• Sign up for updates regarding taking part in health research
• Manage your initial clinical or hospital appointment with a specialist. You can do this in case you are referred by your General Practitioner via the NHS e-Referral Service
• View your GP health record safely
• Order repeat prescriptions and view or even change them.

The app will offer you a single place, where you may not only view but also manage your hospital appointments and referrals.

Feature of NHS App

Before you download this app, you will be interested in understanding its features:

Manage your Health

You can conveniently view your health record on this app. Even, you can view your test results. The app lets you manage your prescription requests and forthcoming appointments as well. On this app, you can even make choices on your health like organ donation decisions.

Receive Messages

NHS App lets you get crucial messages from your General Practitioner Surgery. You can also get messages on other NHS services via the app. When you turn on the notifications, you can get alerts via notifications.

Secure Login

The NHS App will direct you via creating an NHS Login in case you already don’t have one. To use this service, the app will require you to prove who you are. The app will then safely connect information from your NHS Services.

Now, it is easy to get complete information about NHS Services you get right on your smartphone with the NHS App.

Previous Post Revolutionizing Daily Life: The Impact of Mobile Apps on Modern Living

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Scientists discover best way to cut down alcohol intake

D rinkers who want to cut their alcohol intake should track their hangovers on an app instead of following NHS advice, a study has suggested.

Researchers found that heavy drinkers tracking their alcohol use on their mobile phones were able to reduce their intake by an extra two units a week – the equivalent of a pint of beer or glass of wine – compared with those using NHS guidance.

The study compared two different interventions in 5,600 people who were drinking an average of 70 units of alcohol a week, which is equal to 25 pints of beer or seven bottles of wine, but who wanted to cut down .

Half of the participants were directed to online NHS guidance and the other half were asked to download the Drink Less app , which was created by the research team at University College London (UCL).

Those who used the app were asked to set themselves a goal and input their alcohol intake, mood, and quality of sleep, allowing them to monitor progress and the effects of alcohol on them.

After six months, the app users had reduced their intake by 39 units, while the control group following NHS advice reduced their intake by 37 units, the results found.

Around 600 people, or 20 per cent, in each group dropped out before six months and the results did not include them.

Experts said that while reducing alcohol consumption by an additional two units a week seemed small, it was significant “both in terms of preventing potential health harms as well as reducing costs to the NHS”.

Dr Melissa Oldham, the lead author from the UCL Institute of Epidemiology and Health Care, said the study proved the app “could be useful” in helping people cut down on alcohol .

“Alcohol consumption can lead to many health conditions such as cancer and cardiovascular disease,” she said. “About 20 per cent of the adult population in the UK drink alcohol at levels that increase their risk of ill health and the Drink Less app could help these people to cut down.

The NHS recommends people should not drink more than 14 units of alcohol a week, spread across three days or more.

That is around six medium (175ml) glasses of wine, or six pints of 4 per cent beer.

Other apps available

There are other apps available to help people cut down on alcohol, including the NHS’ Drink Free Days app, and alcohol education charity Drinkaware’s MyDrinkaware App.

Dr Claire Garnett, who led the UCL team developing the Drink Less app, said this was the first trial to assess the effectiveness of “an alcohol reduction app”.

“If people are going to use an app, it would be better if they tried one that had good evidence behind it,” she said. “An app that is not effective may make it less likely for that person to try to reduce their drinking in future.”

Dr Sadie Boniface, head of research at the Institute of Alcohol Studies said that “having an app which we know is effective is very welcome news”.

“If the Drink Less app can be scaled up and rolled out more widely, it holds promise for population health.”

She warned that it was a “valuable tool in the box, but there is no silver bullet for alcohol harm” and called for a national strategy.

The research, published in eClinicalMedicine, was funded by the National Institute for Health and Care Research (NIHR).

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Flexible shift patterns in a community district nursing team

13 May 2024

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Midlands Partnership University NHS Foundation Trust (MPFT) piloted a scheme of flexible working, by extending shift patterns in its community nursing teams. Following the success of the scheme, not only has the scheme been rolled out to other teams in the trust (clinical and non-clinical), but also been shared with several community teams across the country to support their flexible working approach. 

Key benefits

• There was a positive impact on the retention and attraction of the workforce.
• The scheme has been adopted by several community nursing teams across the country and can be offered to all staffing groups not just nursing teams.
• There were no additional costs incurred by changing shift patterns.
• Staff gained better work-life balance, there was a reduction in staff working unpaid hours and they were more willing to pick up extra overtime and bank shifts if needed. 
• There was greater continuity in care for patients who were able to see the same member of the team over a longer period.
• Improved efficiency and capacity.

What the organisation faced

MPFT had a number of obstacles to overcome. 

Historical shift patterns

In the community nursing teams shift patterns varied by team and locality but were fixed with little flexibility. Often shifts were 8.45am to 5pm or similar, seven days a week. 

Flexible working

This was available on request to staff who had caring responsibilities, or needed to work differently due to illness or disability but this was often a temporary agreement and was not always available to all.

Poor retention

Exit interviews showed experienced nursing staff were leaving the service to work in other services that supported working shifts over fewer days as standard.

Missed recruitment opportunities

Experienced staff indicated they wanted to move to community nursing but increasingly asking to work full-time hours over less than five days. Some were used to working long days in other organisations and were not prepared to give up their days off. 

Changing demand

MPFT faced challenges in matching available workforce to the changing demand for timed visits. Teams were unable to meet their timed medication demand because of the volume of demand and rigid shift times. For example, staff were not able to provide medication to patients before breakfast or with their evening meal.

Capacity challenges

Capacity in the team was reduced by staff requiring temporary reductions in hours to address caring responsibilities, there were high levels of sickness and requests for special leave.

What the organisation did

The team reviewed current evidence and guidance including the Queen's Nursing Institute guidance on Workforce Standards for the District Nursing Service and NHS England's flexible working guidance. 

The team spoke to other community and hospital based providers to see what worked for them. They also conducted a literature search on the impact of 12-, 10- and eight-hour shifts and found that 12-hour shifts could have negative impact on staff wellbeing and in turn patient care; and were also associated with increased workplace errors. They found no evidence of a negative impact from shifts that were 10 hours or less, on medication or workplace errors, reports of burnout or increased fatigue from staff.

MPFT carried out pulse checks (surveys, group discussions, interview feedback and face-to- face one-to-one discussions) among its staff and found out that while some staff were happy with their existing shift patterns, a large majority of them were interested in doing longer shift patterns over a shortened number of days. 

The trust used N HS Employers' flexible working toolkits to support the change. MPFT also engaged multiple stakeholders such as HR and rostering colleagues, partner organisations and patients to understand how viable the scheme was and what the likely impact of the scheme would be. 

The piloted scheme ran for eight weeks, it consisted of: 

• Two community nursing teams, one city based team with stable staffing and another team that covered a larger geographical area and city and rural localities, with more unstable staffing and high levels of sickness in order to understand the variables.
• 9.5-hour shifts were introduced at either 7am to 5pm or 8am to 6pm, with full-time staff allowed a shift per week where they could finish 30 minutes earlier. 
• Voluntary participation so that anyone who preferred the usual 8.45am to 5pm shift pattern was allowed to maintain their hours. 

Results and benefits

On evaluation of the scheme, they found that there was no increase in complaints, incidents or risk to patients because of the change in shift patterns. Patients experienced better continuity of care having the same member of the team see them over a longer period. 

A staff survey found that there was no change in the number of patients being seen by the team each week regardless of the shift patterns. Staff were also more willing to pick up bank shifts and overtime during surges in demand, as they felt they had adequate rest days within the week. Staff expressed overwhelmingly positive feedback to the change in shift patterns. 

• Workload was perceived to be 35 per cent more manageable.
• Staff reported working less unpaid overtime.
• The flexibility supported their management of personal caring commitments, as well as supporting staff to manage their own health and wellbeing.
• Their work life balance saw significant improvement.

Gemma talks about her experience on the piloted scheme and the changes it has made in her work and life. The shift pattern is now a permanent fixture offered to community nursing staffing groups including admin and leadership teams. 

Gemma's story

Take away tips

• Make sure you involve HR and rostering colleagues from day one, this will help streamline the process and help to plan off duties. 
• Follow a plan, do, study, act (PDSA) cycle. Continuously evaluate the changes, through staff feedback and review of relevant data. Monitor patient feedback, incidents and activity data identify and address any issues.
• Celebrate successes.
• Be open minded and willing to adapt and try new approaches.
• Make the changes optional, listen to the needs of staff as they will change over time so today’s solution may not work in a couple of months. 
• Use resources available such as NHS Employers' flexible working toolkits to support the scheme for change to work more flexibly.

If you would like to find out more about the flexible working practice, please contact Hannah Copeland , Operational Lead, District Nurse and Rachel Bailey , Lead Specialist Practitioner, District Nurse, Midlands Partnership University Foundation Trust.

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North of Tyne Combined Authority

The North of Tyne Combined Authority was a partnership of three local authorities: Newcastle, North Tyneside, and Northumberland and a directly-elected Metro Mayor.

North of Tyne Combined Authority is now part of the North East Combined Authority

The first and only term of the North of Tyne Combined Authority (NTCA), 2019 to 2024, has come to an end. In May 2024 it was absorbed into the new North East Combined Authority.

In those five years, NTCA took a collaborative approach towards solving the problems our communities face. Working in partnership, creating connections between programmes and projects, developing an inclusive approach to investing in our region. 

To read about what NTCA achieved through devolution download their final report Delivering Devolution Together.

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Meeting agendas and minutes, decision notices, forward plans and other relevant governance documents published by the North of Tyne Combined Authority are now available in the document archive.

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Some projects started under NTCA have transferred to the new North East Combined Authority. Details can be found in our projects collection.

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Video shows FedEx cargo plane land on its nose in Istanbul after landing gear fails

A Boeing-767 type cargo plane operated by FedEx ran into a couple of bumps and sparks as it attempted to land at Istanbul Airport in Turkey without its front landing gear Wednesday.

The cargo plane, operated by FedEx, was flying from Paris' Charles de Gaulle Airport, according to a statement by Turkey's Minister of Transport and Infrastructure, Abdulkadir Uraloğlu , when the pilot of the aircraft informed the control tower at Istanbul Airport that its landing gear had failed to open. The official said airport officials sprang into action and assisted the aircraft in touching down, while managing to remain on the runway. Emergency response, medical teams and necessary fire extinguishing equipment was also deployed on standby, Uraloğlu said.

Video footage from the landing shows the plane touching down on the runway before it tilts forward and starts dragging on its nose the runway creating a cloud of dust and sparks. It eventually comes to a stop with its fuselage touching the ground. As the plane comes to a halt, fire trucks douse the plane with water.

"With the successful guidance of our staff, the aircraft landed smoothly on its fuselage," Uraloğlu said.

No injuries reported

Two pilots were onboard the aircraft, according to Uraloğlu's statement, and were medically assessed after the landing. No injuries were reported.

The runway where the plane had landed was temporarily closed for all flights as multiple agencies gathered on site. A video shared by the minister shows crews and officials gathered around the aircraft while a fire truck and ambulance are parked on the side.

An investigation into the incident is ongoing, said Uraloğlu without going into further details into why the landing gear had failed.

Another Boeing plane issue? Don't fall for the headlines.

The freight aircraft involved in the accident is nearly 10 years old and was delivered to FedEx in 2014, according to a Boeing spokesperson. Following delivery, operators oversee ongoing maintenance for airplanes in operation. Reuters reported that Boeing 767 freighter is one of the most common cargo planes.

FedEx, meanwhile, in a statement to USA TODAY, said that the FedEx Express Flight 6268 was flying from Paris to Istanbul when it experienced an issue during landing.

"There were no reported injuries to our crew members," FedEx said. "We are coordinating with investigation authorities and will provide additional information as it is available."

While Boeing incidents have been in the news in recent months after a series of high-profile incidents, aviation experts maintain you shouldn't worry about flying .

“We don’t have to worry that there’s something systemically wrong with aviation,” Clint Balog, an associate professor at Embry-Riddle Aeronautical University, previously told USA TODAY.

Contributing: Staff, USA TODAY

Saman Shafiq is a trending news reporter for USA TODAY. Reach her at [email protected] and follow her on X @saman_shafiq7.