Fundamental change is required to bring NHS Online to life

Digitally replicating what we do today will not be enough to deliver an NHS online hospital service, warns Andrew Davies, executive director, digital health at the Association of British HealthTech Industries

Since the tsunami of government publications over the summer, notably the NHS 10 year health plan and life sciences sector plan we have been left wondering how and when the various initiatives will be delivered.

It has been widely discussed that the 10 year health plan was supposed to have a delivery chapter, but never did. Then we were told the delivery plan was to follow before the end of the year; now it seems we are not getting one.

At NHS England’s July board meeting, chair Penny Dash said that she was seeking to “see a very detailed delivery plan by the beginning of September”.

Now, no single “big document” is proposed. Instead, we are seeing a series of ad hoc announcements.

Most recently, and very interestingly, we have had a promise of the single patient record (SPR) by December and Sir Keir Starmer announcing a new NHS online hospital service.

This service, to be delivered via the NHS App, will be dubbed NHS Online and is expected by 2027.

The latter initiative, unveiled at the Labour Party conference, marks a significant shift in how healthcare services might be delivered in the future. And, at last, seems to be following the lead that has been paved for many years by retail, financial services and the automotive sector.

Learn from retail

While of course health is not retail, that does not mean that we cannot learn lessons from it. One of the key things that the best in retail are doing is offering a multi-channel approach, integrating digital offerings with physical high street or out-of-town presence.

This is the model that NHS needs to replicate rather than a sole digital approach, à la Amazon.

Rather than relying on traditional bricks-and-mortar infrastructure, NHS Online will operate as a fully digital hospital trust, offering remote consultations and specialist care through the NHS App, where patients can book and attend appointments with consultants.

If physical tests or procedures are needed, patients will be directed to nearby facilities, potentially including independent sector providers.

The tech exists. My concerns lie in how NHS Online will be staffed and how it will make the connection between the virtual and real worlds

My initial thought was that the timeline was very ambitious. On reflection, and discussing with others in the NHS innovation ecosystem, that view has not changed, but my reasons for thinking it ambitious have shifted.

Initially, I was concerned about the ability to roll out the technology at a national scale. But the key dependencies are not about the tech – that exists; the NHS will need to work closely with private sector tech providers to bring it to a usable reality.

My bigger concerns now lie in how NHS Online will be staffed and how it will make the connection between the virtual and real worlds.

A question of logistics

At a recent conference, Professor Ian Abbs eloquently described health service delivery as a question of logistics. I think this is an interesting way to look at it.

After all, Amazon is as much a logistics company as it is a retailer or tech company. Does the NHS need to be as much about logistics as it is about health? How can it manage the flow of patients through an increasingly complex process moving between physical and virtual interactions?

Central to this must be putting patients at the centre of care (nothing ground-breaking there in principle). But there is also a need to harness and support the public and patients to be part of the NHS workforce.

By empowering patients to direct their care and enable self-care, we can again learn from other sectors that have harnessed their consumers to undertake processes that used to be undertaken by employees. It is not about shifting workload; it is about empowerment, choice and convenience.

There are other key dependencies, notably the professional workforce. The plan relies on clinicians from existing NHS trusts dedicating time to virtual consultations, through what has been described as an ‘Uber-style’ platform.

How will trusts be reimbursed for time spent on NHS Online? Aligning the financial incentives across the system is going to be critical

For a system under pressure, questions must be asked about personal and system capacity, and incentives.

How will trusts be reimbursed for time spent on NHS Online? Will the physical interfaces, for example with community diagnostics centres, be frictionless? And will capacity exist to deliver on the promise?

If the handover from virtual to physical is not frictionless, the promise of NHS Online cannot be delivered. As ever with the NHS, aligning the financial incentives across the system is going to be critical.

SPR central to success

The SPR will be central to the success of NHS Online. No SPR means no NHS Online.

Health professionals will be able to access a unified view of a patient’s medical history, enabling them to manage the care journey across geographic, technical, organisational, and clinical boundaries nationwide.

This will streamline care and reduce duplication, but current data-sharing laws and governance frameworks pose challenges, as we experience all too often today. It will be interesting to see how reform of the control of patient information (COPI) regulations will be an enabler.

To bring NHS Online to life will need careful navigation of a complex web of workforce logistics, technological infrastructure, and regulatory hurdles.

It will require a vision to not just digitally replicate what we do today, but fundamentally reimagine a digital pathway driven by the patient, centred around the individual, and using tech to provide a frictionless pathway between bricks and clicks.