The NHS app: will it work?

Matthew Honeyman writing at The King’s Fund: It is fitting the new Secretary of State for Health and Social Care, Matt Hancock, is the only MP to have his own app. The NHS is getting its own too. Hancock inherited Jeremy Hunt’s commitment that the national NHS app will be available by the end of 2018.

It has taken a while for the NHS to go down this route. Smartphones have been with us for more than a decade. In the UK, 85 per cent of us have them, 70 per cent use them to go online and for 8 per cent of people they are their only route online. That is a little way off the NHS in terms of universal coverage but mobile technology – and particularly its scale – is something the health system has long struggled to take better advantage of.

The NHS app is being developed by NHS England and NHS Digital, driven by a tight deadline. At launch, it will incorporate the NHS 111 symptom checker, support people’s transactions with GP practices (book appointments, order repeat prescriptions, and view medical records), and provide options to log preferences to be respected across the national system (on organ donation, end-of-life care, and sharing data for secondary use). As with health service reform in general, the challenge here is to integrate services in vast and complex systems. Aiming to combine these existing digital systems in one place is a sensible first step, but the future plans for the app talk promisingly of it evolving into a platform with nationally and regionally commissioned digital services on the app. If these ambitions are realised, one could imagine patients getting access in a single place to the shared care records being developed by the Local Health and Care Records Examplars (LHCREs), or safe and secure messaging with their care teams.

There will be challenges in making the app compelling and useful for patients.

“The team developing the app has spoken about how its initial user research showed the NHS that its ‘brand’ and the promise of a single point of access were important to participants.”

The team developing the app has spoken about how its initial user research showed the NHS that its ‘brand’ and the promise of a single point of access were important to participants. As well as unifying some existing online access points under the NHS brand, increasingly common smartphone-only internet use means this represents an opportunity to maintain and expand access to online services.

The same online transactions that will be involved are already required of GPs but have been historically underused. For many GPs the online access routes are a bit of a side-show or they find them challenging to implement. For example, although GP IT systems will have online booking features, practices often configure their appointment bookings in very different ways and the process to verify a person’s identity can be convoluted, making for a quite complicated patient user journey. It means the experience for people using a single NHS app tapping into these systems could still vary widely depending on the way the 7,000 or so practices in England run themselves. Investment in support and helping practices make choices, think about user journeys and maintain fair access is a really important part of making this app a useful way for people and the NHS to interact.

At our recent digital health conference, there was talk of a ‘multiple app problem’.

“Investment in support and helping practices make choices, think about user journeys and maintain fair access is a really important part of making this app a useful way for people and the NHS to interact.”

The risk is that the NHS app will add to the plethora of ways people and the NHS can interact. There are digital-first services and telehealth services, many of which use their own apps, like GP at Hand. Many local areas have developed, or plan to develop, personal health records (PHRs) and patient portals. The chosen LHCREs, mentioned above, have plans too. Those local initiatives would do well to complement, and lean into the scale of, the NHS app, and be mindful of how things have changed in the US when players like Apple decide to facilitate health records access as part of its platform. The team working on the app at NHS Digital and NHS England will need to ensure it can connect with local areas to ensure their existing work does not go to waste.

But while I recognise the concerns, many apps can co-exist. There’s a role for specialisation and a bloated, complicated and unmanageable national app must be avoided. There are now 70 apps on the curated NHS apps library; some cover fitness or health tracking, some are condition-specific, and some are NHS apps. An app for a service that deals with prescriptions really well, like Echo, one that provides a way for carers to communicate with clinicians about a relative’s care, like rallyround, or a place-based app helping navigate local services would all have their roles. The plan for the NHS app in 2019 and beyond is to provide individuals with a ‘personalised’ view of the NHS apps library which would help people find specialised apps for them.

Two similar principles are commonly expressed in the two worlds my work straddles here at The King’s Fund. Designers in the technology industry, like Don Norman, speak of using human-centred design methods. Health policy-makers and leaders want integrated services focused on people. Where tensions might arise between the local and the national, or the NHS and its partners, returning to this principle should help to resolve them. The issues covered here – and there are more – require careful handling but there are grounds for optimism, provided expectations are managed, sufficient investment is made and future development remains wedded to these principles of person-centred design.