What we did in 2019-20: Product Development

Elizabeth Folarin, integrated safeguarding lead at Central and North West London NHS Trust, says the NHS App has transformed her mother’s management of her diabetes.

The NHS App was released nationally in April 2019, allowing people to book or cancel GP appointments, order repeat prescriptions, view their GP record, make organ donor registrations, change their preferences about the use of their data, and access health and care advice from NHS 111 online and the NHS website.

NHS App registrations rose rapidly from launch, with about 307,000 people registered and about 117,000 GP appointments booked via the app by February 2020. We worked closely with the suppliers of GP IT systems to achieve 100% coverage and by February all English GP practices had access. In March, the app became central to system response, functioning as one of our key channels for patient support and advice during the coronavirus outbreak less than a year after its initial rollout. There were more than 712,000 registered users at the end of May 2020.

NHS login provides a single login allowing patients to access multiple digital health and social care services including the app. Thirteen services are now using it and more than 50 are in development in our ‘sandpit’ environment. We’re prioritising those that can help in the response to coronavirus.

During the year, we introduced mobile device authentication including fingerprint and facial recognition and improved the registration process. We responded to a 142% increase in identity check requests in March by redeploying NHS Digital employees to temporarily increase manual processing capacity and, in April, we introduced greater automation for iOS users. An average waiting time of about three days in late March was reduced to less than two hours by May. Just over 1.3 million people now have a login and for many it has become a convenient, secure way to access digital healthcare.

The NHS e-Referral Service (NHS e-RS), working with NHS login, enabled GPs to email appointment request details to patients, reducing printing and postage costs for GP practices and improving patients’ digital experience. The programme moved to a cloud platform during the year and also developed application programming interfaces (APIs) to allow clinicians to view NHS e-RS clinical information and create referrals in their local systems.

The NHS 111 online service was an increasingly important feature of the NHS’s interface with the public before March 2020. It was used 5.6 million times between April 2018 and March 2019, increasing to 23.4 million times between April 2019 and March 2020. On 16 March alone, there were almost 950,000 user sessions. In February, about 17% of NHS 111 enquiries were digital. That had increased to 80% by the end of March, with up to 87% of all coronavirus triages being carried out online in the second half of March.

We improved the online service’s functionality through the year. After a pilot in Cheshire and Merseyside, we rolled out direct referrals from NHS 111 online to pharmacies, helping cut load on NHS 111 call handlers and GPs. During the crisis, we constantly reviewed advice to reflect changing government and clinical guidance and used the service as a platform for some of the most important digital support offered to the public.

The coronavirus crisis also dramatically increased the use of the Electronic Prescription Service (EPS) as GP practices sought to deliver prescriptions to community pharmacies without a patient having to collect their paper prescription. As a result, we saw greater use of the nominated service, where patients choose which pharmacy should automatically receive and dispense their prescriptions, with usage increasing from 73% in February to 78% in March.

We made two key improvements to EPS during the year. First, we made it possible for controlled drugs in schedules 2 and 3 to be prescribed and dispensed using the system.

About 95% of GP practices can now do this and average use of EPS increased by about five percentage points in practices with this capability. We can also now allow patients to use EPS without having nominated a community pharmacy. We expect average use of EPS to increase to 95% during 2020.

The new GP IT framework Digital Care Services was launched in January 2020 and allows GP practices to choose from 69 suppliers offering about 250 IT solutions based on shared, open standards. More than 95% of practices have fully implemented SNOMED CT, a structured clinical vocabulary that supports effective information sharing across electronic systems, and our GP Connect programme has made it much easier for practices using different systems to view each others’ records.

The National Events Management Service (NEMS), launched in private beta in March 2019, improves the sharing of information about children’s contacts with healthcare. Historically, if something important happened to a child – like visiting A&E or changing their GP – it often took time for professionals to find out about it. NEMS records these ‘events’ securely in real time and allows authorised services to subscribe to updates.

A health visiting service in north-east London reported that health visitors were getting notice of child deaths three to four days earlier in some cases, reducing the risk of families receiving contacts from professionals who had not been informed.

Service providers can publish ‘events’ to NEMS (for example, screening tests) and subscribe to information if they are authorised to do so. For example, the eRedbook, which gives parents a digital view of their child’s health record, puts information from NEMS in the records it makes accessible to mothers and clinicians. Digital Child Health was the first area of focus for NEMS, but it will be used to transform the sharing of information in other areas of healthcare.

We also worked to get better information to frontline professionals. A pilot run by the National Record Locator programme in Liverpool ensured ambulance services were alerted when they were dealing with people with mental health crisis plans, meaning they could get the most appropriate care to patients quickly. More than 61,000 pointers to mental health crisis plans have been uploaded to the system. We plan to use the locator to make a wider range of care information, such as end of life care plans, available to ambulance clinicians and to provide support to other professional groups such as midwives.

We have piloted quick access to patients’ Summary Care Record application records with the London Ambulance Service. Crews can use fingerprint login on their mobile devices to get a summary of a patient’s medical history provided by their GP. As in Liverpool, this informs decision making, helping crews relieve pressure on emergency colleagues, and it improves care.

One London crew said they were able to get vital details about a patient who had suffered a heart attack from the Summary Care Record rather than having to try to get the information from the patient’s family.

The NHS Long Term Plan committed us to allowing 100,000 pregnant women access to their Women’s Digital Care Record by April 2020. We passed that mark in August 2019 and had reached 129,000 by February 2020. Over 60% of women signed up. By 2023-24, all pregnant women will have access. We have developed open standards in the project to encourage the joining up of information across the care pathway. This will allow women to have access to their information through a variety of services that meet their needs.

Ben Glover, a paramedic with the South Central Ambulance Service, says NHS 111 online and the symptom checker tools available in the NHS App will help reduce pressure on services like his.