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The NHS has launched the private beta phase of its long-awaited app, which gives patients access to a range of NHS services at their fingertips.
As patients slowly begin to use the app, Computer Weekly takes a closer look at how it has developed from idea to reality, and what this means for a health service that is moving into the era of self-service.
The plan for an all- singing, all-dancing NHS app was first touted by the then health secretary Jeremy Hunt a little over a year ago.
Seen as a 70th birthday present to the health service, the app was tied in with the launch of the revamped NHS Choices website, now named NHS.UK – the new “digital front door” to the NHS.
The app aims to give patients access to a range of NHS services, including being able to book appointments, view their medical records, order repeat prescriptions, select their data-sharing preferences, organ donation preferences, end-of-life care preferences and access NHS 111 online’s symptom checker and triage service.
Last month, health secretary Matt Hancock announced that the NHS was going live the private beta for up to 2,000 patients in Liverpool, Bristol, south Worcestershire, Staffordshire and Hastings. At the UK Health Show on 26 September, NHS England’s chief digital officer, Juliet Bauer, said the app was now live with the private beta testers.
The beta stage is invite only, and requires an email address from users in order to register. NHS England has specifically targeted areas and GP practices with high Wi-Fi uptake, and high uptake of online services.
The aim of the beta is to iron out any kinks before deploying the app nationally by the end of the year.
It has been a quick turnaround for the app development, which Bauer said has been a huge task, and is far from complete.
Together with NHS Digital, NHS England is also looking at the potential of providing biometric login “simply because it makes it easier to log into the app”, said Bauer.
During the course of the app development, several ideas have been changed, or scrapped. Originally, one of the key ideas was to use the standard procurement model for clinical services, where clinical commissioning groups (CCGs) each procure their own services and therefore there would be local apps, specific to the region.
However, a final discovery document on the app from January this year, which was released under the Freedom of Information (FOI) Act, showed that people were concerned about the user experience, and they found it confusing. It was then decided to go with one simple app for all.
Tied in to all of this is the NHS’s Citizen ID programme, which is intended to be the single and secure way of securely accessing online health records and services. The Citizen ID platform is also in trial stage, and a full identity verification system is unlikely to be launched until 2019/2020.
However, the aim is that people using the app will verify their identity using the Citizen ID platform, thereby being able to securely access their records, or change their preferences on care plans.
The app team and the Citizen ID team have worked closely together to map out the “user journey and system interaction”.
The Citizen ID platform will also use an “offline couching identity service” where the patient’s clinician can generate a “token of trust” for a patient to be able to access their medical records online.
There are currently a number of NHS services in the pipeline to use citizen identity services.
A new era
The launch of the app signals a new era for the NHS. As it becomes increasingly clear that the health service needs to change in order to be sustainable for the future, digital has become a big part of the solution.
NHS Digital CEO Sarah Wilkinson said the NHS is entering the “era of self-service and mobility” as the health service is building a number of products putting the information “directly into the hands of citizens”.
She added: “The NHS app is about putting the patient in control of their data, their condition and their care.
“Over the coming years, we will want to make that an incredibly rich service, exposing more and more NHS-held data back to the patient.”
The NHS is certainly making strides in its efforts to digitise services. By April 2019, the electronic child health record will be rolled out across England; the digital red book is making significant inroads; and by the end of the current financial year, NHS 111 online will be deployed across the country.
Bauer and her team also hope to bring private app developers on board, whose services and apps can integrate with the NHS, for example through signposting in the NHS app for health condition-specific apps in the NHS apps library.
There are sceptics
However, although mobile appointment bookings, medical records access and triaging, all through your mobile phone, sounds like a great idea, not everyone is so keen.
While these are all nationally available services, they are dependent on local GP practices actually offering them to patients. Although there is a mandate for GPs to introduce digital services, many are sceptical.
Criticism includes allowing patients to book appointments when they might not need to, wasting valuable time and money, which means GPs may be reluctant.
Some see the uptake of digital services as a threat to GP surgeries and face-to-face NHS services.
A key example of that is the GP at Hand service. The controversial smartphone app, by Babylon Health, officially launched in early 2017, and allows patients in some areas to register with the on-demand service, giving them access to a GP 24/7 through virtual consultations. It also gives patients access to a symptom checker, driven by Babylon’s artificial intelligence (AI) tool.
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The GP at Hand service is funded by the NHS and run by NHS Hammersmith and Fulham CCG, together with NHS England. The contract is held by a specific GP practice in Hammersmith and Fulham, and along with a few other hubs across London, that is where those needing physical consultations can go.
But while the health secretary has announced his full support for the app, and even uses it himself, others are less enthusiastic.
There has been criticism from the Unite union, whose members wrote to the then health secretary Jeremy Hunt in June 2018, stating that the app “threatens the very survival of NHS general practice”.
Local GPs in the London region have also been sceptical, claiming that it tricks patients into de-registering from their local practice. Another criticism has been that it is mainly targeted at those who are young, fit and healthy and excludes pregnant women, the elderly, people with learning difficulties or drug dependence, and those living with “complex mental health conditions”.
GP practices essentially need those young and fit patients to stay with their practices in order to be able to afford having people with complex medical needs on their patient lists.
This may be a sign that as we enter this new era of self-service, it won’t be enough to put in digital systems on top – there needs to be systemic change across the health service, from payments and tariffs to digital skills and support.
Some also see the new digital initiatives as a shiny new front-end, while hospital clinicians can still spend 10 minutes simply turning on their computer every morning. As one clinician put it: “It’s like continuing to paint over cracked wallpaper – it may look nice at first, but it won’t last.”