The NHS App
13 Months
500m
56%
35m+
A Bold Vision
At NHS Expo in September 2017, then Secretary of State for Health Jeremy Hunt heralded a new decade of ‘patient power’, setting out a bold vision for every patient in England to be able to access their medical records and book a GP appointment via an app.
Over the next 5 years, Kainos supported this vision – helping design, deliver and continuously improve what would become the NHS App.
The NHS App’s goal is to provide a digital front door to healthcare – an integrated digital health service through a single, easy-to-use channel. Not only does this empower citizens to take control of their health and care, but it also reduces the burden on an overstretched clinical community.
The Challenge
Fast development – while enabling future innovation
The Secretary of State’s ambition was for the NHS App to be available by the end of 2018 – the 70th birthday year of the NHS. This meant we had to go live quickly while building the app in a way that would streamline ongoing innovation – so additional capabilities could be added over time.
Integrating the country’s fragmented health and care systems
Designing and delivering the app meant drawing together legacy systems across England and combining them into a new, accessible service. The scale of the integration challenge was colossal, with numerous complex problems around:
- Building the core technical infrastructure
- Ensuring high levels of security and data protection while enabling people to manage their data-sharing preferences centrally
- Enabling interoperability across NHS services and providers partnering with the NHS
- Designing accessible journeys tailored to user needs
- Ensuring a consistent user experience no matter where people live (avoiding a postcode lottery effect)
The primary challenge was the speed at which Kainos and the app team needed to integrate the main GP IT systems so NHS App users could order repeat prescriptions, book GP appointments and view their GP health record – key pledges in the Secretary of State’s speech.
Approach
Understanding diverse user needs
The NHS App needed to be accessible to people with a huge range of digital skill levels and from various demographic groups.
We spearheaded a robust, user-centred approach to design and development, conducting in-depth research consisting of over 500 user interviews, 120,000 quantitative survey responses and engagement with charities and community groups. We had a particular focus on increasing the representation of people identifying as LGBT and non-binary, audiences with low digital literacy, people with disabilities and users with health conditions.
Developing a robust, scalable architecture
Leveraging our deep Microsoft Azure and agile expertise and working closely with Microsoft's engineering teams we quickly built a scalable distributed cloud architecture that would support rapid user traffic increases and a user base of over 40 million people – complete with robust security, business continuity and disaster recovery.
We also implemented a framework to account for the process changes involved in scaling, such as:
- Regularly reviewing architectural patterns
- Modelling usage accurately to support performance
- Identifying small user experience problems that might have a bigger impact at scale
- Analysing hundreds of thousands of pieces of feedback each month
- Designing a self-serve support model
Simplifying sign-up
Historically, if you wanted to access to GP services online, you had to visit your surgery and ask for log-in details.
We worked closely with the newly established identity provider NHS login to create a mechanism allowing people to gain safe access to GP services automatically when they sign up to the NHS App. This saved thousands of hours of GP staff time.
Results
National roll-out in 13 months
The NHS App was live on schedule thanks to our agile delivery techniques and rapid iteration. By September 2018, it was in private beta being tested by thousands of end users, and in December 2018, it was available in the Apple and Google app stores. Importantly, the app became the first digital platform to integrate with the 4 GP supplier systems serving England’s 7,000+ surgeries.
Continuous innovation
After the national launch, we continued working with the NHS to extend the app’s features and capabilities. Noteworthy developments included:
- Password-less log-in – This was a major request during private beta, so we quickly developed an open and reusable standard enabling people to log in using fingerprint, face or iris recognition.
- Full browser support – This rapid innovation allowed people to use the NHS App without a smartphone.
- Partner service integration – Kainos and the app team developed a new web integration approach that became a standard for integrating partner services into the app, . This gives providers control over their own service while reducing costs for the NHS.
- Online consultation provider integration – We developed a Clinical Decision Support API specification in collaboration with NHS Digital and provider eConsult, enabling online consultation solutions to integrate with the app.
- Personal health record provider integration – Kainos and the team worked with provider Patients Know Best to become the first provider to integrate with the NHS App, improving access to patient records. Organ donation service – We collaborated with the NHS Blood and Transplant Team to create a way for people to manage organ donation preferences in the NHS App. This innovation won the HSJ Partnership System and Data Integration Award in 2020.
- Notifications and messaging – We developed the NHS App Notification and Messaging service, giving citizens a single, secure inbox for health and care messages and offering senders a free alternative to email, SMS and letters. Each year, the NHS spends an estimated £100 million sending paper letters and £20 million on SMS, so this represents a substantial cost-saving opportunity that also improves the patient experience.
- Aggregated hospital appointments – In 2022, the team was asked to consult on making hospital referrals and appointments visible in the app. Over 9 months, we collaborated with stakeholders across the NHS Wayfinder programme to research, design and deliver a joined-up experience for users.
A key role during Covid
The NHS App was so successful that it played an important role in England’s Covid response.
At the start of March 2020, NHS England and the Department of Health and Social Care asked the app team for help. On 20th March, just 3 days before the first UK lockdown, the Get an Isolation Note service was launched – a joint effort from Kainos and the NHS team. The Check an Isolation Note service was launched 2 weeks later, which enabled employers to validate isolation notes.
Get an Isolation Note was one of the fastest-ever UK government digital services to move from idea to live service. It allowed millions of UK citizens to self-serve, removing a huge burden from NHS frontline services. Leveraging our partnership with Microsoft, it also created an architectural template that would be used to build many more health and care digital services over the next 12 months.
Over the course of the pandemic, we continued to support the NHS team with developing a range of services, including:
- Enabling people to access GP services on behalf of others, for example, a parent ordering a child’s repeat prescription
- Onboarding new online consultation and personal health record service providers to support the need for video appointments and telehealth
- Developing the Check Your Covid-19 Vaccine Record service
- Integrating the Covid Pass in the NHS App
Many of these self-service capabilities prevented thousands of trips to GP surgeries during the pandemic – and continue to save patient and clinician time today.
Ground-breaking growth
Since the national launch in 2018, the NHS App has seen rapid and sustained growth – scaling successfully with record service levels.
Key achievements include:
- Presenters on ITV’s This Morning mentioning the NHS App and Covid Pass, leading to a tidal wave of new sign-ups with no service outages – this will forever be remembered as the ‘This Morning peak’, and is still talked about with great pride
- Infrastructure successfully supporting over 10,000 transactions every second
- Becoming the UK’s most downloaded free iPhone app in 2021 – ahead of WhatsApp, TikTok, Instagram and YouTube
The usage statistics are astounding:
- 500 million log-ins by August 2022, a number that was unimaginable to even those most optimistic about the app’s potential impact in 2017
- 500,000+ vaccine-related messages sent by the end of 2022
- 500,000 people updated their organ donation decision in the app by the end of 2022
- 32 million sign-ups to the app as of July 2023 – for comparison, that’s 56% of England’s population
- 34 million+ repeat prescriptions ordered via the app as of November 2023
Why Kainos?
Kainos helps healthcare organisations with rapidly building scalable, secure and resilient digital services – underpinned by best-in-class patient experiences and leveraging the latest advances in cloud technologies, data and artificial intelligence. Services we’ve helped build impact 65 million citizens every day, making Kainos the partner of choice for this ambitious and mission-critical project.