Aiming to address “considerable variation in how Advice and Guidance is applied, delivered and monitored”, a framework intending to provide a tool to support ICBs on effective implementation has been published. From April 2025, all ICBs will be required to submit quarterly progress of Advice and Guidance, providing a maturity level, insight into its use and quality.

Over the course of 2025/26, ICBs will also be required to perform a number of actions, completing the quarterly self-assessment survey to provide a national oversight, developing a delivery plan for Advice and Guidance that aligns with elective planning for 2025/26, implementing actions “across relevant sections to accelerate maturity”, and completing planning for 2026/27.

On minimum digital standards to support, the tool notes the need to develop a plan at system level for digitising Advice and Guidance, referral channels, and clearly defining processes. It adds for providers having “open digital channels” to support Advice and Guidance in specialties, to focus on high volume specialities, and to establish a baseline maturity of the digitised use of Advice and Guidance channels.

As part of this, a series of minimum standards are also laid out, such as having in place a named lead for improving Advice and Guidance, implementing actions to address gaps in digital accessibility of pathway referral criteria, and developing and implementing a plan for this digitisation.

For workforce planning, training and development, it looks to ensure users of have access to e-learning resources or training across areas such as referral criteria, policies, and pathway redesign. It cites that “standards for urgent and routine turnaround times for Advice and Guidance requests are locally determined at specialty level”, and “clinically led audits are in place at specialty level”.

Elsewhere, the framework outlines indicators and minimum standards around leadership and governance, improving Advice and Guidance quality, reducing health inequalities, patient and staff engagement, and local commissioning and payment mechanisms. An ICB action plan template is also provided for ICBs to record baselines and quarterly self-assessment results, and to track their delivery plan.

Central digital updates: the wider trend 

The NHS England board meeting in February shared updates and outlooks on operational performance and productivity, the NHS Genomic Medicine Service, children and young people’s health, and vaccination and screening services. On digital, the update noted the continued focus for digital to drive productivity, including improving processes, optimising system capacity, reducing low value activity, delivering more care in the community, harnessing improvements offered by the use of tech like teledermatology, expanding the use of the NHS app, and completing the rollout of planned EPR upgrades.

In March, the board met again to cover more operational, performance, delivery, and digital, data and technology updates. The digital, data and technology transformation update noted the Frontline Digitisation programme is on track for 96 percent of trusts to have implemented an EPR by March 2026. As of March 2025, 19 trusts are listed as having no EPR, but are in the process of procuring, or implementing one. The update highlighted that 70 percent of trusts are on track to meet the core level of digitisation maturity by March 2026, aligning with the What Good Looks framework.

March also saw Keir Starmer confirming plans to abolish NHS England, in a move he states will bring the management of the NHS “back into democratic control” and support the government’s objective of “reshaping the state”. Starmer noted that with this move, the NHS would be brought back “at the heart of government, where it belongs, freeing it to focus on patients, less bureaucracy, more money for nurses – an NHS refocused on cutting waiting times at your hospital”.

For a recent HTN Now panel discussion, we spoke to experts from across the healthcare sector on the future of general practice core systems. This included exploring potential opportunities and areas of future growth, considering challenges such as integration and interoperability, and outlining what “good” looks like in this space.

Our panellists were Bex Cottey, business manager for Conisbrough GPs, Emma Stratful, chief operating officer at OX.DH, Dr Sheikh Mateen Ellahi, GP and practice partner at ELM Tree Surgery and South Stockton Primary Care Network and Dr Shanker Vijayadeva, GP lead, digital transformation for the London region at NHS England.

We kicked off the session by asking our panel: what are some of the biggest limitations with current GP systems? Mateen started by highlighting two of the main limitations which he said were the “user experience and the interface itself” as well as “limited analytic and data capabilities”.

Explaining further, Mateen noted three key focus areas when making the move towards a more modern general practice, including equity and access to care, prevention rather than treatment and using a digital triage system. “But how many practices right now are doing this?” Mateen asked. “Not as many as there should be. And that’s what we need to move towards.” He went on to outline how a lack of predictive analysis within clinical systems “often means clinicians are working reactively rather than proactively” and that one of the best ways to tackle this is by having “more capabilities with regards to collecting good data.” Using an example from his own practice, Mateen highlighted how the introduction of a new telephony system helped with reducing call waiting times from three minutes “down to less than a minute across one whole week of 2,500 calls”. In order to continue to see improvements like this, Mateen added, “what we need to aim for is a modern system that uses AI and machine learning to predict patient conditions based on historical, real-time data, to hopefully enable better patient outcomes.”

Next, Bex spoke about making the switch from one clinical system to another, expressing some of the key limitations her practice found. “We were repeatedly having the system fall down and run slow,” she said. “So the options were to either stop complaining about it and get on with it or change the system.” Because of the limitations posed, the practice ultimately chose to make the switch with Bex adding that “since then the stability of the system has been much better”. Speaking on the wider discussion of which system is best, she added, “the two systems have different features and the features that are the same work in slightly different ways. So, it’s about which system suits you and your priorities best”.

From Shanker’s point of view, he noted how “there is no perfect system at the moment,” and that user needs can vary “from the basics of just getting rid of one extra click to the other extreme of implementing a data flow”. To help tackle this, he suggested making everything very simple, adding how “interfaces have to be easy to use and intuitive, yet also be able to manage a huge range of complexity”.

Emma then talked about how OX.DH has entered the core clinical GP system market via the NHS England Tech Innovation Framework, which she noted was all about “bringing new entrants to the GP market in terms of IT solutions”. Emma continued to outline their OX.gp solution, a modern and intuitive primary care solution, empowering new ways of working to streamline processes and workflows for efficient, patient-centred care.   

Aligning with the neighbourhood health model

We then moved on to discuss how primary care systems align with the neighbourhood health model, Mateen noted how “it comes down to population management. You have to look at the neighbourhood as a whole and what their needs are.” To do this, he highlighted the importance of actively engaging with public health while looking at predictive analytics within communities. “It comes down to risk stratification and patient segmentation,” Mateen said, which has reportedly helped to “reduce hospital admissions by 15/20 percent,” according to one study he read. Giving an example, he explained how “some people might be more prone to getting the flu. If you can identify those patients early, you can get them engaged with the flu programme.”

Adding to what Mateen had to say, Emma highlighted her own experience speaking with GPs and how many are “struggling even just to get two screens in a practice or get reliable internet” while being “limited in terms of quality of data and how it’s structured”. In response to this, she highlighted the importance of focusing on the “quality of data” and using tools such as Power BI to run key reports on risk stratification, stating, “if you’re able to analyse and unpick the data that you currently have within your practice, you’re going to be able to better serve your patients at a patient level but also at the local population level.”

Bex echoed the importance of working closely with public health fellows when creating a neighbourhood health model, but also noted a need to consider the voluntary sector and third party “because they are going to be a massive factor in the success of reducing non-medical burden on primary care”. She suggested having a database of “who’s available and where” but also recognised issues with how much of an undertaking this would be, stating, “it’s wonderful to work as a neighbourhood, but I don’t think people quite realise how big that neighbourhood is, even for smaller communities.”

In response to this, Mateen agreed that creating neighbourhood teams would be a “long and difficult project that will take years to properly implement” but also went on to say it was still possible. “Looking at the whole holistic picture is the best way to go forward,” he said, emphasising the importance of using current systems to the best of their abilities in order to help ease the burden. He referenced statistics from the RCGP, saying, “there’s been a 10 to 15 percent increase in appointments from pre Covid to now” and how “more and more GPs are leaving the profession,” so the best thing to do is to continue looking for new solutions and also “find the best way to use current solutions”.

Overcoming barriers to implementing change within systems 

Shanker outlined some of the barriers to changing systems, including the frustrations around retraining and data migration. He noted how clinicians tend to be “really frustrated by our systems but actually a relatively low proportion of us have the capacity to go through the upheaval to make the change.” He added that key motivations to actually making the switch to a different system often come as a result of “system crashes and the level of functionality being offered by current systems”. However, he also said that when it comes down to it, “it’s all about your mindset. Even if you’ve got that backend functionality, if you think it’s not easy to navigate or it’s clunky, there will still be limitations”.

Bex added that data silos across the NHS were another key barrier, highlighting how “interoperability has to be key” to improving these systems. “We’re not maximising the use of our clinical facilities,” she said, before suggesting how “it may be that we’re not even aware of what’s available to us or that we’re waiting for it be available. Or it’s just so far ahead of the curve that we can’t wrap our heads around it.”

From a supplier perspective, Emma noted how “GPs will utilise existing systems differently, finding workarounds which can affect the quality of data”. To combat this barrier, Emma emphasised the importance of directing GPs “down the same path” and trying to keep systems “simple and consistent so that we’ve actually got something really meaningful to work with to better support patients.”

Using AI to improve systems  

Shanker then brought up the use of AI, noting the “quick wins with workload reduction and clinical decision making” when using AI in these settings. Bex outlined some resistance around this, noting, “half of us are miles ahead thinking how can we use ambient AI to make our clinical systems work better for ourselves. But there’s also this fear that AI is going to make the system even messier rather than more coherent. And I think that’s where we’ll see a lot of resistance in primary care.”

She went on to explain where this hesitation might have come from, adding, “there are practices out there, ours included, still with cupboards and cupboards of paper records. We were told years ago that a system would digitise all those records, but in areas without the funding, that system never materialised”. She highlighted how “the burden of maintenance” seems to always fall on general practice but “we’re not fully supported financially or otherwise to really get on top of that”.

Opportunities for general practice

When discussing some short-term opportunities for general practice, Mateen emphasised the need to enhance the capabilities of current systems. “We always talk about new initiatives and ambient AI etc.,” he said. “But there’s a simple solution, in my opinion: why can’t we clear the space taken up by professional records?” He mentioned how this has already been achieved by many practices in London but that northern practices sometimes get “left behind”.  Mateen also outlined the importance of understanding demand and capacity, enhancing digital access and streamlining the triage and care navigation processes.

For Shanker, it was all about strategy. He noted, “we need a good strategy like we had with electronic prescription services, but we also need to think about those times when we implemented something that was solely driven by addressing a user need”. As an example, Shanker spoke about ambient AI as something that “wasn’t part of a wider strategy but took off because it was agile and fixed a problem”. Shanker also highlighted how “not all clinicians are system thinkers and user experts, so we can’t always communicate our frustrations in a way that will help an IT company work out what the fix should be”. He suggested an opportunity here would be to have a “combination of clinical and user experts to drive some of that change at the bottom end”.

Offering input from the supplier point of view, Emma then explained how OX.DH has been working with a practice in the north of England who have been “very much involved in that UI and that testing,” but also noted how “a GP elsewhere might want something different”. Despite the difficulties of trying to tick every box for each of the seven and a half thousand GP practices, Emma explained how OX.DH instead focuses on building a system that “ticks the majority of boxes and can then be modified to tick other boxes”. She added, “the more insight we get into GP practices and the challenges they face, the more we can make a solution that’s going to be fit for the future”.

Key learnings and areas of focus for the future of digital practice 

Finally, our expert panel spoke about the key learnings from implementing digital solutions in their own practices, with Bex emphasising the importance of time. She explained how it took her practice 12 weeks to switch from one system to another and despite being a “lengthy process,” it was necessary for getting it right. “We needed that time to check every step of the way and even now, a few years on, we’ve not found any gaping holes of incidents which is testament to the process,” she said.

Bex went on to add that finance was also key, at both practice level and ICB level, stating, “it takes a lot of staff and a lot of money to set things up and there’s this insecurity as to whether the funding is going to be recurrent or not.” In order to tackle that insecurity, Bex suggested, having more “long-term investment, not just for this year or even for the next five years, but long into the future”.

Wrapping things up, Mateen expressed his optimism for agile practice as a whole, stating that in his experience, successful integration comes down to three key elements. The first one he outlined was collaboration with key stakeholders, which he said needs to be done “prior to accepting any contracts” and include “everyone who’s going to be using the systems,” otherwise adoption “will not be successful”. The second key area to focus on was effective training on all new tools to “make sure they’re being fully utilised within the practice”. And the last thing Mateen mentioned as being essential for successful adoption was a phased rollout of pilots with continuous celebration of “quick wins” such as patient satisfaction results, staff survey results or just having a good day overall.

We’d like to thank our panel of experts for joining us for this insightful panel discussion. If you’re interested in getting involved in the conversation, check out our upcoming events.

Two primary care innovation projects have been selected for Surrey Heartlands ICB Test Bed Programme, which, supported by £1.3 million in non-recurrent funding, aims to deliver innovation in primary care, focusing on three key areas: inbound, outbound, and business processes.

One of the projects set to be rolled out across three PCNs is Anima, a digital coding platform designed to support primary care workflows, reportedly bringing “uniformity, scalability, and greater resilience to clinical coding processes” for practices.

Another of the projects awarded a place on the programme is Blinx Healthcare’s patient and care optimiser solution, which is said to “integrate directly with clinical systems at both practice and federation level, enabling enhanced patient management and care delivery at scale”.

Welcoming the news in a LinkedIn post, Andrew Roscoe, managing director at GP Health Partners, talked about how the projects would help transform the way practices work, driving efficiency in processes and improving outcomes for patients, adding: “This is a really exciting opportunity for our federation practices to work collaboratively with tools that are fit for the demands of modern primary care.”

Innovation in primary care and beyond

For a recent HTN Now panel discussion on GP practice and PCN improvement through innovation, HTN welcomed panellists Sabrina Khan, business practice manager at Parson Drove Surgery, and Dr Sheikh Mateen Ellahi (Mateen), GP and practice partner at ELM Tree Surgery and South Stockton Primary Care Network. Mateen shared a case study from his practice, detailing successes including reducing DNA rates, encouraging “substantial growth”, improving patient experience, and implementing a “hub model” to speed-up decision-making. 

A panel discussion centred around patient engagement and communication tech looked at innovation in this space, with the help of experts including Jothi Vasan-O’Leary, medical information officer and outpatient clinical lead (GIRFT) at University Hospitals of Derby and Burton; Daniel Parkinson, digital IT project manager at Leeds Teaching Hospitals; Sally Mole, senior digital programme manager – digital portfolio delivery team at The Dudley Group; and Emma Stratful, chief operating officer at OX.DH.

Elsewhere, £3.9 million has been awarded to nine innovations that support the delivery of urgent & emergency care, through a SBRI Healthcare, an Accelerated Access Collaborative initiative, in partnership with the Health Innovation Network, funding programme. The funding aims to support innovations that scope health and care outside of hospitals, support reduced length of stay or improving discharge, or support the workforce.

The Scottish Government has shared details of a £6 million investment to be made as part of the Accelerated National Innovations Adoption (ANIA) programme, supporting innovation across conditions including type 2 diabetes and stroke, and for babies born with rare genetic conditions.

NHS Frimley ICB has awarded a contract to Pungo Ltd for its social prescribing digital solution, Joy, to support the “social needs” of patients across four Slough PCNs and other secondary care partners.

The procurement of the solution aims to improve connections between residents and local services within the region, including adult social care, outpatients, and the voluntary community sector. It supports patients with the self-management of long-term conditions, with the ICB noting how this will “effectively reduce pressures on primary care services through avoidable hospital admissions and GP appointments”.

The Joy app is designed to integrate with EMIS and SystemOne, which will reportedly create a “streamlined referral process” when connecting patients with different care providers.

Having already started in January 2025, the contract will last for 3 years. It is currently valued at £89,718.72 with the option to extend up to 12 months, for a maximum contract value of £120,523.13.

Digital in primary care 

For HTN Now we were joined by experts from across the primary care sector to debate how general practice, PCNs, and ICBs can utilise data and leverage technology to support operational efficiencies and improvements across primary care. Panellists included Kathryn Salt, assistant director of primary & community care, data and analytics for the Transformation Directorate, NHS England; Dr Shanker Vijayadeva, GP lead, digital transformation for the London region at NHS England; Dr Sheikh Mateen Ellahi, GP and practice partner at ELM Tree Surgery and South Stockton Primary Care Network; and Max Gattlin, digital consultant at X-on Health.

An expert panel including Deborah El-Sayed, director of transformation and CDIO at Bristol, North Somerset and South Gloucestershire ICB; Dan Bunstone, clinical director at Warrington ICB; Stephen Bromhall, interim chief officer for digitaland data at South East Coast Ambulance Service; and Laura Thompson, director of marketing at The Access Group, joined us late last year to talk about approaches to tackling challenges from an ICS perspective; new models of care and pathway transformation; the role of technology in supporting the move from reactive to proactive care; and how a system approach can accelerate preventative care.

NHS England published updates to the GP contract for 2025/26, with an £889 million increase in investment across the core practice contract and the Network Contract Directed Enhanced Service (DES), taking the combined total value the contract to £13,176 million in 2025/26.

A study published in the Journal of Medical Internet Research has explored “alert fatigue” from clinical reminders (CRs) amongst GPs, with concerns around design, content accuracy, and “lack of contextual nuance”. Authors suggest ways to overcome this and improve adherence to CRs, including working with GPs on their design, undertaking training on their use and benefits at an organisation level, and sharing best practices on their effective use.

Pointing first to the “growing sophistication of medical knowledge and the electronic systems that manage patient data and inform clinical decision-making”, authors note the effect this has had on the regularity of CRs, and the associated “cognitive load placed on GPs”. Not all CRs are acted upon, the study finds, and whilst in some cases that may be due to their irrelevance or inapplicability, “increasingly GPs are disregarding pertinent or urgent CRs, a chronic negligence commonly referred to as alert fatigue”.

Aiming to improve understandings around GP attitudes to CRs within their role, authors adopted “best practices in systematic review methodology and directed content analysis”, presenting results “through the lens of the NASSS framework developed to support, guide, and monitor the implementation of digital technologies in health and social care”. In doing so, they considered domains, definitions, and influences on implementation, including intended users, acceptability to service users, and the work required in implementation.

A total of nine studies published between 2003 and 2021 were included, with five of those being from the UK, and one each from Australia, Belgium, The Netherlands, and Norway. Data from these studies was then mapped against the NASSS framework, allowing the authors an insight into study outcomes, design, the tested purpose of the CR, participants, and key findings.

Key findings from this process covered domains such as medication, diagnosis, and ongoing management, finding an “overabundance” of CRs, a “preference for accompanying information that aided comprehension” of CRs, that CRs requiring a response “disrupted” the workflow, concerns around accuracy and relevance, and that CRs were “valued for their ability to provoke a decision, particularly in busy environments”.

Four studies noted that inability to process a large number of alerts “was a concern” amongst GPs; whilst three shared that “pop-up CRs that required the checking of drop-down lists or otherwise had to be actioned before any next step were overly disruptive and actually inhibited their engagement with the CRs content”. In five studies, however, GPs reported that CRs were “capable of improving patient safety by promoting reflection on their decision”; whilst one study highlighted GP opinions that CRs could improve long-term practice “by their ability to promote and reinforce appropriate prescribing behaviors”.

When considering factors which influenced GPs engagement with CRs, the studies noted the impact of “hesitation in relying on a computer-generated algorithm”, examples of “unrecognised contraindications” such as drug-drug interactions mentioned in textbooks not being picked up, and the need for “greater transparency between the clinical evidence and the presentation of the CR”.

In particular, training and system capacity yielded significant results to inform suggestions to improve adherence to CRs, with five studies noting the importance of training on the purposes of CRs and their functionality, and GPs sharing how time pressures reduced their ability to properly interact with CRs.

Summing up the key elements of these findings, the study’s authors highlighted that the use of CRs in areas such as diagnosis, prescribing and ongoing management of chronic conditions “was seen as an effective means of maintaining or improving safe and high-quality care, albeit with contrasting effects on clinician self-efficacy”. The efficacy of CRs was found to be “directly linked to their frequency, the presentation and accuracy of their content, and the speed and reliability of IT infrastructure and hardware”; whilst for adopter attitudes, GPs held concerns about accuracy and loss of benefits from their clinical experience and patient context.

From an organisation perspective, authors continued, “the importance of training and the ability of CRs to integrate seamlessly with existing workflows were emphasised”; .whilst suggestions to improve usability for CRs included “the sharing of best practices and involving GPs earlier in the design process to ensure successful embedding over time”.

The study concludes with a series of ten recommendations, including for technology, that a “visual-driven user interface” is used to present information “more effectively” and reduce information overload; for adoption, that “GP-endorsed” or recommended CRs “would promote and increase their uptake”, and that CRs should “transparently reflect the latest clinical evidence”; and for organisation, around greater engagement and training on CRs, as well as better incorporation of CRs into existing workflows. Other recommendations include encouraging GP-stakeholder collaboration enabling feedback and co-design, and enabling alert customisation to allow GPs to deactivate “unnecessary output”.

Citation: Gani I, Litchfield I, Shukla D, Delanerolle G, Cockburn N, Pathmanathan A. Understanding “Alert Fatigue” in Primary Care: Qualitative Systematic Review of General Practitioners Attitudes and Experiences of Clinical Alerts, Prompts, and Reminders. J Med Internet Res 2025;27:e62763. URL: https://www.jmir.org/2025/1/e62763. DOI: 10.2196/62763

Digital primary care from across the NHS

NHS England’s updates to the GP contract for 2025/26 have been published, with an additional £889 million named as the “biggest increase in investment into general practice in over a decade”, requirements for practices to enable functionality in GP Connect, and a reduction in “bureaucracy” for practices.

Last month, NHS Devon ICB shared an update on its Primary Care Access Recovery Plan, highlighting “good progress” on delivery, a focus on tackling variation, and a potential saving of £19 million through digital advancements. Somerset ICB also highlighted progress on its Recovering Access to Primary Care programme, noting digital progress against key deliverables ahead of the conclusion of the programme in March 2025.

HTN also announced the finalists in its Primary Care Awards, showcasing innovations, solutions, case studies, collaborations and projects helping shape future services and systems across health and care.

A feature article from Accurx looked at better ways of managing demand to beat the 8am rush and offer an improved experience for patients and clinicians alike, suggesting a single “digital front door” to direct patients to the most appropriate setting first time, “instead of using primary care’s limited resources to redirect them when their care isn’t best managed there”.

NHS England’s updates to the GP contract for 2025/26 have been published, with an additional £889 million named as the “biggest increase in investment into general practice in over a decade”, requirements for practices to enable functionality in GP Connect, and a reduction in “bureaucracy” for practices.

The £889 million increase in investment will be implemented across the core practice contract and the Network Contract Directed Enhanced Service (DES), which NHSE states “will take the combined total estimated contract value from £12,287 million in 2024/25 to £13,176 million in 2025/26”.

Practices will also be able to take part in an “enhanced service for advice and guidance” which NHSE estimates is worth up to £80 million, to support the move to care in community settings.

On QOF, the update shares the permanent removal of 32 QOF indicators which were income protected in 2024/25, adding: “This equates to 212 QOF points worth c.£298m in 2025/26.” A further 71 points, worth around £100 million, will be “removed outright” and invested into Global Sum, childhood vaccinations and locum reimbursement rates; whilst the remaining 141 QOF points, worth £198 million, will be targeted towards cardiovascular disease prevention “to support the government’s ambition to reduce premature mortality from heart disease or stroke by 25 percent within a decade”.

The update highlights the importance of ending the “8am scramble”, adding a requirement for practices to keep online consultations tools “open for the duration of core hours” by 1 October 2025 for non-urgent appointment requests, medication queries, and admin requests. By the same date, practices will be required to have enabled functionality in GP Connect to allow patients to view their care records, and to offer community pharmacy teams to send consultation summaries into the GP practice workflow, aiming to “reduce the admin burden for general practice teams”.

Along with these changes, NHSE also announces modifications to the Additional Roles Reimbursement Scheme (ARRS) to “increase in flexibility to support PCNs to respond to their local workforce requirements”, creating a “single pot for reimbursement of patient facing staff costs”. The salary element of the maximum reimbursement amount for PCNs to claim for GPs will be increased from £73,113 in 2024/25 to £82,418, in a move to support recruitment of GPs via the ARRS.

Amanda Doyle, NHSE’s national director for primary care and community services, said that the latest contract “sets out the next steps to put the family doctor at the heart of the shift to a neighbourhood health service”, noting specifically the delivery on “priorities that matter most to patients and general practice teams” including additional funding and flexibility to “recruit more staff”. and “improved digital access for patients”.

Digital primary care from across the NHS

Last month, NHS Devon ICB shared an update on its Primary Care Access Recovery Plan, highlighting “good progress” on delivery, a focus on tackling variation, and a potential saving of £19 million through digital advancements. Somerset ICB also highlighted progress on its Recovering Access to Primary Care programme, noting digital progress against key deliverables ahead of the conclusion of the programme in March 2025.

HTN also announced the finalists in its Primary Care Awards, showcasing innovations, solutions, case studies, collaborations and projects helping shape future services and systems across health and care.

North West London ICS’s latest board meeting shared insights into the developments in the region, including challenges around cyber resilience, digital in primary care, an update on its digital programmes and progress towards integrated neighbourhood teams.

A feature article from Accurx looked at better ways of managing demand to beat the 8am rush and offer an improved experience for patients and clinicians alike.

Helena Brown, Interim Head of Customer Success, Accurx

For a long time now, many GP practices have been overwhelmed with patient demand. But what we hear and see from our GP community is that much of this demand could be better managed in a different setting, or even entirely self-managed by the patient.

So why isn’t it? Perhaps the more existential reason is that from a young age, it’s been ingrained in us to ‘call for a GP appointment’. Another reason is that the system has always placed GP practices as the first point of contact for patients, even though they end up spending a lot of time diverting requests that could be better managed elsewhere.

Over the years, this has led to:

• Poor patient access to general practice – GP or PCN appointment waiting times can be over six weeks, and patients often experience the ‘8am rush’ when seeking care.
• Poor patient access to alternate services – it is hard for patients to know what services are available to them and how to get in touch. We recently surveyed 214 practices and the second biggest factor that slows GP practices down with their triage process is having to signpost patients away from the GP to alternate services.
• Poor efficiency – patients end up being seen in more expensive and capacity-constrained settings, and there is significant duplication as they bounce around the system.

But we know there is a better way. Over the past few years, there has been constant innovation and commissioning of alternative and more appropriate channels to direct patients to. This ranges from NHS.UK self-help content and self-refer physio services, to Pharmacy First and out-of-hours GP services. Now we need to put these channels to better use, through creating a single ‘digital front door’ that directs patients to the most appropriate setting first time, instead of using primary care’s limited resources to redirect them when their care isn’t best managed there. In this article, I’ll explore what that could look like.

A digital front door

We believe that the future of digital in primary care is in a single ‘digital front door’ that directs patients to the most appropriate setting, first time. The front door allows the patient to see and get in touch with both primary and secondary care services in their area from one single place, so patients are treated in the right place, with the right person, in time.

For example, if a patient presents with a sore throat or sinusitis, the digital front door could pick up that these are Pharmacy First conditions, and make them aware that they can be treated in their local pharmacy. Of course, showing all options for care would not be appropriate for every patient. The NHS Spine integration would recognise specific cohorts of patients who could be directed immediately to any existing team they were under, e.g. complex care coordination.

A digital front door would reduce demand on GP practices, decrease duplication of patient requests across NHS services and increase the speed at which patients get the right care.

At Accurx, we believe the digital front door we’re building could eventually divert up to 40 percent of requests away, before they ever reach the GP practice.

What to think about when implementing a digital front door

Consider first where a ‘digital front door’ can have the greatest impact, fastest. For example, with a record 3.8million people treated in 2023 by NHS Mental Health Services, and a large proportion of these being for mild to moderate conditions, the digital front door could play a huge role in signposting to IAPT self-referral options locally. We’d recommend connecting with your local IAPT services or pharmacies as part of Pharmacy First to explain the change and how this could affect patient flow. In the case of Pharmacy First, the front door could be a huge incentive to get their completed consultation payment.

Then there’s preparing patients for the change. We’ve come a long way since the pandemic in delivering and accessing care digitally and we know involving patients is integral to any digital change management. Your Patient Participation Group will have some ideas on how to make the transition to a digital front door seamless. Consider starting out by sharing the link to the front door with patients who you know are digital champions and familiar with online consultation. If it doesn’t work for them, it won’t work for the rest of your patients. Then consider what resources might you need to help other patients get on board, and how your admin team can begin preparing patients in their regular touchpoints for the change.

Your local patient population is unique, and their needs will affect what services have been commissioned in your area and therefore what is available to them in the digital front door. By knowing these services, and mapping out which ones you want the digital front door to signpost to, you’ll be able to hit the ground running.

Interested?

If you’re interested in up to 40 percent fewer requests coming to your practice, or the practices in your ICB, whilst improving productivity, access and staff experience, we’re currently recruiting for a front door pilot. Get in touch with customer.success@accurx.com and we’ll add you to our waitlist.

NeoHealth Primary Care Network has commissioned digital health service, Aide Health, to support patients who are suffering with long-term health conditions through the implementation of their self-management platform.

Aide Health’s digital tool is said to “help improve a patient’s capability for self-management” through 24/7 access to consultations and reviews conducted by conversational AI, which is available via a mobile app. This reportedly helps to “reduce utilisation in both primary and secondary care”, with the conversations designed to capture data on blood pressure monitoring, mental wellbeing, symptoms and identify opportunities for medicine optimisation.

The self-management platform can be used to help those with asthma, type 2 diabetes, hypertension and COPD, with Aide Health stating they have further plans to introduce a pathway for chronic kidney disease in Q2 of 2025.

Initial rollout within the PCN will see patients with type 2 diabetes and hypertension being offered the service first, with long-term plans for it to be introduced to other areas of the PCN to help cover their 30,000 patient base.

Ian Wharton, founder and CEO of Aide Health, spoke on this new partnership, commenting:‍ “Dr Razak and the team at NeoHealth have an outstanding reputation for innovation and co-designing care with its community. This new partnership also marks a significant milestone for Aide Health as our first deployment in London. We’re thrilled to continue developing our platform alongside NeoHealth to support patients and the NHS as effectively as possible.”

Digital self-management in healthcare: the wider trend 

For a recent HTN Now virtual discussion, we were joined by panellists including self-management specialist Steph Lowen; Dee McMullan, senior district nurse at Leicestershire Partnership, and Charlotte Furness, partnerships lead at Isla Health, to talk about the implementation of supported self-care.

Over the past year, there has reportedly been a 34.8 percent increase in the number of patients using the minor eye conditions online self-referral within the NHS Mid and South Essex ICS. The online process allows patients to self-refer and access an optometrist without needing an appointment with their GP practice, giving them “quicker access to care”.

Avon and Wiltshire Mental Health Partnership NHS Trust launched the South West Gambling Service, which is an online self-referral form providing specialist therapy for people affected by the impacts of gambling. It works in partnership with Mental Health Matters, H2CD, Togetherall, Dr Julian and Intuitive Thinking Skills.

The ICB highlights that more appointments are being provided than before the pandemic, however its approach to access is wider than focusing on the number of appointments and to “promote community-based person-centred care”. Here, the ICB references as an example, to increase self-referral opportunities for patients and focus on digital innovation to improve efficiency, patient and staff experience.

On tackling the “8am rush” and increasing the number of appointments delivered both same day and within 14 days, current statistics from the ICB show that on average “44 percent of all appointments in Somerset are delivered on the same day” with an estimated “40 percent delivered within 14 days”. The ICB notes that the latter figure “continues to rise” as they work towards the national target to deliver 85 percent of appointments within 14 days.

However, the ICB also shares their work on improving data in general practice, noting that currently its data does not accurately reflect the actual number of appointments. To combat this, NHS Somerset has been supporting practices with the quality of their appointment data as well as focusing on the reduction in workflow tasks within the EMIS clinical system. Here, specific resource of Digital Data Facilitators are being utilised, and discussions around clinical triage systems are being explored with the aim to improve data accuracy. The ICB also notes GP practices within NHS Somerset are currently using 9 different tools for online consultations.

To support uptake of the NHS App across Somerset, the board highlights that “over 40 NHS App registration events” have taken place, with data from June 2024 showing a “5 percent year-on-year increase” in registrations.

The report also gives an update on the rollout of self-referral pathways for musculoskeletal services, audiology, weight management and community podiatry. The ICB notes progress in some of these areas, while others still have some challenges. The use of the getUBetter digital self-management support tool for MSK pathways is underway, with 5,145 patients to have created a getUBetter account. While tier one of the weight management self-referral system is in place, the ICB notes provisions to review and focus on tier two services.

In terms of audiology, the ICB “does not feel it is currently in a position to roll out self-referral”, but are actively discussing the service and looking at further opportunities. Podiatry also faces challenges in terms of waiting times and “sustained workforce shortages” and as such does not currently have a self-referral option. Plans to work on this include reviewing the service and looking at “workforce recruitment and retention planning” with hopes to deliver a self-referral platform at a later date in 2025.

Reported statistics given on self-referrals show a monthly average of “over 57,000” in total across Somerset, highlighting the ICB’s performance against NHS England’s national target of 45k, which was outlined in the 2023/24 delivery plan for recovering access to primary care.

When looking ahead, the ICB highlights key priorities for the year, including: increasing NHS App record views and prescription numbers; continue expanding self-referrals; complete implementation of improved digital telephony; expand uptake of Pharmacy First services; continue implementation of simplified patient access and more. Read further details on the progress of Somerset’s Recovering Access to Primary Care Programme.

Primary care transformation: the wider trend 

Similarly, NHS Devon ICB recently shared an update on its Primary Care Access Recovery Plan, highlighting “good progress” on delivery, a focus on tackling variation, and a potential saving of £19 million through digital advancements.

A recent HTN Now panel discussion, saw a panel of experts from across the health sector discuss how general practice, PCNs, and ICBs can utilise data and leverage technology to support operational efficiencies and improvements across primary care. Panellists included Kathryn Salt, Dr Shanker Vijayadeva, Dr Sheikh Mateen Ellahi and Max Gattlin.

When we asked our audience “two years from now, how many GP clinical system (core electronic health record) suppliers do you think there will be: 1-3, 4-5, or 6+?”, 43 percent of them said 1-3. A further 34 percent said 6+ and 23 percent said 4-5. Find out more about our poll here.

Finally, if you’re interested in the latest primary care success stories, make sure you tune into the HTN Primary Care Awards, where we’ll be celebrating how digital solutions have been transforming this sector. Learn more.