A recent HTN Now webinar took an in-depth look at how technology is transforming skin cancer care at the Royal Cornwall Hospitals NHS Trust, exploring successes in reducing two-week wait referral time from 57 days to 12 days, looking at challenges for implementing this approach, and sharing advice to other healthcare organisations looking to implement similar digital pathways.

Sandy Anderson, consultant dermatologist at Royal Cornwall Hospitals Trust, and Gabi Cohen, director of delivery at Isla Health, joined us to share their insight and experience on the project, which won in the HTN Awards category Case Study of the Year, before moving on to take questions from our live audience.

“I’m a locum consultant at Truro, where I’ve been for about 15 years,” Sandy told us, “but before that my background was in general surgery, then general practice, and then dermatology, becoming a consultant through the Portfolio pathway.” His main passion and experience has been in skin cancer diagnosis and complex surgery, he added.

Gabi also introduced herself and her role, stating: “I’m the director of delivery at Isla, and the delivery team is responsible for implementation and evaluation, focused on all of the things that sit behind brilliant projects like these. Our team make sure that at every step of the process, you have that really rigorous implementation and strong clinical leadership, working collaboratively to make things as easy as possible for organisations like Royal Cornwall.”

Innovating skin cancer pathways at Royal Cornwall Hospitals

Sandy then began his presentation on the community lesion imaging clinic initiative, a project he says “began over a year ago” as a means of overcoming the challenge of “escalating skin cancer referral rates and a shrinking workforce”. Whilst 25 percent of consultant dermatology posts in England are unfilled, he shared, the situation is “particularly difficult” in Cornwall due to its remote nature, “and in the last ten years, our skin cancer two-week wait referrals have gone from around 3,500 to 10,00o per year”.

Up until this initiative was introduced, a traditional model has been in use, Sandy went on, “where we didn’t particularly screen two-week wait or suspected cancer referrals – we just saw them all face-to-face”. A key challenge for Cornwall is also that it has “no plastic surgeons”, and less than two whole-time-equivalent substantive consultants, he shared, “for a population of about half a million”.

The model that the trust looked into was a “low cost, high volume, teletriage” approach to suspected skin cancer, according to Sandy, “and from the start we had to make it more efficient for doctor time, it had to work with what we already had in the absence of lots of funding, and it had to be acceptable to patients.”

With the intention of capturing as many of the trust’s two-week wait patients as possible, inclusion was set to cover all adults, with a maximum of 3 lesions noted by the GP to avoid “the risk of imaging the wrong thing”, and excluding genital lesions. Highlighting results from January to May 2024 and the initiative’s first 1,398 patients, Sandy told us how 24.5 percent had been discharged to a GP with advice, 38.9 percent had been added to the day case list for biopsy or excision, 34 percent had been triaged to face-to-face review, 1.3 percent had a follow-up arranged, and 1.4 percent had been referred to a surgical specialty.

“From seeing 100 percent of patients face-to-face, we reduced that to avoid 65 percent of those initial face-to-face reviews,” Sandy shared, “which freed our team up to do the rest of dermatology”.

Sandy highlighted the findings and impact at Royal Cornwall Hospitals, saying: “We think it’s a safe and effective way to operate; it’s reduced our face-to-face appointments by two-thirds, missed cancer rates are similar to our face-to-face work, and as a by-product, we’re building up a big collection of high-quality dermascopic images and metadata which will be ready to contribute to nationwide databases for testing and training AI.”

Implementing the pathway: Things to consider

“We work with a number of teams when implementing this,” said Gabi, “from contracting through to information governance, clinical safety, and to mapping the interoperability required to do this project well – in this context it’s a bidirectional HL7 feed – through to clinical mobilisation and getting everyone trained and confident with the platform, and then into evaluation and business as usual.”

The key is understanding what it is that you’re trying to impact or change, Gabi continued, “as well as the mechanisms that sit behind that, so we can look at the suite of functionality Isla can offer and make sure we’re offering the best of breed pathway”.

“For us, the bottleneck was around the availability of specialist dermatologists,” Sandy considered, “and it’s very difficult to recruit those, whereas it’s quite easy to train nurses to do biopsies and excisions, and the Isla software allows us to mark-up images electronically and complete our standard booking form on the normal hospital system, so when they come back to these day case lists, they’ve got a marked image and that booking form.” Standard surgical questions are also included in the CLIC questionnaire, he went on, “so that’s all present there, too”.

One of the motivations for the initiative for Sandy was “making it as quick and easy for the doctor as possible”, he shared. “If we made this time-consuming and laborious, it wouldn’t be any more efficient; Isla’s been really good for allowing us to see large numbers of patients quickly, and part of the reason is we’ve worked with the team to adapt the product for our needs.” It now takes less than an hour to triage, list and “do all the actions, including letters and things” for a four-hour clinic, he stated, “and the HCAs see 15 patients in clinic, which is a fair sized lesion clinic, and it takes me about 45 minutes to action that on Isla”.

Gabi shared some insight into the impacts around efficiency from a tech perspective, pointing to the importance of being able to “meet patients where they are,” especially in cases with remote populations like Cornwall. “You’re preventing them having to travel for appointments, and inherently there’s a tech need for that, so data can be accessed really securely and safely from these remote locations,” she said, “and having that really clear need made it obvious why this needed to be a digital-driven implementation.”

Offline access has been released this week by Isla, Gabi shared, “and that’s incredible exciting; not just for dermatology, but a lot of our community nursing teams work in rural parts of the country, where there might be no access to the internet”. That allows images to be stored until connectivity is available, before being uploaded onto the platform, she said, “and we don’t require patients to download anything, so the intention there is to make the burden on the patient as minimal as possible.”

Making sure that there is no added clinical burden or overhead has been an important consideration for Isla, Gabi told us, “and another key factor has been in making sure that everyone on the pathway is clear on what their role is, because as Sandy said, we’re leveraging lots of different members, and training is the priority to ensure everyone knows what their pathway looks like, and their place within that.” For this iteration, training was completed with Sandy and other consultants, and videos and user guides were used to create a module for the HCAs, she said.

A lot of work was done on making the pathway as efficient as possible, Sandy shared, “because when we started, we were uploading referral letters by hand into Isla, as I felt the triaging doctor should just be within Isla, and shouldn’t have to have four different systems open, so as much as possible has been kept within Isla, except booking the procedures, although even that is now automated to pull referral letters straight from ERS into the patient’s Isla record when a patient is added to our clinic.”

From a clinician’s perspective, Sandy continued, “within Isla I can have the referral letter there, the questionnaire data, the images, and I fill in a quick review form detailing my opinion and outcomes, and then we just select everything and output it as a PDF back to our EPR.” That has the added benefit of meaning that when admin staff are “outcoming the clinics and doing letters,” they don’t necessarily need to be on Isla, they can choose to stay in the EPR, he added.

Measuring success

Answering some incoming questions from our audience around measuring success, Sandy told us how the team is currently allowing six minutes on average for triaging a single case, with job plans accounting for “90 minutes to triage a four-hour clinic”, which also covers the admin time for processing results.

“When we’re looking to capture the impact of any implementation, we always start off thinking about safety and accessibility,” Gabi considered, “and then we think about clinical productivity and any cash implications”. For this two-week wait pathway, “there are some very specific KPIs like referral to treatment,” she went on, “as well as other efficiencies such as how long it took to action the patients.”

Keeping patients and patient experience at the centre of the model is integral, Gabi said, “and we’re making sure we’re listening to feedback and iterating on the model to make sure we’re really thinking about what that patient experience looks like”. Alongside that, it’s considering the clinical experience and usability, with co-production with clinicians a regular feature and discussions around tweaks that could be made to make the tech “more effective, more efficient” on delivering key outcomes.

Sandy shared some feedback from “a snapshot of between 100 and 200 patients” given feedback questionnaires, acknowledging “coming to the hospital and parking seems to be the biggest barrier to accessing healthcare.” Estimating that it was “about 96 percent positive”, he said: “A lot of the feedback was about being able to be seen locally, feeling listened to, and having everything moved along quite quickly.”

Ensuring successful implementation and adoption 

Having rigorous governance in place when approaching this kind of initiative and assigning clear roles and responsibilities is essential, Gabi noted, “as well as having input from admin and service managers on what standard operating procedures should look like”. It’s normal to “have some anxiety” around a new process, she said, “so we had a regular weekly forum where we discussed any challenges and worked through those in a really methodical way – key to that is having the right people in the room.”

Building acceptance and encouraging adoption is helped along also by ensuring alignment with wider organisational priorities and strategies, Gabi shared, “so we’re articulating the impact something is going to have on patient populations, getting that weekly governance in place, and making sure we can address challenges quickly and effectively.”

“I have found Isla has been very responsive to any challenges we might have,” Sandy agreed, “including in the beginning where we had occasional bumps and glitches – they’ve always been fixed within a day or two, and I think that relationship has been key to the implementation.” Running “dummy clinics” first and testing out things like admin processes and image capture was important, he said, “and we’ve grown it from there, starting with one clinic a week and then adding clinics at different sites.”

Everything that is put into Isla is coded, Sandy told us, “it’s all drop-downs, so there’s no free text, and I can get Excel spreadsheets and CSV files at short notice, either by myself, or via request if it involves big numbers.” That functionality has been “brilliant”, he went on, “and we’ve been able to present and publish a few things so far using that, which is very different to other software I’ve used, and far more reliable than any of the hospital outcome data I’ve encountered before.”

Key takeaways and advice for those considering similar implementations

Moving on to consider what advice they would offer to anyone on the call looking to implement a similar pathway, Sandy said: “There’s no need to reinvent the wheel – get in touch, you can share our processes, share our training packages.” It’s been “a very open and transparent process”, he went on, “and I’ve seen all the costs and the IT security side of it, the data ownership, and so on, so you just need to keep things transparent and honest.”

Planning is key to success, Gabi considered, “and also from our side, it’s having flexibility to tweak things or update them, being open to iterating as we work through the project, learn new things, and review data.”

When considering safety and risk when implementing a pathway like this, Sandy said: “The HCAs have got clear guidance on that if there’s any ambiguity or uncertainty, the procedure should be abandoned and a face-to-face review should be arranged. Similarly, if a patient tells them they have another 12 moles on their back that they would like checking by a doctor, the procedure is abandoned.”

Discussing how the Isla platform can support data security, Gabi pointed to Isla’s focus on ensuring data can be captured and stored in a “really secure way”, before being made ‘immediately accessible to the different teams that need access to that data”. As a cloud-based platform, she said, “the upload process is encrypted, and nothing is stored locally on any device – when using iPads, for example, that information is uploaded straight into the Isla solution”.

The panel also looked at the potential for the images collected and uploaded to Isla to be used for research, with Sandy noting “lots of opportunity” for AI in dermatology and skin cancer diagnosis. “From the start, we’ve asked patients to consent to their images being uploaded to their medical record, but then offered a separate consent for those images to be anonymised and used for teaching and training, including in the training of AI.”

Having collected between 10,000 – 20,000 dermoscopic images of lesions, “we’re now going back and adding their diagnostic tags”, he went on, “and my vision, along with others, is that we end up contributing to an anonymised nationwide research database that we can use to test and train AI products on real world data.”

One key takeaway from an implementation perspective is that “there isn’t one solution that fits every single patient population or every single trust we work with”, Gabi considered, “so getting an idea of how this might look in your organisation and mapping out the problem you’re trying to solve is really important”.

“My key takeaway would be not to be afraid of this being clinician-led,” Sandy said, “because as much as this is about technology, this pathway will be successful if it’s driven by clinicians.”

NHS England has issued recommendations alongside a “what good looks like” framework for antimicrobial resistance (AMR), pointing to the use of clinical digital systems for prescribing, integrating the coding process and decision support tools into clinical workflows, displaying timely and relevant clinical information, and more.

On prescribing, the recommendations outline that clinical digital systems should support clinicians by offering “appropriate” treatment choices and durations, and making it easy to record prescribing decisions. In secondary care, they should support the use of start smart then focus principles, whilst in primary care and outpatient settings, they should facilitate the use of delayed or back up prescribing strategies. The role of clinical digital systems in reviewing and revising prescriptions by offering access to key information and decision support tools, supporting electronic referral of patients to AMS teams or infection specialists where required, and flagging key clinical advice on treatment plans, are also considered.

The framework adds that these systems may also play a role in tackling inconsistency in the coding process, according to the recommendations, which point to the need for workflows in primary care to be structured so that diagnosis coding occurs prior to a prescription being generated. It adds, for systems to require documentation of diagnosis linked to the prescription in secondary care with the potential for this to be reviewed, and for all prescriptions to be linked to a coded diagnosis to facilitate audit.

Diagnostic tests, clinical decision support tools and treatment guidelines should be integrated into digital systems and be visible at key stages of the clinical workflow, the recommendations state, whilst relevant and timely information on things like recent microbiology culture and sensitivity results should be easy to view. NHSE also notes the importance of systems supporting the increased uptake of patient-facing tools by improving functionality and ease of use; interoperability between care settings; support for surveillance and reporting on key metrics; alert prioritisation; agility and adaptability to support innovation.

The accompanying digital framework for antimicrobial stewardship offers best practices for the use of IT systems, across seven success measures: well led, smart foundations, safe practice, support people, empower patients, improve care, and health populations. This looks at how organisations can ensure that their stewardship teams are supported to drive digital transformation, including through building digital and data expertise in this area, creating clear accountability and governance processes, and building partnerships with suppliers. Smart foundations also covers IT infrastructure and data, looking to workforce capacity, technical expertise, and the reliability and secureness of hardware.

Across the remaining measures, NHSE highlights steps that organisations should be taking to support the real-time use of data, optimising alerts and decision support to improve care and minimise disruptions to workflows, promoting digital literacy amongst the workforce, placing patients at the centre of service design, embedding digital and data to transform care pathways, and using data to inform care planning.

More on the use of digital from NHSE

NHS England’s board met last month to discuss 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 Like framework.

The latest progress report from NHSE on its Rare Disease Action Plan highlights progress against its four priorities of faster diagnosis, increased awareness, better co-ordination of care, and improved access, as well as introducing three new actions, and outlining digital and data work streams. In its final year, the plan introduces three new actions, to establish a new model for clinics for multi-system disorders, improve rare disease clinical research, and support for “individualised therapies, specifically designed to a unique disease-causing variation in an individual’s DNA, addressing the root cause of the condition”.

NHSE also recently published eight principles for the “appropriate use” of digital technologies in mental health settings, aiming to provide a guide for procurement, implementation, data protection, policy, staff training and recording in patient care and treatment plans. Designed to help clinicians decide whether using digital technology is the “most appropriate, effective and least restrictive” way of treating patients in mental health settings, the principles focus on: a human rights approach, consent and capacity, equity of access, co-production, therapeutic and personalised care, safety planning, evidence base, and treatment outcomes.

NHS England has confirmed a two-year extension worth up to £36 million for its national breast screening system (NBSS) IT software platform, which has been delivered by Hitachi Digital Services UK Limited since 2015. The extension means the contract will now run to 31 May 2027.

NHSE notes that the screening platform is “critical” to the provision of breast screening services, providing the ability to make bookings and onward referrals, with the notice highlighting the system is “extremely complex”. Justification for the new contract award is noted on the basis that there are no reasonable alternatives for the provision of this service.

With NBSS in use in over 70 different breast screening offices, NHSE also highlights the complex and time consuming nature of rolling out new releases, adding: “This new contract award (which is a restating of the previous contract) will provide service continuity while the future long term strategy for NBSS continues to be developed and subsequently implemented.”

Tech procurements from across the NHS

Greater Manchester Mental Health NHS Foundation Trust has awarded a contract worth £572,000 to DrDoctor for the provision of a patient engagement portal. In a contract award notice published earlier this month, the trust shared details of the contract award, described as the “provision of services for patient engagement tools, consumables, transformation services”, made by direct award via G-Cloud 14 Lot 2 “after pre-established internal requirements were entered into the digital marketplace”.

Hampshire and Isle of Wight Healthcare NHS Foundation Trust announced a contract award of £102,000 for a one-year deal to London-based Dr Julian Medical Group Ltd for Talking Therapies third party provision. The notice shares that the trust required an “innovative, efficient, and effective solution to support and enhance the delivery of Talking Therapies and associated Psychology services (Step 2, Step 3 and Step 3+)”, which would also offer “flexibility and responsiveness to changing needs and demands of the services and patients”.

NHS Greater Glasgow and Clyde has awarded a £307,000 contract to the virtual care solution Doccla, for its remote management platform aimed at helping patients with long-term health conditions. The contract covers the installation of the Doccla virtual ward solution, which was chosen for its ability to offer remote support to patients and scalability capabilities which will reportedly help “manage the expansion of patient numbers”. It also integrates with the health board’s “cornerstone clinical systems” in use.

88 per cent of care homes in the South West London region now have digital social records in place, and 45 per cent are live with the London Universal Care Plan, according to an update from the ICS, which also shares that these developments are contributing to a 9 percent reduction in the number of residents taken to hospital by ambulance among the care homes using the system.

The update highlights the “particularly crucial” nature of the plan for those reaching the end of their lives, helping record their wishes about how and where they would like to be cared for, as well as personal preferences. Minh Ha, manager of Beulah Lodge in Croydon, noted how being able to see live information prior to waiting for results from a doctor was “helpful” in speeding up the discharge process; whilst Andrea Howell-Jones, manager of Alexander House care home in Merton, pointed to its usefulness in offering access to information under one roof, meaning “in case of an emergency, we just need to tell the paramedics we’re on the Universal Care Plan”.

Other tech in use in care homes across South West London includes the Magic Table, a digital entertainment system offering games and puzzles for residents and family members, said to support “a change in social stimulation and with some of the residents’ anxiety”.

The PainChek solution, is also in use in 20 care homes in the region, which utilises AI to identify subtle expressions indicating someone is in pain, supporting those who might be unable to express their pain verbally. The ICS noted that “in 2024, over 8,000 PainChek assessments were completed for more than 500 residents, improving pain detection accuracy and speed.”

Tech and data in supporting care

Last year, NHS England published a case study entitled “Improving care home residents’ wellbeing through digital technology – South Devon and Torbay”, in which Digital Health Devon, a collaboration between the NHS, Torbay council and local Healthwatch; aimed to support care homes and their residents in making the best use of SMART technology. Using an introductory pack from Digital Health Devon, which comprises of Amazon Alexa devices, a meta portal, mobile phones and Wi-Fi extenders; staff in care homes receive online training to help them to put this plan and tech in place for their residents.

In December, NHSE published its enhanced health in care homes (EHCH) framework, highlighting a series of digital enablers including digital readiness and data sharing, to support the provision of proactive care. The framework is intended for PCNs, providers and commissioners of community health and social care services, “so that the entire system works together to provide personalised care, improve outcomes and promote independence for people living in care”. It highlights changes to working practices driven by the pandemic, including the use of digital to enhance integration and information sharing.

Earlier this year, Bedfordshire, Luton and Milton Keynes Health and Care Partnership shared an update on its work through the Digitising Social Care Programme, highlighting how use of online service Proxy Access is helping them to order medications “safely and quickly” as well as supporting working relationships between GPs and care homes. So far 80 care homes across the region are using Proxy Access, through which care providers can share medical information with residents’ GP practices, with nominated staff able to view and order medications, check test results or allergies, view upcoming appointment dates and book new appointments.

The Department of Health and Social Care is calling for “expert ideas and evidence” that can support the development of the national cancer plan for England, inviting comments and feedback on questions across prevention, access, early diagnosis, treatment, research and innovation.

Focusing on maximising impact using the most up-to-date tech and innovations, the DHSC also notes intentions to empower patients by offering more control over their own care, and to improve communications to support patients in making decisions about their diagnosis and treatment.

Setting out aims to “go further” to prevent cancer, to speed up diagnosis and treatment, to improve outcomes, and to ensure patients have access to the latest treatments, digital tools and technologies; the call for comment notes the potential for piloting innovative diagnostic technologies and modernising cancer screening in enhancing early diagnosis.

The survey asks for feedback on where changes could make the most impact in areas like early diagnosis, with options such as “increase diagnostic test access and capacity”, “support timely and effective referrals from primary care”, and “increase support for research and innovation”.

The call for evidence closes at 11:59pm on 29 April. According to the DHSC, evidence gathered through this exercise will inform the upcoming national cancer plan for England, with the organisation set to respond to evidence received and publish the plan later this year.

Transformation in cancer care

In January, a report titled “Cancer Services in Wales: A review of the strategic approach to improving the timeliness of diagnosis and treatment” was published by the Auditor General for Wales, outlining that “despite increased investment, there is a continuing failure to meet the national performance targets for cancer”, highlighting risks to patient safety from fragmented digital systems and the need for more consistent national data.

Google has announced a partnership with the Institute of Women’s Cancers, with the aim to find ways in which AI tools can help “improve outcomes” for female patients with breast cancer and gynaecological cancers. Formed at the France AI Action Summit, the partnership aims to develop an understanding of how AI can “help better address cancer” with research focusing on the role of AI tools when predicting the progression of cancer and any potential risks of relapse. Other areas of focus include utilising their combined expertise for the “identification of new biomarkers that can predict which patients will benefit from specific therapies” and exploring the “origins of tumours, their evolution over time and the specific characteristics of rarer and more complex cancers”.

East Kent Hospitals University NHS Foundation Trust together with the Kent and Medway Cancer Collaborative, have opened a procurement for a cancer information system, aiming to support the management of their cancer pathway. The trust plans to introduce the platform across the entire cancer pathway, providing the ability to manage referrals for suspected cancer, ongoing treatment of confirmed cancers, self-supported management pathways via NHS login and patient portal, holistic needs assessment, treatment summaries and screening and surveillance of liver and lung cancers.

NHS Gloucestershire has published its first draft ICS data strategy spanning 2025-2030, pending approval from the board, marking a “bold step forward” in drawing on system strengths and transforming how data is used to improve health and care outcomes in Gloucestershire.

It focuses on improving citizen-facing care, workforce empowerment, transparency, and innovation, overcoming identified issues around limited or inconsistent access to data for both staff and patients, and overcoming siloes of data to effectively respond to system pressures, monitor performance, and plan strategically for future needs.

Currently, staff across the ICS face the challenges of navigating multiple “disconnected” systems, the strategy shares, with this fragmentation also impacting on data flows, reporting capabilities, risk, and the delivery of person-centred care. By leveraging the ICS Intelligence Function Guidance Toolkit, which emphasises collaborative working and the support of BI professionals, NHS Gloucestershire hopes to promote a holistic approach to intelligence that will facilitate the sharing of best practice, the best use of resources, and improvements in care quality. “Our integrated models of care will adopt innovative data analytics and predictive modelling tools, fostering a culture that is ready to leverage data for continuous improvement,” the strategy notes. “It will ensure our systems and practices are designed for future scalability and readiness.”

Fragmentation is also found in current enterprise architecture, the strategy shares, which includes legacy solutions and a lack of communication between systems. To develop this, a focus will be on be on integrating systems and providing a foundation for data access across all roles, with interoperability and shared access to data helping empower the workforce and supporting unified decision making and consistency. The ICS also looks to innovate for the future, evolving the architecture “iteratively” to incorporate emerging tech like AI and predictive analytics.

Focusing on developing a “data-informed” workforce and equipping data professionals with the skills they need to support advanced analysis and improved forecasting, the ICS commits to offering structured pathways for data analysts, data scientists, data engineers, database administrators and other specialists, to support the retention and development of talent. Staff not working directly with data will also be empowered to engage with analytical findings, “ask the right questions”, and apply data-driven insights within their role, the strategy continues.

Moving on to consider data quality, the strategy outlines current challenges around variation across the system, referring specifically to inconsistencies in data capture and “a lack of reliable documentation” undermining trust and leading to inefficiencies. Tackling these issues, it goes on, will help support the development of services tailored to citizen needs, improve the coordination of care, allow staff to use available data confidently in decision making, support proactive care planning, and ensure alignment between organisations.

A roadmap of deliverables covering the short, medium and long term is also provided within the strategy, with the focus for the short term on cross-functional teams, mapping strategic uses, ensuring security and compliance, a career development framework for data professionals, staff data literacy, data stewardship and ownership, and establishing horizon scanning cycles.

In the medium term, the ICS hopes to establish a decision support unit to enhance decision making, develop a unified enterprise architecture, consolidate and integrate systems, prepare a data quality toolkit, and establish an ICS-wide innovation hub.

In the longer term, the ICS commits to collaborative platforms for data sharing and communication, the deployment of standards-based interoperability, alignment of job descriptions across organisations, a centralised data catalogue, convergence with national and regional strategic platforms, the development of AI processes, and the adoption of a collaborative procurement strategy.

Success, the strategy outlines, will be dependent on a number of factors, including ongoing engagement, shared priorities, and a “clear and collaborative” governance structure promoting continuous evaluation. “By embedding evaluation into every stage of the strategy, we will create a feedback loop that drives continuous improvement,” the strategy details. “This will ensure that our approach remains responsive to the needs of the ICS and its stakeholders, enabling us to adapt to new challenges and opportunities as they arise.”

To read the One Gloucestershire draft data strategy in full, please click here.

Data use and best practices from across the NHS

In January, a HTN Now panel discussion focused on how data can help transform primary care, supporting operational efficiencies and improving outcomes. 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.

Dr Nicola Byrne, National Data Guardian for Health and Social Care shared their annual report for 2023-24, highlighting the use of health data across the NHS. Dr Byrne opened the report citing the renewed focus on health data following Lord Darzi’s report into the NHS and Professor Sudlow’s review into the UK health data landscape; and the accompanying commitments to data and digital initiatives made by the UK government to help the NHS transition from analogue to “a digital future centred more on preventative care”.

The government’s State of Digital Government Review also offered a “realistic and unflinching” analysis of tech in public services, highlighting fragmented technology, underused data, low service reliability, dependence on external resources for core skills, and funding which does not reflect modern digital practice. Headline findings from the review include that users of public services “expect more”, and that “45 percent of NHS services still lack a digital pathway”. The review notes that £45 billion per year in “unrealised savings and productivity benefits” could be achieved through full potential digitisation, the “fragmented and duplicative” nature of public sector tech, and the underuse of data which “holds back AI, machine learning, and advanced analytics”.

Imperial College Healthcare NHS Trust has opened a market engagement exercise for the procurement of a “suite of workforce management solutions” to be used across multiple trusts within the region.

The trust first aims to “gather industry feedback to inform the development of service specifications and commissioning strategies”, before they move on to procure a solution that will “enhance operational efficiency and optimise staffing resources” across a number of North West London NHS trusts.

This includes exploring e-rostering for staff scheduling, a bank and agency booking platform for temporary staffing, a digital platform to support job planning and a rota design and compliance system. According to the trust, adding these solutions will reportedly “support seamless workforce coordination, enhance efficiency, and drive improvements in service delivery” while also helping to ensure “high-quality patient care”.

To help the trust assess the market, interested suppliers have been asked to respond to a series of 15 key questions, covering the capabilities of potential innovations, after which a formal tender process may take place. Learn more about the notice here.

Workforce transformation in digital healthcare: the wider trend 

For a recent HTN Now panel discussion, we welcomed experts from across health and care, to discuss go-live projects within their own organisations. We covered a range of topics including post go-live best practices, key learnings and challenges when it comes to engaging the workforce and measuring adoption. Forming our panel was Sally Mole, digital programme manager at The Dudley Group NHS FT, Fhezan Ashraf, clinical configuration manager at The Dudley Group NHS FT, Stacey Spence, EPR programme manager at Medway NHS FT and Hayley Grafton, CNIO at University Hospitals of Leicester NHS Trust.

At Digital Health Rewired 2025, we attended the digital transformation opening keynote, where chief technology officer for NHS England, Sonia Patel, announced plans for a new initiative around Let’s Talk Architecture and creating a “digital and data blueprint for health and care”. Taking to LinkedIn to add more context to the initiative, Sonia put out a call to action to thought leaders, policymakers, professional bodies, innovators and enthusiasts to “share their insights, experiences, and visions for the future of architecture” within the NHS.

Salford Royal Hospital recently went live with the Sectra Picture Archiving and Communication System (PACS), for reporting and diagnostic imaging. This reportedly gave reporters and radiologists at Salford Royal the ability to view and report on imaging studies, “rather than having to navigate separate systems to provide reports that inform patient care, diagnoses and treatment”.

NHS Greater Glasgow and Clyde has awarded a contract to the virtual care solution Doccla, for its remote management platform aimed at helping patients with long-term health conditions.

The contract covers the installation of the Doccla virtual ward solution, which was chosen for its ability to offer remote support to patients and scalability capabilities which will reportedly help “manage the expansion of patient numbers”. It also integrates with the health board’s “cornerstone clinical systems” in use.

Valued at £307k, the contract was awarded on 8 April. It comes shortly after NHS Greater Glasgow and Clyde reported “good progress on its programme of digital improvements” as part of their wider Digital On Demand plan, in which they have noted that “154 projects are now underway across 12 key areas”. Some key areas of development include the introduction of a remote blood pressure monitoring system, a new digital pathway for dermatology services and a multidisciplinary team app for cancer care.

Virtual wards in health and care: the wider trend 

In a similar story, the Black Country ICB also published a prior information notice for the procurement of a remote monitoring and virtual ward platform. They’re looking for a solution to support the delivery of “multi-disciplinary and collaborative health services”, by opening a pre-market engagement ahead of a procurement mid-2025.

NHS England South East recently reported that a total of 175,000 patients have used virtual ward services since April 2022. The latest updates show the “steady growth” of this care pathway with “over 85,000 admissions to virtual wards” across the region during 2024, resulting in an 18 percent uplift since 2023.

In February, Bradford Teaching Hospitals NHS Foundation Trust shared an evaluation of its virtual royal infirmary programme. This included a total discharge of 752 patients from the virtual ward since its launch in 2023, as well as an increase in inpatient bed availability by 6.7 and 11.5 beds per day.

To learn more about virtual wards in health and care, be sure to join our upcoming webinar on virtual wards in practice: approaches and learnings / what does the future of virtual wards look like?With the help of our panel of experts, we’ll discuss a range of approaches to the virtual ward concept, including examples of best practice, challenges, failures and successes.

The Northern Care Alliance NHS Foundation Trust’s latest board meetings in January and March, to see what insight they offered on ongoing digital transformation projects, digital priorities, innovations, challenges, and more.

Approving NCA’s EPR business readiness and business plan is listed in the trust’s objectives for the year, as part of the principal objective to prepare infrastructure, systems, and processes “that work towards improvement in population health and continue to work with partners to address health inequalities”. As part of the board assurance framework, the trust also sets out controls currently in place including an infrastructure remediation and an EPR transformation programme, and gaps in control that could be filled to mitigate risk associated with digital systems sustainability, noting the need for a “multi-year investment plan aligned to infrastructure and application roadmap”. Risk score here remains “high” at 20, with a target risk score of 9.

Andrew Stallard, senior responsible owner for the EPR programme, shared an update highlighting delays “primarily due to extended timelines for obtaining outline business case approval from NHS England” and concerns that these delays could “increase the overall cost and pressure on resources within the organisation”. Risks are also outlined around ensuring organisational readiness for “a complex digital transformation”, and limited capacity within the digital team. The programme’s current focus is on readiness activities, the update continues, to include mapping applications and aligning projects like the electronic document management system; whilst next steps involve refining the programme’s governance and ensuring “the readiness of key systems”.

In a programme update on NCA’s digital infrastructure remediation work, the trust shared that seven projects are “progressing well”, including working with suppliers to complete project phases prior to implementation. For Wifi optimisation, delivery is reportedly “well underway”, with hardware delivered to relevant sites for deployment; the business case for a project looking to make a strategic upgrade to Windows 11 has been approved and moved into delivery phase; a project looking to implement a new on-premises and cloud backup and recovery platform has been successful and is entering the closure phase; and work on platform re-engineering remediation has moved to a delivery phase.

The trust’s January meeting also shared a report from its research and innovation committee which highlighted challenges around recruiting and retaining clinical coders, an area where NCA is “hampered by digital limitations and the reliance on coders being on site due to the heavy reliance on paper systems”. Referring to this as “a developing problem”, the papers go on to note that whilst agency staff could be used to keep the trust moving, “as other trusts were modernising their electronic patient records, they were recruiting more coders”.

A challenge for the trust relating to the population health agenda, as brought to the board’s attention by Lorna Allan, CDIO at NCA, is reportedly that initiatives in this space require “a patient record on an effective digital footprint”. Whilst Lorna confirmed that “discussions were being held around the development of an appropriate data strategy and use of artificial intelligence”, she added that there was “significant work needed to progress this agenda”, suggesting a need to “revisit what could realistically be achieved in relation to the population health objective”.

Elsewhere, a report from the quality and performance committee noted the impact of a “lack of data and digital visibility” around dates of discharge on forward planning, with plans to discuss the potential for greater visibility to be achieved using current digital systems. And in a report from the research and innovation committee, the “age and scale” of the data centre server estate is listed as a “cause for concern” due to a third of 1,900 servers already being unsupported and a further third to “age beyond supported software versions each year over the next three years”.

A further update is also offered by the board in March around digital systems sustainability, with the trust sharing that good progress has been made, and that discovery work has been undertaken around enterprise architecture. Also, recruitment is ongoing for solution architects and data architects, although the expensive nature of this specialist skillset means the organisations is “exploring creative ways to onboard experienced and creative people into these roles”.

We covered NCA’s first digital strategy back in October, setting out plans up to 2030 for the future of digital within the organisation in areas in areas including self-care, remote monitoring and access to records. The strategy focuses in particular on the next three years, with the aim of establishing the foundations for a “safe and more effective NCA”. These foundations are to be achieved primarily through the implementation of a single EPR solution across all acute hospitals, with a targeted go-live in 2027. Additionally, NCA plans to establish a single community services EPR intending to strengthen NCA’s connectivity to its places; this programme aims to commence in 2025. Once these foundations have been achieved, the trust expects to gain “greater clarity regarding the transformational opportunities that exist and will form the basis of an iterative and evolving digital strategy”.

Digital progress and priorities from across the NHS

For a recent HTN Now webinar, we were joined by a panel of experts to discuss the role of digital in supporting NHS reform – modernising services, shifting from hospital to community, and supporting the move from reactive to proactive care. We welcomed Dawn Greaves, associate director of digital transformation at Leeds Community Healthcare; Ananya Datta, associate director of primary care digital delivery at South East London ICS; and Stuart Stocks, lead enterprise architect with Aire Logic. Panel members shared their insight and experience from a wide range of digital projects, highlighting what worked well and their learnings; how their organisations are currently tackling key challenges such as capacity and demand, and managing waiting lists; and balancing risk with innovation.

Developing digital infrastructure is a key facet of South West London ICS’s latest digital strategy for 2025 – 2028. It notes actions to be taken on digital infrastructure, to include establishing expert digital teams and developing digital competence, implementing systems and processes that are effective, and consolidating systems to reduce duplication. It adds developing a consistent, robust, and secure digital infrastructure to cover cyber security and effective information governance, and ensuring interoperability and value for money of system procurements, as well as levelling up provider digital maturity.

An update from Chris Ibell, CDIO at Staffordshire and Stoke-on-Trent ICB, highlighted the system’s focus on cyber security, outlining the cyber risk to its organisations, and sharing plans to focus on an integrated care system approach to incident response planning. The update follows a cyber crisis simulation event, ICB board development sessions and cyber security workshops over the past year. The cyber simulation event identified 22 actions, the update notes, focusing on processes, plans, and the need for colleagues to “continue to embed an ICS approach to threat mitigation and incident response”.

For HTN’s latest interview, we spoke with Julian Coe, managing director at X-on Health, to discuss the future of the digital front door in primary care, including what good looks like, the importance of the user experience and approaches to improving primary care. We discussed complicated vs complex in primary care, how best to serve people in a way they want to be served, and how to support primary care with change in the future.

To start us off, Julian provided his own definition of a digital front door as “a way that delivers a good patient experience and helps the surgery manage the demand they’re facing with the capacity they’ve got”, while adding that an advanced cloud-based telephony system “should absolutely be part of the digital front door”.

Complicated vs complex in primary care  

Julian then went on to highlight one of X-on Health’s key messages, which concentrates on drawing a distinction between the complicated and the complex when it comes to primary care. He explained that primary care is “complicated in that there’s a lot of demand and there’s a lot of parts to put together, but actually it’s not complex,” going on to state how “complex systems bring lots of unknowns”.

He expressed that the goal of all tech providers should be to make things easier, with a focus on “helping you get the answer you want first time as quickly as possible,” adding that solutions should also be “omni-channel with everything you want to know being accessible via your smartphone, if that is your preferred channel”.

Tackling the challenges of digital in primary care 

In order to tackle some of the more complicated aspects of digital in primary care, Julian noted how important it is to “serve people in the way they want to be served,” which to him means “automating all the different elements” and then taking the “simple steps of linking up all the automations to make the system work.”

However, he also recognised the extent of this undertaking, highlighting that in order “to improve the patient experience and improve access to primary care, you’ve got to help 6,400 surgeries in England.” But with a surprising number of these surgeries “only just removing fax lines,” Julian noted that “giving them a choice of 25 to 30 telephony providers, online consultation providers and website providers and then telling them to link it up to the NHS” just makes things more complicated, especially from the practice manager point of view. “You can introduce the fanciest bit of AI,” Julian added, “but it’s not going to be able to answer a question or do what you want unless you have someone there to hook it up and make it work.”

He went on to use X-on Health’s telephony system as an example, explaining, “we’ve got our telephony system in 3,600 surgeries and not many of them use it to the fullest extent. And that’s the same with any software system.” To address this challenge, Julian highlighted the team’s new “managed service ethos” in which they spend more time with each surgery “to take them through making simple changes in their telephony system”. This includes helping the surgery to switch on the features they need and understand how to “make use of it all”. 

Julian also outlined their three-pronged approach to delivering new systems, which includes bringing together technology, expertise and data to better “affect change” within these surgeries. 

Tudor Lodge case study 

To demonstrate the success of X-on Health’s approach, Julian used the example of their award-winning case study at Tudor Lodge Health Centre, where they performed a full audit looking at “how access was working for them”. This included reviewing the centre’s telephony data, their online consultation data and NHS app usage.

“We did a very large patient survey in multiple languages so people could answer in their own native tongue,” Julian explained, with the results showing “53% of the patient population who responded to the survey having never used the online booking solution”. In response to this, X-on Health looked at simple fixes to help improve the service, including the introduction of their chatbot and a dashboard that shows the flow of data, while also “providing them with a managed service” which focused on linking everything together.

The future of primary care and the digital front door 

Julian then outlined how X-on Health’s new approach and ethos fits in with the future of primary care over the next three years. He emphasised the need for guidance when it comes to implementing new tools and software, highlighting the fact that “there’s lots of tech that can change the world, but our strongest message overall is about deploying it”. Julian added that “self-learning is nowhere near as simple as being given a hand” and that there should be a particular focus on “helping the practice manager”. 

Julian then went on to speak about the importance of consolidating tech to “make it easier” for surgeries and practitioners to use these tools. Using the NHS App as an example, he said, “the drive to the NHS App is totally valid and it has all that fantastic functionality, but unless it speaks to you on an individual level and unless your surgery is using it to refer you to the right local services, you’re probably not going to use it”. He then emphasised the importance of using solutions that work “down on the ground. Otherwise, it’s just another bit of tech that’s procured centrally and does nothing.”

Julian also spoke about the introduction of AI voice agents as part of the digital front door, stating that “at the moment, you can ring up and speak to one of these voice agents in multiple languages and it will understand what you’re asking, but unless you’ve connected it to the patient management system, it has no idea what appointments to give you.” This linked back to his focus on consolidating systems, but also allowed him to emphasise the potential for this type of tech, especially when it comes to personalisation. He explained how “the ability to personalise is moving very rapidly, so we will have the perfect receptionist for you shortly,” referencing X-on Health’s plans to introduce their own voice agent as part of their offering. 

Building the case for change 

With all these challenges and ideas in mind, we spoke about how to implement the necessary changes within primary care and what the case for change would look like, with Julian stating that “there’s absolutely zero case for the current status”.

He expanded on this by using online shopping as a comparison to healthcare services, explaining that with online shopping we get “minute-by-minute tracking of where the van is and when the delivery is coming”, but we don’t get the same service when it comes to the more “important experience” with a GP. 

When considering how to address this, Julian explained that ultimately, “it’s not really a tech issue. It’s about how we use the tech to help the GPs provide the service to the patient.” From his perspective, Julian noted how “we should make the tools available to GPs to make it easier for them to provide that level of customer experience” and ease the burden when they’re already “tasked with managing their own business, managing complicated workflows and being fantastic clinical providers.”

Adding to this, Julian also highlighted that “one of the really important facets of improving patient access is that we return to healthcare professionals having more time to provide care and to achieve a more proactive healthcare model rather than a reactive one”. He emphasised how tech should help clinicians focus on “doing what they’re there to do rather than being workflow models”, which she said is “a real core facet of what we’re trying to achieve” at X-on Health. 

Key considerations for the future 

Julian’s final comments focused on the key considerations that should be taken into account for the future of primary care and the digital front door. He suggested that “people have got to start buying solutions and not individual point systems” which require them to “try and put it all together”. However, he also added that this should be beholden to the powers of the NHS who should only “procure solutions that deliver outcomes” and “make the tech providers responsible for delivering those outcomes rather than selling them.”

He emphasised the importance of digital for the future of primary care, stating, “I don’t want to underplay what technology can do,” but also added that their main focus will be on “trying to simplify and consolidate all these tools” in order to make things easier for the surgeries using it. Julian ended our discussion by reiterating the fact that introducing new tech systems is no good “unless you do the hard yards down on the ground and link everything up.” 

We’d like to thank Julian for taking the time to talk to us and provide their expert insights on this topic.