From: DHSC
Assessment date: 16/11/2023
Stage: Alpha
Result: Met
Service provider: DHSC
Service description
This service aims to prevent heart disease, stroke, diabetes and kidney disease, and some cases of dementia among adults aged 40-74. The service being developed is a new national digital channel that will work alongside the existing face-to-face check.
The service includes a behavioural questionnaire and collects measurements of height, weight, blood pressure, and cholesterol to calculate a person’s 10-year CVD risk. The results will be fed back online with personalised advice, and, as the results are automatically added to the patient’s electronic record, GP follow-on and clinical pathways will be initiated for those with higher-risks identified.
Service users
This service is for…
Primary Users:
- 40-74 Year Old Adults
- Registered at GP Practice in England
- Have not had an NHS Health Check in previous 5 years
- Do not have a pre-existing cardiovascular condition from defined list
- These users will be split across the face to face and digital service, based on a number of factors such as patient preference, provider discretion, health confidence and digital confidence.
We have developed personas to indicate where our research has highlighted that the digital service will likely be the desired route, and where the face-to-face service will be a more appropriate option.
Secondary Users:
- Providers of the NHS Health Check
- GP Administrative Staff
- GP Healthcare Assistants
- GP Practice Nurses
- GPs
- Community Providers
- Pharmacists
- Commissioners of the NHS Health Check
Report contents
- Understand users and their needs
- Solve a whole problem for users
- Provide a joined-up experience across all channels
- Make the service simple to use
- Make sure everyone can use the service
- Have a multidisciplinary team
- Use agile ways of working
- Iterate and improve frequently
- Create a secure service which protects users’ privacy
- Define what success looks like and publish performance data
- Choose the right tools and technology
- Make new source code open
- Use and contribute to open standards, common components and patterns
- Operate a reliable service
1. Understand users and their needs
Decision
The service met point 1 of the Standard.
What the team has done well
The panel was impressed that:
- the team has a strong, team-based approach to user research, and everyone demonstrated a solid understanding of the end users and their needs
- the team’s user profiles, and user needs were of high quality and evidence-based. It was clear how the team were using them effectively in their work
- the team has engaged with end-users who have accessibility needs in order that they begin to understand their needs and has clear plans to continue to do so
- the team is working towards providing a safe and easy-to-understand service that will enable end-users to access self-serve behavioural advice for prehabilitation
- the team demonstrated a good understanding of the problems they still need to solve for users and have a credible roadmap to address them
What the team needs to explore
Before their next assessment, the team needs to:
- continue efforts to identify and undertake research with individuals who have low health and low digital literacy, and/or accessibility needs
- focus much more on the needs of health check providers as primary users of the digital service
- build a more complete understanding of all provider touch and pain points relevant to all points in the end-to-end service. This could include administrative staff involved in the selection and invitation of end-users and both clinical and administrative staff involved in providing follow-up care in relation to moderate and high-risk end users
- review that provider needs are understood across different electronic health record systems
- undertake face-to-face and contextual research with end-users and providers to ensure research is as inclusive as possible. This is essential for delivering on the service goals of burden reduction for end-users and providers
- continue working with behavioural scientists to understand how to improve engagement with the digital service and more active data collection methods throughout the end-user journey
- ensure the size and quality of the research team is maintained. Changing or reducing it would pose a significant risk to a successful private beta
2. Solve a whole problem for users
Decision
The service met point 2 of the Standard.
What the team has done well
The panel was impressed that:
- the team has considered how the existing face-to-face service could be complemented by a digitised service, the benefits of which have been clearly articulated to the panel
- the team has identified a need for clear and simple content to be present throughout the whole service
- the team has introduced “Save as draft” functionality, showing the team has identified and understood the service is potentially complex and lengthy for users
- the team has worked to identify what works well and not-so-well in other services working in a similar space
What the team needs to explore
Before their next assessment, the team needs to:
- continue to explore how end-users can be prompted to review their results
- consider further how the digital service could also support improvements in the face-to-face service
- undertake the planned research to support practices to invite end-users using a diverse range of invitation methods that meets users’ preferences for communication
- assess how the outcome of the lab testing procurement exercise impacts on service users
3. Provide a joined-up experience across all channels
Decision
The service met point 3 of the Standard.
What the team has done well
The panel was impressed that:
- the service owner is responsible for both the online and offline service
- the team are collaborating with other related service teams to ensure a more joined-up experience
What the team needs to explore
Before their next assessment, the team needs to:
- ensure that wording in the digital experience offers the option to transition to face-to-face support throughout the end-user journey
- ensure the data can be directly fed into local IT systems to reduce the burden on the GP surgery admin staff, or demonstrate that any other solution is still delivering on the burden reduction goals
4. Make the service simple to use
Decision
The service met point 4 of the Standard.
What the team has done well
The panel was impressed that:
- the team has a strong understanding of the design system and is using common components and patterns
- the team’s user research and prototype testing with a range of patient users is informing design choices and iterative improvements
- the team has a good understanding of other related NHS and cross-gov services such as BMI healthy weight calculator and calculate your heart age and is proactively using and sharing research learnings around health question patterns
- the team is planning to integrate the service with capabilities like NHS Login and the Personal Demographic Services, Communications manager, and later Cohorting as a service, to leverage existing capabilities and to ensure that information the NHS already has about the user can be prefilled
- the team recognises the likely negative impact of biometric tests on completion rates and is helping quickly redirect users to face to face services if they can’t complete these at home
- the team has question logic in place to reduce the questions that some users need to answer
- the team has ensured that save and return will be available so that users can complete the service in more than one session
- the team is working towards solving the challenge of integration with local GP and health check provider systems to ensure data can be transferred directly
What the team needs to explore
Before their next assessment, the team needs to:
- ensure that service design is informed by primary research with health check providers
- continue to work to solve the challenge of integration with local systems, the solution currently proposed works with a supplier that represents around half of the primary care market
- do more to tackle the concerns highlighted in the feasibility study around low invitation response rate, low conversion rate and likely inequalities of access of a digital service. This will be essential to delivering the overall target of 22% increase in service uptake
- do more to tackle the risks raised in the discovery report around the use and placement of NHS Login, ensuring that identification and authentication requirements are proportionate
- include the end-to-end service in testing, considering both patient- and provider-initiated entrance points, as well as handover points between the digital service and health check providers
- do more to understand the unhappy paths for users who have difficulty in accessing and completing the service digitally, and consider how the service needs to support users transitioning to face to face services
- use the personal demographics service as the primary source of patient contact data to ensure a smooth experience for users moving between the digital service and primary care services, which use PDS as the primary source of contact data
- ensure that providers will trust blood pressure readings or blood test results entered by patients who have come through the digital service
- carry out further testing on the eligibility information and screening questions to ensure this is understood by users
5. Make sure everyone can use the service
Decision
The service met point 5 of the Standard.
What the team has done well
The panel was impressed that:
- the team has a good understanding of accessibility requirements and inclusive design principles
- the team’s user research has included a range of participants from different demographic groups
- the team is aware of the potential impact of asking users about their sex and ethnicity and is using existing UR in the space
- the team plans to ensure that users who do not want to disclose this information can still access the service
- the team has ensured that a face to face service will still be available for users who do not want to or cannot use the digital service
What the team needs to explore
Before their next assessment, the team needs to:
- gain a more in depth understanding of users that are most under-served in the existing service and consider how the digital service design could help reach these people
- ensure user research considers a wider range of hard-to-reach users who experience barriers to accessing health care and that the whole team is actively involved in user research
- align the question about sex with inclusivity, clinical and data needs to ensure users understand how to enter in accurate data and be given an accurate result. The current choice is binary and may exclude people
- ensure that use of colour and images to convey test results comply with accessibility standards and that complex health information is written in plain English
- make sure that users understand they can access the digital service both in a native app and browser environment so that users who do not want to or cannot download the NHS app to a device are not digitally excluded
- carry out an external accessibility audit and ensure the service meets WCAG 2.2
6. Have a multidisciplinary team
Decision
The service met point 6 of the Standard.
What the team has done well
The panel was impressed that:
- the team, despite its large size has a comprehensive structure put in place to manage it appropriately and ways of working have been iterated over time
- the team has ensured there is a clear ownership of the programme between DHSC / NHSE and the supplier
- the team has incorporated SME’s into the wider multidisciplinary team
7. Use agile ways of working
Decision
The service met point 7 of the Standard.
What the team has done well
The panel was impressed that:
- the team is doing show and tells, deliberately growing attendance, and that the team have been able to incorporate feedback from this wider group of stakeholders
- the team has informal drop ins, outside of normal ceremonies, to raise issues or concerns
- the team have a defined route for escalation which varies depending on the nature of the issue
8. Iterate and improve frequently
Decision
The service met point 8 of the Standard.
What the team has done well
The panel was impressed that:
- the team is collaborating with the behavioural insights team to iterate messages to increase uptake and engagement
- the team worked collaboratively to iterate and improve digital prototypes in response to user feedback
- the team is conscious to review its own ways of working and iterate them
9. Create a secure service which protects users’ privacy
Decision
The service met point 9 of the Standard.
What the team has done well
The panel was impressed that:
- the team has ensured, by using existing systems and focusing on integration, the additional collection and storage of data is minimised
- the team enables the service to meet the required policy NHSE policy on securing access by service user access via NHS login
What the team needs to explore
Before their next assessment, the team needs to:
- explore how patient data is protected with the introduction of lab testing partner(s)
- ensure minimisation of data collection and persistence in the integration platform
10. Define what success looks like and publish performance data
Decision
The service met point 10 of the Standard.
What the team has done well
The panel was impressed that:
- the team has a plan to collect the mandatory KPIs
- the team has identified a number of additional KPIs which are derived from user needs and linked to wider strategic objectives
- the team has a dedicated performance analyst with responsibility for designing measurements that span offline and online services
- the team has a plan to publish their performance statistics
What the team needs to explore
Before their next assessment, the team needs to:
- measure user satisfaction for health check providers and ensure clear feedback routes are provided to providers at various stages of using the service
11. Choose the right tools and technology
Decision
The service met point 11 of the Standard.
What the team has done well
The panel was impressed that:
- the team is utilising existing technology and services already in use within NHS England
- the team has avoided vendor lock-in and procurement challenges by building an integration service architecture using common cloud components
What the team needs to explore
Before their next assessment, the team needs to:
- be clear on how the service will integrate with GP system providers (beyond the initial integration with EMIS)
- demonstrate working with lab provider market to simplify integration, identifying potential open standards and adopting where appropriate
- work with wider screening services to identity potential reuse of the integration platform and how that might impact on future architectural decisions
12. Make new source code open
Decision
The service met point 12 of the Standard.
What the team has done well
The panel was impressed that:
- the team is following NHS England’s approach of working in the open
What the team needs to explore
Before their next assessment, the team needs to:
- ensure compliance with NHS England’s open source commitment and hosts infrastructure and application code in the open
13. Use and contribute to open standards, common components and patterns
Decision
The service met point 13 of the Standard.
What the team has done well
The panel was impressed that:
- the team uses existing services wherever possible; NHS App, login, Comms Manager, GP Systems, etc.
- the team’s use of the NHS App provides a consistent user experience with other national services, leveraging and providing the ability to contribute to existing patterns and components
What the team needs to explore
Before their next assessment, the team needs to:
- use and contribute to open standards where integration with the platform occurs, making sure all opportunities are taken
- explore how integration with wider GP system providers will be possible
14. Operate a reliable service
Decision
The service met point 14 of the Standard.
What the team has done well
The panel was impressed that:
- the team, where possible, is using existing well developed national systems
- the team are developing new components, when they do this, they are using standard technology approaches common within NHS England
What the team needs to explore
Before their next assessment, the team needs to:
- ensure the added complexity of operating, supporting and observing a serverless, event-driven architecture is considered
- how the chosen lab provider(s) performance will be monitored and managed
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