Project Overview
An NHS Integrated Care System (ICS) covering 12 GP practices and 240,000 registered patients wanted to replace...
Technology Stack
Compliance & Standards
The Challenge
An NHS Integrated Care System (ICS) covering 12 GP practices and 240,000 registered patients wanted to replace the NHS 111 online booking system with an ICS-operated appointment booking platform — providing same-day booking for urgent appointments, 2-week advance booking for routine appointments, and telephone callback booking. GP Connect Appointments FHIR R4, NHS Login, DTAC all 5 domains, and DCB0129 clinical safety (appointment booking has direct patient safety implications) were mandatory. Budget: £85,000.
Our Approach
GP Connect Appointments FHIR R4
- GP Connect Appointments (FHIR R4): search for available appointment slots per GP practice (GET /Slot), book an appointment (POST /Appointment), cancel an appointment (PATCH /Appointment).
- NHS Smartcard authentication for clinical system access — not required for patient-facing booking (NHS Login sufficient).
Slot types
routine (routine appointment), urgent (same-day), telephone callback, extended access (evenings/weekends).
Slot availability
real-time from GP clinical system via GP Connect.
NHS Login P5 and P9 Integration
- NHS Login P5 (email verification) for basic appointment booking.
- NHS Login P9 (identity-verified, NHS Number confirmed) for accessing appointment history and booking urgent appointments.
- Identity step-up: patients who have not completed P9 are prompted to verify identity for urgent appointment booking — links to NHS Identity scheme.
- NHS Number retrieval from NHS Login sub (anonymised ID) → PDS FHIR R4 lookup.
- Clinical Safety —
DCB0129 Hazard Log
highest hazard is inappropriate patient self-triage resulting in urgent appointment for non-urgent condition (displacing genuinely urgent patients) — mitigated by triage questionnaire with GP-approved urgency criteria, and clinical override (GP can convert to routine).
Second highest hazard
- patient unable to book during emergency (urgent unavailability) — mitigated by prominent 999/111 links and availability monitoring alert to GP practice manager.
- Accessibility and WCAG 2.1
PSBAR 2018
- NHS digital services must meet WCAG 2.1 AA.
- Patient population includes elderly patients with varying digital literacy — high accessibility bar.
Plain language
- all clinical language converted to patient-friendly descriptions.
- Large text option (AAA contrast where possible).
Screen reader testing
NVDA and VoiceOver on iOS (many NHS patients use iOS).
Carer access
carer booking on behalf of patient (with patient consent, recorded in appointment record).
The Results
DTAC approved all 5 domains.
Platform live at 14 weeks, £78,000 — under budget.
Appointment bookings via digital platform: 68% in first 3 months (previous digital: 12%).
DNA (Did Not Attend) rate: 14% → 8% (automated reminder via GOV.UK Notify).
Out-of-hours call centre contacts (booking-related): reduced 52%.
WCAG 2.1 AA: zero non-compliances in Cabinet Office monitoring.
Patient satisfaction: 4.5/5.
GP practice admin time: 40 minutes/day → 12 minutes/day.
“DNA rate from 14% to 8% — that is a 43% reduction in wasted GP appointments. At scale, that is hundreds of appointments per month that were previously wasted now being available for other patients. DTAC first submission. 68% digital adoption in 3 months with a patient population that includes a significant elderly cohort — the accessibility work made that possible." — Chief Digital Officer, NHS ICS (name withheld)”
Project Details
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