Primary Care Region Series: London
Welcome to our primary care region series, where we explore the latest on digital and data in primary care from each of the seven NHS regions in turn. In this first instalment, we turn our attention to the London region, where we cover digital strategy from integrated care boards, hear from professionals in the region, and explore market trends.
Insights from the region
We spoke with Dr Shanker Vijayadeva, GP and London region GP clinical lead for digital transformation in primary care at NHS England, who highlighted the impact of recent announcements about cuts to NHSE and ICBs on what can be planned for next 12 months. Due to these changes, “digital plans/prioritises are more focussed on “keeping the lights on” for basic functionality (e.g. messaging to patients, online consultation etc)”, he said.
Shanker also shared with us details of plans for digital primary care in the London region, saying “AI (such as ambient scribe) is a general priority, as well as looking at A&G platforms as reflected in the new GP Contract. With the shift of care, I am looking forward to wider roll out of EPS beyond primary care, and also expecting more growth in pharmacy referrals with the development of BaRS within S1 and no local cost for EMIS Local Services for pharmacy referrals.”
For improving access, the focus is on engaging with the NHS app team, “as appointment booking optimisation requires (in my mind) further development of booking API with GP IT systems and a redesign of the profiling of appointment slots in GP IT system to make it easier for patient to book the ‘correct appointment slot’ for their need”. Shanker continued. “Automation/AI using 3rd party products can help facilitate appointment booking, document management, prescriptions which can free up resources to improve access.”
And on progress toward PCARP and some of the challenges in this space, Shanker reflected on the issues posed by a lack of dedicated or ring-fenced funding for digital elements beyond April 2025, adding: “change is always harder/slower than we can hope for and progress can be slower than hoped”.
Digital strategy for primary care
North Central London
The ICB’s latest meeting in March highlighted progress around neighbourhood health, including the recent launch of NCL’s first neighbourhood team in Camden, and ongoing baseline work to establish “where things currently stand at neighbourhood level”. NCL has also reportedly met the four Medical Royal College recommendations for improving the primary/secondary care interface, commenting: “Although this is a positive development, it is essential to ‘live’ this going forward, through strong engagement across the patch.” A review of the primary care infrastructure position for estates and digital is scheduled for June 2025.
North East London
NEL ICS’s Joint Forward Plan Refresh for 2024 highlights the need to strengthen “key enablers” including digital infrastructure, as part of securing the foundations of the system, and the potential role for technologies such as AI to play “a major role” in determining workforce needs over the next ten years. For primary care specifically, the strategy focuses on personalised, digital-first health services, and modernising primary care provision using digital tools. Providing patients with access to their information and granting them the ability to interact digitally with health and care providers, and expanding the NHS app’s functionality to digitally enable patients and free up resources, are part of digital plans.
North West London
NWL ICS’s health and care strategy offers insight into plans to improve access to care, including by continuing to embrace digital technology such as virtual consultations in primary care. It also highlights the importance of using digital to support self-care and monitoring, with work on digital inclusion being “vital” to ensuring that nobody is disadvantaged. GPs will reportedly be supported with clinical decision support digital tools to help direct referrals, whilst electronic scheduling systems will help manage appointments, and the ICB hopes to continue to explore the potential for AI in supporting diagnostics and ensuring “specialist staff capacity is used effectively”. As well as adopting an integrated approach aligned with the ICB’s digital and estates strategy, NWL commits to working with primary care to “develop the infrastructure that wraps around to staff”, and to build capacity in primary care to help connect research, innovation and clinical delivery agendas.
South East London
The Digital, Data and System Intelligence strategy for 2024 – 2027 from SEL ICS outlines the current position for primary care, sharing that of around 200 GP practices all but one is on EMIS, that digital tools are in use for patient triage, document handling and referrals, and that there is “low usage” of automation and AI. It also notes “strong support” for NHS App capability in GP practices and developing work to use data to support improvements, as well as concerns around the inconsistent digital enablement of referral pathways. Objectives, it states, include empowering people to manage their health with access to their information, making the care record available to care providers to support decision making, using digital innovation to drive service transformation, and using data driven insights to tackle population health.
South West London
SWL’s Digital Strategy 2025 to 2028 highlights patient portals and the NHS App in helping empower patients and support informed decision making, outlining work completed since its last strategy and current or continuing work across primary and secondary care. Work is currently underway, it states, to promote the use of the NHS App across primary care, with the help of four digital care coordinators who will be recruited and deployed to work in GP surgeries. Tech will also be used in helping signpost people to appropriate services and in improving collaborative working, whilst PCNs will be provided with “timely population health insights and analytical support” to help understand capacity bottlenecks and where to target service redesign. Consideration is set to be given to how AI can help enable a digital front door for primary care, the ICB states.
How Restore Information Management increased clinical space and enhanced patient care for Oxford practices
A key challenge often faced by staff in general practice is that of physical space. Appointments have been recorded manually on paper for many decades, and for busy practice staff, this can lead to the time-consuming process of having to visit a storage space to locate a particular patient record. Unstructured data is also an issue, which makes it more difficult for clinicians to access the information they need, when they need it, and detracts from the usefulness of data for things like population health management.
There can also be significant financial implications associated with this approach, with space within the practice used to store records when that space could be better used for caring, sometimes leading organisations to look at hiring physical storage elsewhere. This then leads to further costs relating to accessing and sharing files, which practices also need to take into consideration. There are challenges with the vulnerability of paper records, both physically given their delicate nature and in terms of security, with greater risks of GDPR breaches or loss of information.
There can be knock-on effects for patients, too, given the length of time that the retrieval of documents or information on a patient’s history can take, particularly if that information is currently held by a different provider. This can mean delays for patients, or errors in patient care in the event of a miscommunication; and there are additional financial and security implications from having to post papers securely to the appropriate location.
Oxfordshire (which has since formed part of Buckinghamshire, Oxfordshire and Berkshire West ICB) approached the Restore Information Management team with similar challenges.
Initially, the plan was to store the records at box level, capturing records in range order with a view to keeping the costs minimal. However, Restore Information Management identified that this method could lead to additional costs further down the line as a result of potential difficulties with maintaining a full audit trail. Following discussions to pinpoint the best and most cost-effective approach, Oxfordshire CCG opted to document each patient record individually.
Importantly for the organisation, records had to be retrievable at all stages. To minimise costs, practice staff boxed up the records, capturing the start and end range on each of the boxes before they were transported using one of Restore Information Management’s GPS-tracked vehicles to their secure facilities at Upper Heyford. A data capture of the box range on initial entry into the storage facility was performed, which allowed access during the data entry stage, and then Restore began the process of capturing the name, NHS number and date of birth of each patient, uploading the data to the Records Information System. Access to this was granted to each practice via Restore’s online portal, RestoreWeb, which allowed oversight of what records had been stored and enabled requests for retrieval.
The results? Processes and systems were set up within agreed timeframes, enabling practices to free up much needed space for patient care, and improving employee experience. Sarah Harwood, senior commissioning manager for primary care at the CCG, described how initial discussions enabled the development of a contract for the work to be undertaken, with Restore Information Management also contributing to a responding Data Protection Impact Assessment, supporting the CCG with information governance, and helping to identify risks. “They have been hugely accommodating,” said Sarah, “extremely responsive to any issues that have arisen and very easy to work with.”
In particular, Sarah noted: “Feedback from the practices who have been involved with the project has also been positive.”
Click here to find out how Restore Management can help free up clinical space in your practice >
Recovering access to primary care in the London region
North Central London
In its November board papers, NCL ICB shared an update on its work toward PCARP, noting 130 of 176 practices in the region have either remained stable or improved. A communications campaign titled “Your Local Health Team” has reportedly helped highlight different routes of access to primary care for the public, whilst engagement is also underway to explore public opinion on changes which might be required to help general practice meet growing demand. The ICB also shares that it is building on the vaccination programme delivered with general practice to ensure prevention is being addressed.
On the impact of digital tools, the ICB highlights that 100 percent of practices are now using cloud-based telephony systems, 99 percent have enabled repeat prescription ordering via the NHS app, and 90 percent now offer the booking and cancelling of appointments. 85 percent of practices offer online registration for new patients, and 56 percent of residents in NCL are now registered with the NHS app. Use of digital tools such as online consultations and two-way SMS continues to be monitored, and a dataset to “monitor implementation of the interface commitments between primary care and trusts” is in development.
Further work is required on applying system changes or manually updating patient settings to provide prospective record access to patients, with the ICB noting that as of September 2024, 64 percent of practices now offer full prospective records access to patients, with the system planning to focus on working with those yet to enable this access to “establish timelines and processes for completing the enhanced reviews”. The ICB also commits to working with practices to offer directly bookable appointments online, but adds that “due to high level of triage taking place” the number of appointments made available in this way is “likely to be low”.
North East London
A chair’s report presented to the NEL board in March highlighted a “desperate need” for a focus on the primary care network estate and digital infrastructure, based in feedback from discussions with general practice across the system. Work continues to implement the Primary Care Recovery Plan, the board notes, with all 60 practices that were on analogue systems now transferred to digital cloud telephone systems, and all practices that were on non-compliant digital telephony systems set to move over to systems with greater functionality including ‘call back’ functions by 2025. In board papers from January, an update on the delivery plan for recovering access to primary care refers to “good progress”, with “lots of work” happening in the digital space, but a continued need to bear in mind the potential for digital inequalities.
An earlier update from November’s meeting of the board shared that £1.6 million in transitional funding had been spent in 2023/24 for practices to move toward modern general practice, with a further £2.5 million for cloud-based telephony. 38 practices have chosen to use funding to work with the Education and Quality in Practice (EQUIP) Quality Improvement (QI) Team, it states, working on initiatives such as enhanced care navigation, increased use of the NHS app, and workforce training in readiness for the move to modern general practice. As well as focusing on improving the interface between primary and secondary care, the ICB commits to addressing variation in access.
The ICB sets out progress against key milestones for recovering access to primary care, highlighting good progress for Pharmacy First and the ongoing development of a digital dashboard to provide data on Pharmacy First at place and practice level to enable the targeted support of those with the lowest uptake. Digital tools is given a RAG rating of amber, with discussions reportedly underway with GP IT teams on future purchases, and with certain digital tools “still being procured via legacy frameworks”. The primary-secondary care interface is rated as red, with the ICB noting that this is a “resource intensive piece of work”, adding that programme management support is being offered to local interface groups to help support them in their delivery of key elements. Self-referral pathways is also given a red rating, with the second phase “currently on pending sufficient transformation/contracting capacity within ICB”. Also of note is practice websites, where an amber rating indicates a reported lack of funding, and next steps including promoting standardisation by encouraging all practices and PCNs to use the same “Gold Standard” website benchmark piloted across three practices and PCNs in NEL.
South East London
The CEO’s report from the ICB’s October meeting describes the system as “on track” to deliver all of the ten nationally mandated ICB actions for 2024/25. Whilst NHS app use has decreased in some areas, the digital team is working to increase uptake. Currently, 66 percent of practices are listed as being compliant in making prospective records access available for patients, with further assistance to be offered in this area. And the ICB plans to support practices in moving to advanced cloud telephony and introducing advanced features. SEL is also reportedly meeting its targeted share of self-referrals across a number of pathways.
In january the ICB offered further insight, including that the ICB is developing a short-term Primary Care Workforce Implementation Group to address challenges around recruitment, retention, and development, “prioritising retention of early career GPs, recruitment of nurses and development of practice management teams”. Linking primary and secondary care clinicians and system leaders to tackle a range of issues has led to “quick win” improvements in processes and “an improved understanding of operational/clinical issues across teams”, the board share.
South West London
In March the ICB shares details about plans for primary care including increased utilisation of the NHS app, an exploration of AI in primary care, and the evaluation of tools to manage waiting lists. Within the Board Assurance Framework, a risk titled “failure to modernise and fully utilise our estates” talks about how a lack of funding could hinder service transformation in primary care, with a data collation exercise reportedly having taken place to help better understand the primary care estate, covering areas such as making better use of digital technology.
An update from the quality and performance committee shared how a focus for SWL over the next year will be to reduce unwarranted variation. And in the ICB’s performance report for January, also included in the March papers, the ICS’s COO notes that appointments in primary care were “above planned levels and exceeded the target of 92 percent seen within two weeks”.
Virtual and online appointments in the London region
NHS England recently published new figures on GP appointments, which highlight that across the London region, 7 percent of appointments (327,000) in March 2025 were either by video or online, compared with a national average of 7.4 percent.
The top performing ICB for March was South West London, which reported carrying out 11.4 percent of its appointments by video or online, a total of 84,000 out of 738,000 appointments. In second place is South East London, where 8 percent of appointments were conducted by video or online, or 64,000 of 795,000 appointments.
Snapshots on digital primary care from London
Aaron Hamilton, senior project manager at Healthcare Centre London GP Federation, joined us for an HTN Now webinar presenting a blueprint of NWL’s digital access e-hub for consultations, along with the NHSE Blueprinting Programme.
Around the development of the hub, Aaron highlighted the role of a senior clinical decision maker who oversaw decision making and processes to make sure they were safe, and the team’s work on creating a pilot with a small cohort of practices “to make sure we got it right”. Alongside their clear governance structure, they conducted liability mapping around patient journeys to test who was responsible and at what point.
“It was an in-hours service, so offered 8am-6:30pm Monday to Friday, with the team based at the HCL office. The core team was comprised of a GP clinical lead, six ARRS-funded care coordinators, and two ARRS-funded advanced nurse practitioners. Then we added in the extended team, which was the clinical pharmacists, first-contact physios, and then community pharmacist consultation service.
“This work has given us a solid foundation to start to layer on top of. We are in the process of moving all of our practices onto one shared cloud telephony system, and linking that up so that the centralised hub can provide another layer of support to our practices via the team of already-dedicated care coordinators that have been working to process online consultations. We’ve got solid redirection pathways in place to redirect patients out into the community and self-help services; we’re in line with IIF targets; and we’ve made efficiency savings working at-scale and taking a centralised approach.”
Dr Shanker Vijayadeva, GP lead, digital transformation for the London region at NHS England, joined us in March for a panel discussion 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.
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”.
Trends in digital primary care
The British Medical Association (BMA) shared a “vision to rebuild general practice”, setting out “essential changes that need to happen” in order to achieve sustainability, including moving forward a public health data-driven model and investing in technologies. The BMA places focus on stability, urging the government and NHS England to commit to a minimum general practice investment standard and restore core funding. As part of this, the vision emphasises the need to work with the profession to understand “where simple tech could revolutionise pathways and speed acute flow”, giving the example of investing in electronic prescription services in trusts.
Late last year, NHSE published a strategy detailing the primary care implementation of the NHS patient safety strategy, noting the role of digital and data in areas such as automatically flagging patient safety issues to support reliability, and supporting clinical decision-making by digitally embedding diagnosis advice and safety netting. Looking firstly at safety culture, safety systems and inequalities, the strategy sets out a number of local commitments for ICBs and providers, including the need for ICBs to identify digital clinical safety officers responsible to help build understanding within general practice and provide a means for staff to raise and discuss any safety concerns.
HTN’s Primary Care Awards celebrated innovations, solutions, case studies, collaborations and projects helping to shape future services and systems across health and care. The awards highlighted excellence in digital primary care across four categories: Partnership of the Year, Digital Solution of the Year, Case Study of the Year, and Improvement Initiative of the Year. A digital awards ceremony announced winners and runners up across each of the categories.
A panel discussion in January considered 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.
A recent poll on our LinkedIn page asked the question, what do you think should be the biggest priority for digital primary care – patient-facing digital tools, interoperability, funding to support innovation, or back office efficiencies? With 39 percent of the vote, patient-facing digital tools came out on top. Coming in a close second was interoperability with 38 percent of the vote, with interest from GPs, practice managers and pharmacists.
