Co-creating the digital front door to the NHS

Research shows that while most people with basic digital skills and access to devices use and value the NHS App, certain groups face persistent challenges. These include older adults, people living in areas with higher levels of deprivation, people from minority ethnic communities, people experiencing homelessness and disabled people.

With 37.4 million people already signed up for the NHS App, the government's 10 Year Health Plan commits to ensuring that "people who have not previously been able to access and use healthcare on their own terms will, through digital technology, be able to".

Understanding who is represented and underrepresented in our research helps us design more informed initiatives to ensure diverse and inclusive representation across all aspects of the app. 

The barriers are wide-ranging.

Some people have limited access to smartphones or reliable internet. Others face barriers to developing digital skills, or speak English as an additional language, or have experienced situations that have affected their trust in digital or healthcare services. People facing poverty often have limited access to both the technology and support needed to use digital services.

These same groups face barriers to engaging with healthcare services and often experience poorer health outcomes. Addressing these barriers isn't just about technology access – it's about ensuring that as healthcare transforms, it doesn't leave behind the communities who need support most.  

The majority of users find the NHS App easy to use and helpful for managing their health, with features like ordering repeat prescriptions, viewing test results and accessing health records among the most valued. Carers especially appreciate being able to manage services on behalf of those they care for. 

But some users face challenges finding the information or services they are looking for in the app. Some are unaware of the difference between primary and secondary care systems or understand that their health data comes from multiple sources across these different settings.  

While users can access their key healthcare services in one place through the NHS App, we are making improvements to the layout and language in the app to help people find services more quickly. We expect these changes later this year. 

While recent studies show the NHS App outperforms many other healthcare apps in terms of accessibility, we must go further to understand and support users facing barriers. 

NHS England works closely with charities and community groups such as:

• the Royal National Institute of Blind People (RNIB)
• National Hearing Loss Charity (RNID)
• Rheumatoid Arthritis Society (NRAS)
• Mencap
• Smartlyte
• Learn for Life
• Good Things Foundation
• Patients Association
• 100% Digital Leeds
• SignHealth
• Scope
• organisations that support people affected by homelessness

These partnerships help us reach people who are often under-represented in research. This includes asylum seekers, people who speak English as an additional language, or people whose cultural or linguistic needs have not been met by existing NHS services.

We're expanding our partnerships to include NHS trusts, libraries and local organisations that help people who need support with digital technology or accessing healthcare.

Partnerships work both ways. Community groups don't just help us find people to talk to – they also help us plan how to carry out research. Sometimes, we need to work with advocates or specialists first, especially when working with people who've experienced domestic violence or trauma, to make sure we do things safely and respectfully. 

Changes to the NHS App from this research – whether big or small – all help more people use the services they need. 

Following research with RNIB, we improved heading and menu labelling to make it easier for people with visual impairments to navigate the NHS App. This and other inclusive research have been a key reason for changing the overall information architecture of the app. 

Research with communities where people with varying levels of health literacy and research with people who speak English as an additional language helped us to ensure prescription tracking statuses made sense no matter their abilities. 

As stated in the 10 Year Health Plan, "one of the most important ways we can maximise the inclusive potential of digital technology is by co-creating it with patients".

We are working closely with people who face the biggest barriers to using digital health services to uncover problems early and design solutions together, with the communities who will use them. This means accessibility and inclusion are built into the NHS App from the start, not added on later as an afterthought.  

NHS digital service manual design principles - these principles guide all of our design. Use them to get started on a project and to help with making decisions.

GOV.UK Service Manual service standard - principles for building a good service explaining what teams can do to build great services that will meet the standard.

GOV.UK Service Manual user research - principles of how to understand user needs: plan research, prepare for sessions, share and analyse findings.