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NHS app uptake affected by demographics

by Emily Roberts
30 June 2023

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Uptake of the NHS app in England is 25% lower among patients in the most deprived GP practices, research has shown.

Registration of the app is also 36% higher in practices with the highest proportion of registered white patients.

The findings revealing there is an unequal pattern of app registration have sparked calls for further research to look at how the digital tool may be affecting health divides, as well as patient experience and care outcomes.

An observational study of uptake and adoption of the NHS app in England was published in the BJGP.

The app was launched in January 2019 as a ‘front door’ to digital health services, giving patients access to their personal health information and allowing them to digitally book GP appointments, order repeat prescriptions and check symptoms.  

Authors said that while preliminary research has shown that patient portals such as the NHS app may improve health outcomes, there are known issues around patient confidentiality and ‘growing concerns they may be contributing to, worsening, or even creating new health divides’.

So, part of the research’s aim was to explore trends of uptake across different population groups.

The study, funded by the National Institute for Health and Care Research, analysed monthly app metrics at GP practice level, including total app downloads, registrations, login sessions, appointments booked, GP health records viewed and prescriptions ordered between January 2019 to May 2021.

The study found there were 8,524,882 NHS App downloads and 4,449,869 registrations during the research period, with a four-fold increase in downloads when the Covid Pass feature was introduced in May 2021.

It identified differences in app registration rates across the different socio-demographic groups, highlighting ‘unequal trends of adoption, with higher usage in less deprived and less ethnically diverse practices, with a generally younger population.’

Analysis found:

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– 25% lower registration in the most deprived practices

– 44% higher registrations in the largest sized practices

– 36% higher registration in practices with the highest proportion of registered white patients

– 23% higher in practices with the largest proportion of 15-34-year-olds

– 2% lower registration at practices with the highest proportion of people with long-term care needs.

The authors said the findings showed ‘there has been strong adoption of the app, and that Covid has significantly expedited uptake,’ but added that ‘further research is needed to evaluate continuous usage of the app over time across different population groups and if it yields any benefits’.

They also concluded that there needs to be more understanding on ‘the extent to which it influences inequities in health and whether it impacts care outcomes’.

Meanwhile, a report released today has recommended to the Government that the benefits of using technology (including the NHS App) need to be set out more clearly, as well address risks and patient concerns.

The ‘Digital transformation in the NHS’ report, produced by the Health and Social Care Committee, said that while plans are in tow to improve the range of services available via the NHS app (such being able to have video consultations and receiving notifications regarding health checks and screening appointments), the Department of Health and Social Care and NHS England ‘need to demonstrate the continued value of the app.’

‘Otherwise they may increase functionality while decreasing the number of sign-ups,’ the committee warned.

The report also highlighted there is a risk of digital exclusion with ‘those unable or unwilling to use digital services’ finding themselves unable to access services. It was highlighted, for example, that figures from Age UK showed that a third of people over 65 do not use smartphones. The committee has recommended that non-digital channels remain available as the NHS ‘develops and implements its digital offer’.

And finally, the Government was told, it needs ‘to ensure that the wider workforce, including clinicians and frontline staff, has the time, headspace and training to allow them to fully engage with digital transformation’.


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