NHS.uk is the official website of the National Health Service (NHS) in England. It serves as a comprehensive online resource providing information, guidance, and services related to healthcare, with high annual visitor numbers. NHS.uk is accessed globally, with 86% of users accessing the site in the UK, and 14% of users based outside of the UK*. The BJSS team has a history of involvement in many projects, most of which are ongoing and have spanned over several years. NHS.uk offers a variety of features and functions, including:

  • Health information: NHS.uk provides detailed information on various health conditions, symptoms, treatments, and medications.
  • Information on local services: Users can locate nearby hospitals, general practitioners (GPs), pharmacies, and other healthcare facilities using the website's search function.
  • Health and lifestyle advice: NHS.uk offers guidance on maintaining a healthy lifestyle, including tips on nutrition, exercise, and mental health.
  • Access to NHS services: The website provides information on how to access various NHS services, such as appointments with GPs, emergency care, mental health support, and sexual health services.

A requirement for inclusive and accessible user-centred design

There was a need for the NHS.uk to create an inclusive, informative service that is accessible for all demographics. Addressing diverse ethnicities poses challenges, requiring consideration for a wide spectrum of users. With the key challenge lying in accessing and understanding the unique needs of these groups, adding value through a design approach that involves overcoming complexities, obtaining user feedback, and maintaining a clear direction to create an inclusive and effective solution.

With healthcare in general moving towards a more personalised digital experience, BJSS is ensuring the NHS provides this service to users. The NHS aims to establish NHS.uk as a globally trusted, valuable, and user-friendly information source, emphasising the incorporation of user-centred design principles to address the diverse needs of various user groups across different variables.

With the ultimate goal of ensuring service users are more engaged and empowered to manage their healthcare, the NHS engaged BJSS to ensure a variety of different services on NHS.uk cater specifically to the needs of users and foster trust and engagement. Working on various projects within NHS.uk, including tools such as theBody Mass Index (BMI) calculator and services like proxy and Medicines A-Z, BJSS addresses challenges such as inclusivity, and service standardisation.

BJSS' mission is to empower patients and enhance their engagement in their healthcare through user-centred design. With an outcome-focused design philosophy, and the primary goal of ensuring service users are more engaged and empowered in managing their healthcare, BJSS emphasises research and alignment with NHS values to create a trusted, user-friendly digital NHS presence that caters to diverse needs, fostering trust and engagement.

Proxy

The NHS offers a proxy service allowing individuals to nominate someone they trust to access their medical records or communicate with healthcare professionals on their behalf. This service required standardisation, as although it currently exists, there is no cohesive solution, the new national proxy service will enable nominated proxies to manage a patient's healthcare digitally via the NHS App through a nationally standardised set of policies.

The Body Mass Index (BMI) calculator

The NHS BMI calculator is a tool designed to assess an individual's body mass index (BMI) based on their height and weight. The tool offers guidance on healthy weight management and potential health risks associated with BMI categories. However, it has experienced longstanding criticism for its simplicity and lack of accuracy in determining overall health.

Medicines A-Z

The medicines A-Z catalogue provided by the NHS offers comprehensive information on 300 medications, accounting for 80% of prescribed medications. It was developed as an online resource, enabling patients and healthcare professionals to understand the uses, side effects, and precautions associated with various medications. Users can access details such as general dosage and strengths, instructions on administration, and potential interactions with other drugs.

The solution

BJSS engages in a diverse array of projects across the NHS. By working on multiple projects, BJSS can leverage its expertise and resources to make meaningful contributions to enhancing healthcare services and outcomes within NHS.uk.

Research conducted by BJSS within the NHS is guided by reason and purpose, emphasising the importance of treating individuals with respect and using the information they share to improve services across the NHS. This commitment reflects a core ethical principle of ensuring that research is conducted ethically and responsibly, with a focus on benefiting individuals and society as a whole.

The goals of the BJSS team align closely with the core values of the NHS, underscoring the team's commitment to promoting patient-centred care, where individuals are empowered to make informed decisions about their health and well-being. By aligning with NHS values, BJSS demonstrates its dedication to supporting the mission and vision of the NHS in delivering high-quality, accessible, and equitable healthcare services.

Challenges in the Design of Healthcare Tools – The BMI Calculator

One of the primary challenges when designing healthcare tools like the BMI calculator is the balance between accuracy, usefulness, and trustworthiness. One specific challenge in designing the BMI calculator was addressing the limitations of BMI itself. BMI does not consider factors such as muscle mass, bone density, or distribution of body fat. The impact of ethnicity on BMI adds another layer of complexity. Research has shown that in the past BMI calculations may not accurately reflect health outcomes across different ethnic groups.

The project began with research on The National Institute for Health and Care Excellence (NICE) guidelines, NHS England standards, and existing studies, followed by a comprehensive content review. User needs were addressed throughout via research, interviews and consultations with healthcare professional subject matter experts were also carried out, culminating in both quantitative and qualitative data analysis to inform decisions and improvements.

A usability test involved 31 users from diverse BMI and ethnic backgrounds, including those with cognitive impairments. Employing Multivariate testing (MVT) with over 3,000 users, predominantly ethnic minorities, aimed to assess sensitivity, inclusivity, comprehension, representation, and disclosure rates, determining the most effective design variants.

Users demonstrated a limited grasp of BMI and its calculation, especially among ethnic minorities who were surprised to learn their higher risk of long-term conditions with a BMI above 23. Users expressed a need for clearer information on these links and associated health risks.

The inclusion of ethnicity in the BMI calculator aims for a more inclusive and accurate user experience. Multivariate testing allowed for refining user representation and design. With 98% of users comfortable sharing ethnicity, categorisation accuracy improved, and users felt mostly represented in ethnicity groupings. Most tested users (66% from ethnic backgrounds) had no issue sharing ethnicity yet desired more context on BMI differences by ethnicity, with the findings underscoring the importance of upfront explanation for the requirement of ethnicity information.

Medicines A-Z - Developing a Personalised Medication Experience

Developing a personalised medication experience, particularly within the context of a "Medicines A-Z" feature, involves addressing several challenges while striving to maintain trust and reliability. One significant challenge is linking individual prescriptions to generic medication information. While personalised experiences can enhance user engagement and satisfaction, there's a delicate balance to strike in ensuring that the generic information provided remains accurate, trustworthy, and relevant to the user's specific needs.

Research showed that patients do not expect personalised medication information when redirected to Medicine A-Z from their prescriptions, as it was compared to the information leaflet that can be found in medication packaging.

However, from a clinical perspective there remains a risk that when a patient is prescribed a medication for an unusual or rare condition, and is given a different dosage or administration instructions, that it might cause the patient to change the way they are using their medications based on the generic information.

Another insight from the research was that the placement of this information (as part of the prescription) was not intuitive to users. Currently, the prescriptions on the NHS app focus on requesting medications and approved prescription requests. The medicine A-Z information would be available as part of an approved prescription only, due to technical limitations. On top of that, approved prescriptions disappear after 36 days, so a more permanent and consistent placement such as a GP health record was recommended. More research is needed to confirm the most intuitive place for this information.

Proxy Service Standardisation

The goal of standardising the proxy service is to establish a uniform approach to proxy access nationwide. However, difficulties lie in persuading GP practices to adopt a consistent and secure method for proxy access. While proxy services currently exist in different formats, there's a need for a cohesive solution.

Central challenges include guaranteeing data security and safeguarding various user groups. Additionally, there's the task of addressing the substantial demand from patients seeking access to the service, which GPs are likely to confront. Overcoming these challenges involves demonstrating to GPs the long-term benefits of standardisation of the proxy service. GPs often hesitate to endorse the proxy service due to the extra manual workload required to ensure safe access and appropriate utilisation. Currently, proxy access is only available within primary care, limiting the utility of the service for user groups who regularly access secondary and community care.

The proxy service occupies a unique position within the NHS ecosystem due to its positioning across multiple other NHS services and care settings. Many of the features of the service rely heavily on the integration and suitability of other services within the ecosystem, requiring close and ongoing relationships with multiple teams across the digital landscape. The proxy programme comprises a cross-functional and multi-consultancy team, with a focus on a user-centred design approach.

The completion of this work is ongoing, however, BJSS has supported the launch of an initial pilot across 40+ GP practices aimed at adults acting on behalf of another adult with capacity to consent. A second pilot, due to go live in March 2024, will engage 70 GP practices and focus on adults acting on behalf of a child. Both pilot schemes are supported by extensive qualitative user research and UX research across core user groups, such as, children, parents and carers, adult patients and GP staff.

The outcomes

BJSS facilitates a user-centred approach, inclusivity, collaboration, and the importance of addressing specific challenges in healthcare design to create a trusted and empowering experience for patients within the NHS.

BJSS' research efforts within the NHS are guided by a commitment to ethical conduct, a diverse portfolio of projects aimed at addressing healthcare needs, and alignment with NHS values focused on patient empowerment and engagement. Through these efforts, BJSS contributes to advancing the goals of the NHS and improving healthcare services for individuals across the UK and beyond.

Working with stakeholders, healthcare professionals, and NHS service users helped to provide the insight needed to develop and deliver the tools that can provide benefit to all users.

With the primary goal of ensuring service users are more engaged and empowered in managing their healthcare, BJSS' work with NHS.uk resulted in:

  • User-Centred Design - A user-centred experience for the NHS website, where diverse user needs are considered. A truly user-centred digital NHS presence.
  • Outcome-Focused Design – An emphasis on designing solutions that truly meet the needs of user groups through thorough research and contribute to a user-centred digital NHS presence, promoting trust and engagement.
  • Inclusivity and Diversity– By recognising the diverse needs of different user groups, including various ethnicities and minority groups, inclusivity is a key aspect of the designed healthcare solutions.

* Source: NHS analytics team, figures exclude Apple users.