Requirements Specification for NHS Wayfinder

The services will enable NHS Digital to provide a service to NHS patients in England through the NHS App, both in mobile and desktop formats, to securely view summary details of their scheduled appointments with acute NHS Trusts and to enable them to access further details about those appointments from the NHS App.

To enable users to view, book, change and cancel their referrals and secondary care outpatient appointments in the NHS App, various systems have been integrated to enable data flow between the NHS e-Referral Service (e-RS) and hospital Patient Administration Systems (PAS) and the NHS App where patients will access it. A Patient Care Aggregator system has been built by NHS England which will aggregate referral information from e-RS and appointment information from partnering Patient Engagement Portals (PEPs) who, in turn, aggregate data from the PAS systems of the trusts who have engaged them. At each point where a new system is accessed, the patient’s login is validated against NHS Login.

NHS Digital’s remit in the performance of the Services is to provide users with NHS Login-validated access to referral and appointment information from the Patient Care Aggregator and direct them to e-RS or the relevant PEP system (using deep link functionality) so that they may book, change, or cancel their appointments and access further information about their appointments. This includes the operation and maintenance of Wayfinder functionality in the NHS App, integrations between NHS digital systems and the Patient Care Aggregator and provision of  first and second line live services support.

The Wayfinder (NHS App) services will be available to people who have a secondary care outpatient appointment at an acute trust in England and who use the NHS App. The Services MVP will cover c. 43 acute trusts, with the objective of reaching c 75 Trusts after the Beta testing phase, at Go-Live.

This specification should be read alongside the Technical Specification for Wayfinder (NHS App) Services 2022.

NHS Digital will exercise such systems delivery functions of NHS England as are necessary for it to 

• provide users with access to the Services via the NHS App, both in mobile and desktop formats
• present an aggregated view of all outpatient referrals and all secondary care outpatient appointments associated with the user’s NHS Number:
  • Referrals: Directly Bookable, Indirectly Bookable and Referral Assessment Service (RAS) referrals and their status (Ready to Book, Ready to Rebook, In Review, Review by Clinic Overdue, Booked, Ready to Confirm Appointment, Cancelled)
  • Secondary Care outpatient appointments: future appointments and their status, including cancelled future appointments
• Referrals and appointments will be sourced via API integration with a new NHS England Patient Care Aggregator. This service processes appointment data from multiple Patient Engagement Portals (PEPs) and will apply business rules regarding what appointment data will be presented
• enable users to access (using deep-link functionality built on existing NHS App web integrations and reusing Login token generated when user accesses the NHS App):
  • e-RS, to book their initial outpatient appointment, using the existing Manage Your Referral (MYR) synchronous-booking functionality
  • PEPs, to book, change and cancel appointments
• integrate the aggregation service with NHS Digital Organisation Data Service (ODS) to validate the appointment specialty data presented to the user
• provide guidance to users as to why their appointments may not be showing (including restrictions on use by under 16s) and provide guidance on how the appointment tooling works 
• provide a mechanism by which users may provide feedback during beta testing

The remaining functionality provided by the Services will be delivered by NHS England systems, e-RS and partnering PEPs.

Where users encounter an issue with the Services, these will be handled as follows:

• first and second line support: NHS England instructs NHS Digital to provide support according to its existing standard operating procedure
• third line support: NHS England instructs Servita to provide third line support.

NHS England will be data controller for live services support data.

NHS Digital will process personal data to the extent necessary to make available the relevant appointment information to the user through the NHS App, to meet the Purpose set out in the Direction.

The NHS App will present but will not store appointment information, which it will source from the Patient Care Aggregator.

For the appointment information to be displayed in the NHS App, the following processing will take place.

In addition, the Services will provide the ability to check if a patient is registered with the NHS App and provide access for the user to register if not.

NHS Digital will process the following data as part of delivering the services:

Personal Data:

• NHS Number
• Surname
• Date of Birth

Non-personal Data:

• Referral Identifier (UBRN)
• Referring organisation (ODS Code and name)
• Referral date
• Referral status
• Referral due date
• Specialty
• Service
• Appointment Identifier
• Appointment Date
• Appointment Type/description
• Appointment consultation medium
• Appointment Status
• Appointment Requested Status
• Appointment Priority
• Appointment Location
• Appointment NHS Organisation (ODS Code and name)
• Portal URL (deep link)
• Portal identifier (e-RS, the PEP systems)

The data to be processed to deliver the services includes personal data and is subject to the UK GDPR.  Under the UK GDPR, NHS England and NHS Digital will jointly determine the purpose and means for the presenting of appointment information to patients in the NHS App. NHS England and NHS Digital will therefore be joint controllers for the processing of personal data associated with the delivery of the services.

Internal processing

To deliver the services, NHS Digital will carry out the following processing activities:

• Collection and validation of NHS Login token with NHS Login. Transmission of NHS Login token to patient care aggregator
• Validation of NHS Login tokens from third parties (PEPs)
• Issuing and validation of application access tokens within API-Management (API-M) from the NHS Login Identity tokens
• Retrieval and presentation in the NHS App of data from the Patient Care Aggregator, including the deep link URL to provide access to e-RS or the PEP system relevant to the appointment

Provision of ODS data to the patient care aggregator via API for validation purposes

All other processing will be done by the patient care aggregator, e-RS and PEP systems

Before issuing these Directions, NHS England has consulted with:

• NHS Digital
• NHS England data teams
• North East Commissioning Support (NECS)
• patient-representative groups, via user research and testing
• trust representatives as part of design and during onboarding
• Government Digital Service: Alpha assessment completed 16th June 2022

Discovery for the Wayfinder programme built upon former primary research form the Bookings, Referrals and Appointments Management workstream (published September 2021). This workstream interviewed cohorts of patients, clinicians and technical delivery staff across primary and secondary care.

A further feasibility study, which also incorporated research from internal behavioural science, the NHS Long-Term plan, Patient Voice, and further primary research, was published in December 2021, focussed entirely on Wayfinder outcomes.

Ongoing discovery has continued throughout the development of the product, including user research with clinicians and patients and user testing of prototype products.

Changes to this specification will be agreed in writing between NHS England and NHS Digital.  Any changes will include consultation with the following stakeholders:

• NHS App and Login
• NHS e-Referral Service (ERS)
• NHS Organisation Data Service (ODS)
• NHS API-Management Service (API-M)
• Patient Care Aggregator
• Patient Engagement Portal systems