Bath and North East Somerset, Swindon and Wiltshire ICB wireless trial: Creating an office in a box with Starlink

Aimed at addressing connectivity challenges in rural GP sites, the office in a  box system ensures seamless internet access during outages or in temporary medical locations. Pre-configured for rapid deployment, it minimises downtime, safeguards patient safety, and supports clinical efficiency.

Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board (BSW ICB) supports the care of 940,000 patients in the South West of England, in an area covering 1,511 square miles.

BSW ICB are exploring the use of a Starlink satellite solution to provide backup connectivity when primary connections fail at their GP sites. This will allow for rapid deployment of seamless access to clinical applications during power or network outages, or when setting up a new or a temporary location.

The trial has proved successful, with the following benefits: 

• provision of an easy to set up reliable internet backup for GP surgeries and small sites
• ability to set up temporary, connected health hubs at short notice

Having a stable and fast connection to the internet is increasingly vital for delivering quality care. Whether it is updating patient records, or liaising over scan results with consultants, the bandwidth demands in the NHS continue to grow exponentially year on year.

Unfortunately, many GP sites in the region face connectivity challenges that impact everyday activities. Many of them are situated in rural and remote areas, which suffer from poor connectivity. The previous attempts to provide a cellular 4G or 5G solution were not fit for purpose.

Additionally, the current backup lines for the ICB’s primary care sites are copper phone lines. This outdated technology can no longer support the network throughput for clinical applications used in healthcare today.

In cases where main connections fail such as a fibre cable breakage these sites are left with little to no internet connectivity. In some cases, this can last for as long as a week. Given the lack of access to patient administration systems, this forced downtime can result in practices not being able to diarise appointments.

Additionally, there may be circumstances in which a temporary medical site is needed to be set up in a remote area, such as a disaster recovery measure. Here, there is a need for a solution that could quickly turn any building into a temporary health hub, regardless of location. 

Therefore, any potential solution employed by BSW must:

• allow medical sites to have a resilient backup connection when their main lines fail
• be simple and quick to set up
• provide the ability to set up remote sites where required
• have both suitable bandwidth and latency to support both clinical systems and Voice Over Internet Protocol (VOIP) telephony

BSW ICB developed a General Practice Office in a Box solution, which leverages satellite technology to ensure universal backup connectivity for GP practices during extended internet outages.  This solution can be deployed from any of 4 hub sites across the region and can provide connectivity within a couple of hours including set-up and travel time.  All that is required is power and a clear line of sight to the sky, which is easier in rural areas. 

BSW procured and created a commercial satellite connectivity product, as well as hub-and-spoke SD-WAN kit. The team mounted the devices on standard server racks and assembled all possible cabling before storing this in a transportable flight case for ease of rapid and repeatable deployment. 

This, in practice, means that anyone can travel to a site with a network outage, plug the power and network cables in, set up the satellite dish and wait for the dish to automatically align with a satellite. Pre deployment testing found around 160Mbps download, around 25Mbps upload,  around 30ms latency, and 100% uptime for the tested timeframe, which met their current GP site demands. 

Their solution architecture is designed so that the method of connectivity could be anything satellite, 5G router, or even home internet. Anything that can provide a network port can, when plugged into BSW’s plug and play kit, create a secure network that can access clinical applications. 

This hub-and-spoke architecture is also beneficial for BSW’s overall network. With a mix between on premises hardware and cloud computing, a cost efficient and cyber secure network has been created that can accommodate further infrastructure development within the ICB as required. 

After internal IT testing of the General Practice Office in a Box, a suitable live test site was required.  A power outage in Dorset provided the ICB with the ideal opportunity to deploy their solution using a live site.  

Silton village had a complete power cut on the 12 November 2024 and had asked the ICB if they could provide HSCN access to keep the local GP surgery running. As the power cut affected the whole village, it also meant the local telephone exchange was down and therefore no communication access for voice or data.  

The surgery sourced a small generator to provide power to the site, and the trust deployed their General Practice Office in a Box. 

The trust worked with the surgery to set up the General Practice office in a Box in the building and placed a Starlink Enterprise satellite dish temporarily in the valley of the roof of the surgery. The set up of the dish was easy to complete, with the trust providing the following steps: 

1. Find most secure area with visibility of the sky. 

2. Place dish on a balanced surface and connect to the switch (in the surgeries case, the existing site LAN used an MS120-48 switch). 

3. When powered up the dish will calibrate to a satellite but may require a change of location before it will provide service.  This can be done from the Starlink Mobile Phone App once the dish is online. 

4. Ensure users are connected to any relevant VPNs for connecting to HSCN. 

As a part of installing at Silton surgery, the trust had a variety of practical considerations to take in mind before and during the deployment.  

Cost of solution 

There are a variety of possible satellite dishes available from Starlink and other satellite providers as well, and the trust worked to find Starlink dish that provided the best compromise between price, speed and quality. This led the trust to use the Starlink Standard Actuated Dish for their trial, ideal for small offices (and worked for their GP surgery). 

If a trust looking to deploy a Starlink solution, it is worth reviewing what is available to make the correct choice for their organisation. 

Dish positioning 

Testing from the trust currently indicates that all that is needed is a clear view of the sky and to be within 25m of the building for cable runs due to the model of the dish used. In addition, any surface the dish is placed on must be stable and allow the legs of the dish to be well balanced when pointing up. Although the dish has been tested to work in heavy rain, some consideration should also be made for strong winds and other adverse weather conditions.  

Physical security 

When determining where to place the satellite dish, there should be consideration for the dish’s physical security. As an exposed piece of equipment that is not secured to the deployed sites, BSW had to think about how to best avoid vandalism and theft, whether by people or local wildlife. 

The first step in reducing this risk is to place the dish in a secure area, such as a flat, remote roof or secured garden. In addition, the power cable to the dish is plugged in and cannot be removed easily.  

Finally, the trust attached an anti-theft alarm normally used for bikes, that will activate on movement, emitting a loud alarm to alert staff members of any disturbances to the dish, as well as deter any potential tampering. 

While it might be assumed that deploying the solution was an involved process, after the kit was developed and tested, the entire deployment to the live site took only an hour of set-up time. 

Once set up, the results were immediate and positive for the surgery. The Starlink setup not only provided HSCN access via GovWiFi through remote services but were also able to restore the surgeries’ telephony by patching their Voice Over IP (VOIP) system into a guest network. 

As the screenshots from the Starlink app show, the general resiliency of the network was very high. In the first four hours of the solution being utilised, there were only four outages, each of which were for one second or less. For the GP staff, this was barely noticeable, with a brief disconnection of telephony calls the most detrimental experience.  

Dr Neil Harding. M.B, Ch.B. Partner provided a glowing testimonial to the effectiveness of the trialist’s General Practice Office in a Box: 

Commenting on the quality of their connection, Dr Harding said that “We wouldn't have known it was a satellite connection… [it was] virtually indistinguishable from our normal setup.” 

When asked to provide any improvements to the solution, all he could add was that “The VoIP telephony was occasionally crackly, but no more than normal.  The only issue was that the 0.6s 'No signal received' [outage at 10.35AM] caused a disconnection of the phones momentarily.” 

As a practical demonstration of the trial, the General Practice Office in a Box solution has proved that it is possible to provide small care sites with an accessible and affordable backup to their internet connectivity at relatively short notice from only a small number of strategically placed portable units.  

Everyone involved with the test deployment spoke highly of the ease of setup (even for less technical staff members).  

The trust has added that this solution would also enable the creation of short term connected pop up health sites, in venues such as local community centres. This would let a trust respond to emergencies in less connected areas or provide additional capacity to tackle larger scale healthcare requirements.  

As the NHS continues to explore applications of better connectivity, and the technology gets more sophisticated, organisations such as BSW ICB are showing there are innovations that can mitigate the operational difficulties clinicians regularly face. This is doubly true in rural areas, where the lack of connectivity makes reliable and flexible backups like this even more important to delivering good patient care.  

We are excited to follow the General Practice Office in a Box as BSW ICB continues to refine and build upon what they have learnt during their trial. If reading this case study has inspired you to investigate deploying a similar solution, please get in touch at [email protected]