NHS England has awarded a contract with a total value of £9.9 million to Kainos Software Limited to support preparations for the Online NHS Trust, the digital-first hospital that will deliver NHS Online.

The work falls under Alpha Development Phase 2 of the virtual hospital programme. NHS England lists data management services, digital definition, DevOps and end-to-end development within its scope. The contract may also be used for "short term/time bound/outcome based statements of work" on related initiatives.

The central deliverable is a clinician workflow tool. NHS England says it should support a patient from referral through triage, diagnostics, consultation, prescribing, discharge and onward care, and act as "the primary control point for the service". Clinical logic, workflow progression and safety controls are to be built in and exercised through normal use. The tool must connect to national NHS England systems to support national reporting, and to the NHS App.

By the end of the contract, clinicians should be able to take patients through the full pathway in a beta-ready service. NHS England expects it to cover clinician interaction and support, patient access and communication, operational flow management and prioritisation. Testing must show that data captured at the point of use allows decisions to be traced and audited, and identity and access controls must allow work to be allocated to the right clinicians. Artificial intelligence is to be used where it helps decision making or reduces manual effort. The service must also prioritise patients according to clinical need. NHS England says success will be judged on whether the service can be run, tested and supported end to end in a controlled setting.

The foundations for the clinician tooling and for the patient journey through the NHS App were largely developed in earlier alpha phases, NHS England notes. They now need to be made ready for production, with user testing and feedback incorporated.

The activities listed for clinicians include accessing patient information, ordering diagnostics "on a national scale" and prescribing medicines. They would also hold virtual consultations supported by ambient AI, refer patients to physical providers, place them on patient-initiated follow-up or ongoing monitoring, and discharge them to a GP. Patients will view information and services through the NHS App. The NHS Online management team will handle onboarding, training and regulatory compliance, and will have visibility of performance data.

NHS England describes the trust as a digital-first entity that will deliver care "unconstrained by geographical boundaries", allowing clinical capacity to be matched more closely to patient demand. Pathways will be delivered remotely, and the existing workforce will be used through flexible working arrangements.

The Prime Minister announced NHS Online in September 2025, and the trust was formally established on 1 June 2026. Services are due to begin rolling out in 2027, with an aim of delivering up to 8.5 million appointments and assessments in the first three years. Patients referred for specialist care by their GP will be able to choose NHS Online through the NHS App. Triage will be completed there, and appointments for scans will be offered at local community diagnostic centres. The trust will start with nine common conditions, including menopause and prostate problems, with the aim of speeding access to specialist care.

NHS England published a preliminary market engagement notice in May to explore the feasibility of end-to-end diagnostic testing pathways for the service. Recruitment began in July for senior posts including medical director, chief nurse, chief people officer and chief financial officer.

John Browett, a former chief executive of Tesco.com who now chairs the Institute of Directors, was named chair of the trust in June. Seven non-executive directors were appointed alongside him.