The NHS App was meant to be the digital front door to the health service, a single pane of glass through which patients could see their care. Instead, it has become the latest casualty of NHS England’s cost containment drive. In a move framed as rationalisation, NHSE is dismantling parts of the patient engagement portal market in pursuit of £11m in savings, promising a simpler, standardised experience for millions.
The ambition is not small. NHS England wants the NHS App to be the single entry point for appointments, documents, notifications and pre-visit questionnaires, replacing a patchwork of patient engagement portals that have acted as intermediaries between hospitals and the app. Officials argue that the current model is too expensive and too inconsistent, citing more than £20m a year spent on PEP suppliers, a figure that rises once integration and variable costs are included. Patients, they say, experience a disjointed journey, with different interfaces and workflows depending on which trust they attend. The answer, according to NHSE, is direct integration from hospital electronic patient records into the app, a programme known as Wayfinder direct integration, and the withdrawal of suppliers from five core features over the next three years.
There is logic here. The NHS cannot afford duplication at scale, and the digital estate has grown like a Victorian terrace, extended in parts, never fully redesigned. A standardised appointment journey could reduce confusion, cut call centre volumes and support the government’s drive to make the app the default channel for elective care communication. Yet there is an uncomfortable truth beneath the savings narrative. The NHS App, for all its promise, is not yet a product that patients love. It is useful, sometimes indispensable, but it is not intuitive in the way modern consumers expect. It is not like a Netflix subscription that learns your habits, anticipates your needs and feels coherent across every interaction. Nor is it built by a single, best-in-breed product house with obsessive focus on user experience. It is the output of layered procurement, internal teams, legacy integration and multiple contractors, each with their own incentives and timelines. Standardising the plumbing without reimagining the experience risks delivering a cheaper version of something that was never fully great.
The danger is twofold. First, technical risk. Direct integration from every electronic patient record and patient administration system into the app assumes a level of interoperability that the NHS has historically struggled to achieve. Trusts run different systems, at different maturity levels, with varying data quality. Forcing a uniform pathway could expose brittle interfaces, increase local costs and create new failure points. Suppliers argue that the market which has grown around patient portals is not simply a middleman economy but a layer of innovation, competing on usability, messaging, reminders and workflow design. Removing them from core features may flatten variation, but it may also flatten progress. Second, commercial risk. A vibrant UK digital health ecosystem has emerged around NHS integration. Signalling that core functionality will be brought in-house could chill investment, reduce competition and ultimately leave the NHS more dependent on a narrower set of large incumbents. Cost containment, if poorly sequenced, can become cost displacement, with integration and remediation costs quietly exceeding the headline savings.
If the NHS App is to justify its centrality, it needs to move from being a functional utility to a trusted digital companion. That requires more than consolidation. It demands product discipline. A single accountable product owner with authority across policy, technology and user experience. Clear service level standards for performance and uptime. A ruthless focus on reducing clicks, simplifying language and designing for those with low digital literacy. The app should feel the same whether a patient is booking an orthopaedic follow-up in Leeds or completing a pre-operative questionnaire in Kent. That consistency cannot be achieved by wiring systems together alone; it requires deliberate design, tested with patients, iterated rapidly and measured against outcomes such as reduced did-not-attend rates and shorter administrative turnaround times.
There is also a smarter path to savings. Rather than simply removing suppliers, NHSE could define open standards for core appointment data and allow certified vendors to compete on top of a common integration layer. Payment models could shift from licence fees to outcome-based contracts tied to reductions in call volumes, improved attendance and faster document turnaround. Trusts could be supported with central funding for integration, conditional on meeting interoperability benchmarks. Data generated through the app could be used to predict capacity pressures and smooth demand, aligning digital investment with operational performance. Most importantly, the NHS App strategy must be linked to prevention and pathway redesign, not just appointment management. Notifications and questionnaires are useful; proactive prompts about screening, medication adherence and lifestyle change are transformative.
Cost containment is a reality for NHS England and few would argue for preserving duplication for its own sake. But the NHS App cannot be treated as a line item to be shaved. It is the public face of a £180bn service and the channel through which citizens increasingly judge its competence. If the app is to become the true front door, it must be coherent, resilient and designed with the same care that the best consumer platforms devote to their users. The prize is significant: fewer missed appointments, lower administrative burden, better patient engagement and real, recurring savings. The risk, if reform is reduced to consolidation alone, is that the NHS ends up with a cheaper system that still feels confusing, still fragments responsibility and still falls short of the seamless experience patients now expect as standard. In digital health, as in clinical care, doing it once and doing it properly is almost always less expensive than doing it twice.
