The Challenge 

The NHS has a vision to deliver “a fully operational any-to-any booking, referral and appointment management ecosystem for health and social care that is efficient, effective and scalable.”

The process of booking, referrals and appointment management (BRAM) is a routine activity across the NHS, with over 120 million appointments made in England each year. However, the mix of BRAM tools, standards, architecture and functions in place across the NHS and social care created significant challenges for those delivering and receiving services. 

In 2019, the UK Infrastructure and Projects Authority was commissioned by NHSE&I to conduct a strategic review of bookings and referrals. Several recommendations were made, one of which was to better understand users’ needs across the system.  

To address this, a small NHSX/NHSD team, led by the NHSX CTO, was stood up to carry out a pre-discovery and discovery into the existing digital ecosystem and understand future needs as the NHS sought to transform BRAM across primary, community, secondary, and tertiary care. 


The Approach 

BJSS was asked by NHSX/NHSD to provide research, design and technical expertise to this multi-disciplinary team of clinical, technical, design and delivery experts. The team was brought together to undertake an initial 12-week discovery of bookings, appointments and referrals across patients, care settings and care pathways. Taking a GDS, user-centred design approach, the discovery focused on: 

  1. Identifying common patterns and themes found in different care pathways and settings where common national digital solutions - services, standards or guidance - could be applicable. 
  2. Understanding user needs and the digital capabilities necessary to support the transformation of outpatient, primary and community care anticipated by the NHS Long Term Plan, as well as how to meaningfully empower patients throughout the process. 

To do this, the team researched the user needs of patients, clinicians, and administrative staff whilst engaging with providers, commissioners, software suppliers and BRAM-related projects and programmes to understand the systemic challenges, complexities and opportunities to apply digital solutions at a national level.  


The Outcome 

Through mapping the problems experienced by patients, staff and the wider healthcare system, and identifying their root causes, the team were able to develop a strategic model for referrals and appointment booking aligned to the vision of the NHS Long Term Plan. In addition, the discovery identified the capabilities needed to build and support this radical new model of appointments and referrals.  

The initial discovery has led to BJSS working with NHSD/X to deliver a strategic suite of programmes and capabilities, providing the building blocks for delivering on the national vision for booking, referrals and appointment management.  

Supported by the Secretary of State for Health and Social Care, BJSS’ ongoing work is enabling the testing of national models in areas such as post-Covid elective care recovery, ambulance services and mental health care. This ongoing work is transforming not just the digital services of the NHS, but the way modern NHS services are delivered. 


“The BJSS team have not only helped us to develop a compelling strategy for one of the NHS’ largest technology platforms but throughout have ensured we remain user-centric, impact-focused and clear on the practical ways to deliver technology-enabled transformation.” 

Martin O’Neil, e-RS Programme Director, NHSX