The NHS is embracing technology to improve efficiency, to help staff do their jobs and to provide better patient care. But while technology has the potential to deliver significant benefits in healthcare, it can be daunting. Assessing the potential, feasibility and drawbacks of transformation is often overlooked, and implementing technology at scale can be fraught with risk.

Since 2012, BJSS has collaborated closely with healthcare clients, helping them to find innovative and cost-effective technology solutions to tough operational challenges.

As one of the largest technology providers to the NHS, BJSS has deployed its Queen’s Award-winning delivery approach – Enterprise Agile, to successfully deliver award-winning technology outcomes to these questions:

How do you move referrals away from paper systems and connect every GP system in the country to every hospital EPR in the country?

How you rebuild the 20-year-old activity tracking system used NHS-wide?

How do you enable suppliers to move into a GP IT market which has been a duopoly for decades?

How do you update the central register of NHS information without any operational disruption?

How do you design and build an app to enable the general public to have access to their health records?


The NHS e-Referral Service (e-RS) combines electronic booking with a choice of place, date and time for first hospital or clinic appointments. Patients can choose their initial hospital or clinic appointment,  which they can then book online (a telephone service is also available) or in the GP surgery at the point of referral.

The NHS makes over 40,000 “GP to first outpatient” referrals every day.

These include referrals to clinical assessment services, General Practitioner Special Interest (GPSI) services, Allied Health Professional (AHP) services, nurse clinics, ophthalmology services, diagnostic services and day case services.

Using Enterprise Agile®, BJSS developed the Electronic Referrals Service (e-RS), the successor to Choose and Book system. The system handles:


  • Over 40,000 referrals daily
  • Approximately 35,000 appointment bookings every working day
  • Over 300,000 registered NHS users, of whom >70,000 regularly use the system
  • Over 30,000 services polled every evening for appointment availability
  • Over 300 dynamic webpage requests every second

The initial development involved removing dependencies on the existing electronic healthcare records service product by delivering new business logic and data access layers. The user interface was redeveloped in collaboration with users while maintaining the look and feel to minimise training. An extensive data migration approach was also designed and implemented to migrate over 25 million patient records to e-RS.

e-RS was delivered using a lightweight, Open Source stack with services delivered using Open Standards for reusability and to remove dependencies on proprietary software – significantly reducing licensing and running costs. It is designed to be scalable, capable of being hosted on commodity hardware and ready to be migrated to he Cloud if required. The NHS regained control of this key application, with no vendor lock-in and much-reduced support and maintenance costs.


Spine supports the IT infrastructure for health and social care in England, joining together over 23,000 healthcare IT systems in 20,500 organisations.

NHS Spine is the world’s largest public healthcare platform, forming part of the UK’s critical national infrastructure.

As the strategic delivery partner for NHS Digital, BJSS was engaged to completely re-architect, re-engineer and rebuild Spine using Open Source products and agile ways of working.

Working in close collaboration with NHS Digital, this major programme saw the entire NHS transfer onto this new, improved system that facilities the movement of data between key sections of the service such as the Electronic Prescription Service and the E-Referral Service.

According to data provided by NHS Digital, the re-engineered NHS Spine:


  • Has saved the service over £130million since 2014
  • Enables the NHS to save over 750 working hours every day
  • Has improved response times by over 90 percent
  • Processes over 3,500 messages a second when data transfer is at a peak
  • Handles over 1 billion transactions every day – more than four times the average load on the UK’s entire credit and debit card transaction system

The system uses Open Source rather than commercial products and was delivered iteratively using the award-winning BJSS Enterprise Agile® approach. This facilitated a rapid delivery, allowing for greater cost-savings and reliability and removing vendor lock-in. Spine is based on 12 Open Source products, ranging from databases to developer tools. These software products are proven on an Internet-scale, offering a viable alternative to commercial packages while delivering significant capital and operational cost-savings.

Automation is integral to the ability to support rapid and cost-effective change. Spine now includes comprehensive end-to-end test, deployment, service recovery and operational automation. This has resulted in a significant reduction in administrative overheads in comparison to the legacy system and has made it easier to make changes to the system.

It also encourages the rapid development of new digital services thanks to a fully-supported set of APIs. BJSS continues to support the integration of fresh innovation that adds further functionality to Spine, creating a more connected NHS and better patient experience.