My 6-month appointment wait led me down a rabbit hole of legacy systems and wasted opportunities
The Problem
12 million NHS appointments go unused every year, costing £1.2 billion while patients wait months for care. Why? The NHS runs on tech that makes COBOL look modern.
The Current Tech Stack (Yes, Really)
- 60% of NHS trusts still use mainframe systems from the 1980s
- 200+ incompatible systems across different hospitals
- Appointment letters sent by physical mail (often arriving late)
- No real-time availability checking
- Zero integration between systems
For context: NASA's Mars rovers have more modern tech than most NHS booking systems.
What We Tried (And Failed)
2002-2011: Government spent £12.8 billion on NPfIT (National Programme for IT)
Result: Complete failure. Project abandoned.
Why it failed:
- Tried to replace everything at once
- Ignored user needs
- Changed requirements with every government
- Classic big-bang approach disaster
What Actually Works (Small Wins)
SMS Reminders: 18% reduction in missed appointments for £0.05/text
Flexible Scheduling: 12% improvement with basic time slot options
AI Triage: 40% reduction in unnecessary face-to-face appointments
The Tech Solution (That Could Actually Work)
Instead of another £12B replacement, build a simple integration layer:
Smart Appointment API
// Simple REST API for appointment management
GET /api/appointments/available?specialty=cardiology&location=manchester
POST /api/appointments/book
PUT /api/appointments/{id}/reschedule
DELETE /api/appointments/{id}
Core Features
- Real-time slot aggregation across NHS trusts
- Webhook notifications for cancellations → auto-offer to waitlist
- Multi-channel reminders (SMS/email/push)
- Flexible booking: "Any Tuesday afternoon" vs fixed slots
- Travel time integration with Maps API
Tech Stack Suggestion
Backend: Node.js/Express or Python/FastAPI
Database: PostgreSQL for appointments, Redis for caching
Queue: Bull/Agenda for notification scheduling
Integration: RESTful APIs with existing NHS systems
Frontend: React/Vue.js PWA
Mobile: React Native or Flutter
Database Schema (Simplified)
-- Core appointment table
CREATE TABLE appointments (
id UUID PRIMARY KEY,
trust_id VARCHAR(50),
specialty VARCHAR(100),
datetime TIMESTAMP,
status ENUM('available', 'booked', 'completed', 'missed'),
patient_id UUID,
external_system_ref VARCHAR(100)
);
-- Waitlist for intelligent rebooking
CREATE TABLE waitlist (
id UUID PRIMARY KEY,
patient_id UUID,
specialty VARCHAR(100),
preferred_times JSONB,
priority_score INTEGER
);
Implementation Strategy
Phase 1: SMS reminder system (quick win)
Phase 2: API layer for 3-5 pilot trusts
Phase 3: Patient-facing app
Phase 4: Intelligent waitlist management
Phase 5: Scale across all trusts
Why This Would Work
✅ Incremental approach (no big-bang failure)
✅ Works with existing systems (no replacement needed)
✅ Proven tech stack (battle-tested components)
✅ Measurable ROI (£1B annual savings potential)
✅ Modern UX (patients expect Uber-level booking)
What Other Countries Did Right
Denmark: Single health platform, 89% patient satisfaction
Estonia: 98% digital adoption, 30% faster appointments
They built new systems instead of patching legacy ones.
The Developer Opportunity
This isn't just a healthcare problem—it's a classic systems integration challenge that developers solve every day.
The NHS needs:
- API design expertise
- Legacy system integration
- Real-time data processing
- Mobile-first UX design
- Scalable cloud architecture
Call to Action
The NHS wastes £1B annually while patients suffer. We have the skills to fix this.
Ideas for developers:
- Build NHS appointment checker tools
- Create open-source integration libraries
- Design better booking UX prototypes
- Contribute to NHS Digital's repos
The tech solution exists. We just need to implement it properly this time.
What would your ideal healthcare booking system look like? Drop your thoughts below.
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