In his latest column for Healthcare Leader, digital expert Dr Tom Micklewright explores the digital patient and how policy and governance can keep up
Last month, I went for coffee with a close friend, who I knew had been struggling with his mental health. We talked about his worries and the challenges of waiting lists and an overburdened mental health system before he threw me a curve ball; he had recently turned to ChatGPT for his mental health. Before I had chance to suggest this might not be the best idea, he described what a transformative impact it had had.
He was better able to articulate his feelings to his partner, he had developed coping strategies and he had gained insights into unhelpful thinking patterns and beliefs he’d carried for a life time. By no means was I a convert – clinical risks with general-purpose AI abound, as I’ll describe – but it confirmed for me that the digital patient is here, is mainstream, and they are reshaping healthcare faster than policy, procurement or governance can keep up. But is this a challenge to be mitigated? Or an opportunity to leverage?
A poll from Mental Health UK revealed that more than a third of people are using AI chatbots to support their mental health, driven primarily by ease of access. This should give every healthcare leader pause. Not because patients are turning to technology, but because 66% of those users are engaging with general-purpose LLMs such as ChatGPT; tools that are not medical devices and not designed for clinical or crisis use. Within that same poll, 11% of users reported receiving harmful information about suicide, including advice relating to suicide that could increase risk.
This is not an isolated signal. It echoes findings from ORCHA, whose UK surveys show that 47% of people have used a health app, and that 18–44 year-olds are more likely to choose digital mental health tools than prescription medication. In fact, most adults in that age group report a preference for digital mental health support over pharmacotherapy entirely.
Something profound has shifted. Patients, frustrated by access constraints within the NHS, are no longer passive participants in the system; they are circumventing it. They are becoming self-directed consumers of care. And increasingly, that care is algorithm-led.
From DIY healthcare to mainstream self-care
A decade ago, self-directed healthcare was niche. It was the domain of the especially motivated, informed or resourced. Today, it is mainstream. Social media has democratised health messaging. Consumer devices such as wearables have normalised the quantification of personal health. And private pharmacological self-care has exploded into the open.
Click2Pharmacy estimates that ten times more people in the UK now purchase Mounjaro privately than receive it via the NHS. Pair that with the rapid commercial uptake of GLP-1 therapies outside traditional prescribing pathways, and a clear pattern emerges: patients are treating access delays and clinical bottlenecks as prompts to take control themselves.
Importantly, this movement towards self-care is not intrinsically harmful. The clinician-patient relationship has been evolving for years, shifting from paternalism to partnership. But until 2018, those arguments were largely philosophical and ethical. Then came the economics.
Patient activation: The strongest ROI in healthcare we still don’t fund
In 2018, Barker et al. from the Health Foundation analytics teams used the Patient Activation Measure (PAM) to quantify a patient’s knowledge, confidence and capability to self-manage long-term conditions. The findings were striking:
- 38% fewer emergency admissions
- 32% fewer A&E attendances
- 28% fewer GP appointments
All in patients with the highest levels of activation, compared to those with low activation.
So, if patients are more engaged than ever, more comfortable using digital self-management tools, and the economic argument is overwhelming, why are we still not funding or scaling support for this?
Because it is always easier to say no than to say yes responsibly.
It is easier to warn patients away from digital tools than to evaluate, govern, endorse and fund safe alternatives. It is easier to focus on short-term throughput than long-term activation. And it is easier still to treat digital self-care as a personal choice, rather than a clinical and economic investment priority.
Challenges facing system support of the digital patient
Healthcare systems face a convergence of challenges that complicate any attempt to support digitally activated patients safely and sustainably.
1. Assurance is fragmented and underpowered
The digital health market is enormous, commercially driven, and largely unregulated at point of adoption. ORCHA’s evaluations highlight the scale of the quality gap: only 20% of consumer-facing digital health products meet basic standards for data security, clinical assurance, accessibility and usability. Commercial app stores and general-purpose AI tools are not designed as regulated clinical environments, yet they have become de facto points of care for millions.
Without a scalable national or regional assurance layer, leaders cannot confidently recommend or integrate many of the digital tools patients already rely on.
2. Governance burden falls on clinicians, not systems
Even where digital tools are validated, clinical governance remains an unfunded workload. Clinicians are left to manage the risks of digital self-care conversations, app interpretation, and AI-derived patient insights during appointments, without dedicated time, training, or reimbursement. This creates a paradox where the system benefits of digital self-management are undermined by clinician overload and governance fragility.
3. Digital inclusion is not engineered into service design
A substantial proportion of the population remains digitally excluded, not due to lack of interest, but lack of access, literacy, language support, or digital confidence. Despite a heavy commitment in the NHS 10 year plan to patient-facing digital health, The Good Things Foundation estimate that 31% of people still cannot access health services online. Even when digital self-care tools are effective, safe and desired, they will still fail at scale unless leaders invest in inclusion, capability-building and equitable access. NHS England’s Inclusive Digital Healthcare Framework recommends several actions that healthcare leaders can take to improve digital inclusion, but these all sit within a system of severe budget constraints and central leadership restructure. I’ve yet to meet a healthcare leader who doesn’t understand the importance of digital inclusion. What I question is whether the system has created the conditions to act on it meaningfully.
4. The scope of the challenge feels overwhelming
Healthcare funding still prioritises throughput, episodic care and acute demand management. Shifting focus and resource towards patient activation – and dare I say it, prevantative models of care – requires great courage and the capacity to accept risk, which many Primary Care Organisations, Trusts and ICBs simply do not have. That, paired with an industry that is growing faster than healthcare leaders can keep up with, is an intimidating challenge to stare down.
Concrete steps healthcare leaders can take
To lead effectively in the era of the digital patient, healthcare leaders must start by recognising that digital self-care is no longer competing for legitimacy; it is competing for safety. Patients are already adopting tools that feel responsive, immediate, and empowering. The leadership task is therefore not to accelerate adoption, but to shape the environment in which adoption occurs.
This begins with assurance. Leaders need governance models that allow them to endorse digital tools, including AI-enabled support, with the same confidence they would apply to any clinical pathway. That means developing curated libraries of validated applications and AI tools at system or regional level, tested not only for clinical accuracy and data security, but for accessibility and usability by the patient too. Without this layer, clinicians are forced into informal sense-checking during appointments, and patients are left to navigate risk alone.
Equity must come next. Digital adoption tends to follow existing gradients of advantage, meaning that the benefits of self-care will scale fastest for those who need formal services least. Leaders must therefore invest in digital inclusion as a prerequisite for digital self-management, mapping their existing hotspots for digital exclusion and then embedding literacy and access support into care pathways through community partnerships and digital champions. Digital inclusion is the key ingredient to patient-led digital transformation at scale.
Financial discipline is the final guardrail. Digital innovation is too often interpreted as new procurement spend, when many systems already hold dormant assets bought in previous commissioning cycles. A systematic audit of licences and utilisation data should become standard practice before any new technology investment is approved. Redeployment of existing, compliant digital tools into patient self-care pathways can unlock significant value without breaching budgetary constraints. What’s more, many publicly available, digital health tools, such as health apps, are free, contain a free version with optional upgrades, or cost less than the current NHS prescription charge; might it be acceptable for NHS organisations to signpost patients to digital tools, without feeling the need to procure the tools themselves? And where NHS investment is needed, starting with clinical areas where self-management holds the greatest promise of cost-savings and the digital markets are most mature, such as MSK care, weight management and mental health, can help generate momentum and demonstrate returns before expanding further.
Critically, leaders must also change how success is measured. The KPIs of the digital era should move beyond registration numbers and download volumes, towards metrics that reflect patient capability, sustained engagement, and avoidable demand reduction. Digital self-care delivers its strongest ROI when patients are not just logged in, but are knowledgeable, confident, and able to self-manage in ways that safely reduce reliance on emergency, acute, and primary care services.
If we miss this opportunity, the digital patient will not wait for permission, assurance frameworks or workforce readiness plans. They are here. They are self-managing. They are buying privately. They are trusting AI models for crisis support that were never designed to hold that responsibility.
The only question left is whether healthcare leadership rises to meet this moment and harness the enthusiasm of patients to play a more active role in the care – or continue to treat digital self-care as a nice-to-have, until the system buckles further.
Dr Micklewright works as a GP and a Clinical Lead with Cheshire and Merseyside ICB. He also works as Medical Director ORCHA Health, a private digital health company.
