NHS England - Transformation Directorate

Delivering RPA

Automation designing and delivering lifecycle

Robotic Process Automation (RPA) is a transformation programme. It is important to consider the end-to-end lifecycle from project to business-as-usual (BAU) service to enable sustainable and lasting change. Designing and delivering RPA solutions are divided into 4 stages, which will be covered in the first section of this chapter. The second section will highlight how to successfully and safely sustain RPA adoption by embedding 4 pillars into your RPA programme.

Stage 1. Demand generation

Identifying opportunities for RPA

To ensure that the maximum benefit is realised by an RPA programme, a backlog of RPA opportunities must be created to support the continuous and ongoing throughput of solution development.

RPA teams/programmes can build upon existing backlog which might already be in place to develop the initial pipeline. Validation and collaborative working with the process SMEs across clinical and non-clinical teams will help ensure accuracy. 

This also requires understanding how operations are set up, as they might be very specific to teams, trusts or particular GP surgeries depending on local models and requirements. Hence from the outset, it is important to engage with and empower staff to become advocates of the programme to help gain buy-in, support and provide a multi channel forum for them to identify future automation opportunities.

Multi-pronged approach to identifying RPA opportunities

Comprehensive analysis

This can help in identifying high-value opportunities for teams in the early stages of their RPA journey. It has two approaches:

  • Top down – Focus on improving efficiencies through full time equivalent (FTE) effort and allocation. In this approach, processes are evaluated based on how much time staff are spending on manual activities and how often.
  • Bottom up – Detailed review of individual target process areas to identify opportunities for improving staff and patient experience, driving operational efficiency and reducing duplication.

Staff engagement

This helps identify and generate demand through engagement with staff, in the form of a marketing and comms campaign to raise awareness, demonstrations and drop-in sessions to highlight the art of the possible, and proactive engagement with key process owners and teams. In order to build a sustainable pipeline, it is critical that this is planned effectively and delivered throughout the life of the RPA programme.

Design thinking workshops

This brings together a diverse set of stakeholders, from IT, clinical teams, operational staff and wider organisation units, to gain their support and consensus for RPA initiatives. It enables them to gain a holistic view of operations and identify potential target areas for automation while collaborating with each other.


Stage 2. Demand triage – shortlisting RPA opportunities

An effective triage framework ensures limited resources and investment can be focused on best value opportunities driving the best ROI for communities, NHS services users and staff.

Once there are use cases identified to create an initial automation pipeline, the RPA teams will need to prioritise the order for development.

Teams will need to outline a benefits management process, which will provide a consolidated view of opportunities mapped against organisational, financial, and safety measures (these should be endorsed by the executive team or programme sponsors).

An example of ABC criteria to assess requirements versus existing and planned RPA activity is provided in this page. Teams can use any combination of the example metrics that align best with your requirements.

Example of ABC criteria

A - Appropriate for automation service

To assess the suitability of the business process to be automated we recommend considering process size, complexity, exceptions, type of data input (structured and unstructured) and the technologies required.

B - Benefit and value to the business

Processes should be ranked based on the benefits delivered; the benefits are defined according to organisational priorities, and RPA teams should work closely with individual department leads to ensure the prioritised backlog is constantly aligned with changing organisational priorities.

C - Cost (automation effort)

Processes are ranked according to the level of complexity and effort to automate them, thereby driving cost; large or complex processes are tackled in small chunks and later effort remain in the backlog.

This results in a triaged backlog: Prioritised and sequenced for the optimum delivery of benefit which can be delivered by the RPA teams as they ramp up capacity and capability.


Stage 3. Build and develop – a lean approach to process development

A lean based development approach to RPA solutions will ensure processes are optimised before being built and automated.

Due to COVID-19, the backlog of routine work has suffered significant delays. With the ever-increasing need for our NHS to work harder and faster, any capacity created in the system is extremely valuable, not just from an operational perspective but from staff wellbeing perspective as well.

For the development of RPA and intelligent automation solutions, in addition to engaging the right stakeholders, teams also need to engage CIO/CCIOs who understand how the operational efficiencies can be made in a clinically safe way. This should be combined with a lean based approach – for example, the PRE-ACT model.

P - Purpose of process is clear with a focus on operational efficiency and business value

R - Reduce exceptions, variants, workarounds, by assuring prerequisites of upstream processes by using lean thinking

E - Eliminate wasteful or unnecessary activity by applying lean principles

A - Automate using RPA or task application

C - Combine (manual and automated) tasks (group into larger chunks of continuous process, develop skills and changing responsibilities, if necessary) and reduce over-specialism

T - Transfer to the right people – (team with capacity, skills and lowest cost)

This approach examines the current state of operations to reduce exceptions, minimise variants and remove wasteful activities so that only value-adding activities are automated, if required.

The future mode of operation should be as stable, lean and efficient as possible, thus reducing development and support effort and time, and improving the benefits from automation for the organisation.


Stage 4. Release and embed and run managed services

See also Sustaining RPA.

It is important to plan for the effort and cost of managing and running the digital workforce in a business-as-usual (BAU) setting so that quality of care and safety standards are maintained.

Just as the human workforce requires facilities, training and line management support, the digital workforce needs platform and oversight in the form of bot managers or controllers.

The strategy for managing and supporting the automated solution should be agreed during process design and implemented in parallel to development. It should also include documenting how the to-be process works in BAU; what are the potential risks, business criticality and hence business continuity planning (BCP) options to ensure everyday operations are not impacted. This ensures adequate planning time to determine the optimum approach for the support model. Elevated support arrangements should be considered and put in place for any critical processes, especially those that directly impact clinical services.

Once the support model has been established and there are digital workers in production, teams can also consider building ‘Auto robots’ that can not only automate the monitoring but can also take remedial actions autonomously in case of process failures. The process which the Auto monitoring robot is not able to correct successfully can be escalated to the support team. Support teams will escalate to the IT support function for issues related to the underlying IT infrastructure comprising of network, servers and devices.

Key service components for managing digital workforce:

  • Platform management

    • Automation platform maintenance
    • Routine patching, impact assessment and upgrades of automation tools, testing of workflows after patching or upgrades
    • Access management for robots and users
    • Licence keys management
  • Service management

    • Standardised support using ITIL v3
    • Incident management
    • Service request management
    • User access management
    • Wide support coverage
    • SLAs /KPIs – defined as per business criticality of the processes
  • Monitoring

    • Check process run as per schedule
    • Trigger bots manually in case of failure
    • Monitor platform availability and utilisation parameters
    • 24x7 bot monitoring, exception handling
    • MIM Process
  • Change management

    • Impact analysis and estimation
    • Break fix development
    • Deploy to production
    • Business process change
  • Reporting and dashboards

    • Business KPI, benefits KPIs
    • Robot productivity, utilisation
    • Success rate, exception rate
    • AHT, SLAs
  • Continuous improvement

    • Reactive problem management
    • Proactive problem management
    • Small enhancements

Examples of existing processes

The sections below provide a list of processes which have been automated as identified by respondents to the NHS National RPA Survey 2020.

Administrative processes
  • Ambulance to ER admin
  • Call reminder send daily report
  • Demographics batch service (DBS) and System-C Medway PAS
  • Endoscopy waiting list
  • GP ERS accept referrals
  • GP referrals from ERS to Kainos Evolve
  • Invalid contact details
  • NHS object library - ERS
  • Patient appointments
  • Patient call reminder
  • Process referrals
  • System synchronisation
Clinical processes
  • Antibody testing
  • Cardio-Respiratory diagnostic tests
  • COVID-19 oxygen flow
  • Data synchronisation
  • Finds and downloads results
  • GP referrals – Check eRS referral for correct service & schedule appointment
  • GP referrals – eRS to EPR (CED)
  • Maternity self-referrals into Cerner
  • Monitor O2 levels
  • Outpatients clinics
  • Patient letter analysis
  • Register patient and admit to ED
  • Uploading referral into EPR
  • Waiting list pathway analysis
Finance processes
  • Agency invoice processing
  • Allocation of agency payment
  • Completing budgets
  • Completing Henry Schein budgets
  • Completing supply chain budgets
  • Completing uniform budgets
  • On boarding: COVID starters into ESR payroll
  • Email PO order budget holders
  • Emailing debt reminder letters
  • Emailing PO receipting reminders
  • Formatting billing data for uploads
  • Genetics referrals (eRS) to EPIC
  • Invoices to web centre
  • Invoicing processing
  • Raising a quote
  • Raising invoices
  • Reporting and invoicing
  • Realtime financial reporting
  • Realtime workforce reporting
  • Running a debtor list
Human resources processes
  • Accounts payable invoicing registrations
  • Advertising jobs
  • Auto-enrolment letters
  • Birthday bot
  • Callbot
  • Conversational bot
  • Authorisation rights changes
  • ESR staff movements
  • Longlisting vacancies on TRAC
  • HR on-boarding: numerous
  • HR staff account creation
  • Long to short listing HR
  • Maternity and FT reminders to managers
  • Maternity letters process
  • NHS Electronic Staff Record (ESR) - update password expiry launched
  • NHS object library – NHS jobs
  • NHS object library – TRAC
  • Pay progression reminders
  • Payroll processing
  • Process agency invoices
  • Processing factual reference requests
  • Professional reg report and visa reports
  • Recruitment - sending conditional offers -
  • Running cycle to work report
  • Running HR reports
  • Running monthly childcare report and associated emails
  • Running weekly Topdesk reporting figures
  • Workforce conditional offers
IT processes
  • Add user to NHS.net
  • Appointment booking
  • Choose and book reporting
  • Synchronising database
  • Analyse staff directory
  • KPI analysis
  • Staff directory snap
  • COVID daily status – group daily report (data gathering only)
  • ED sitrep submission
  • eReferral admin
  • eReferral processing
  • Exchange account deprovisioning
  • Extract referral data
  • Health records processing
  • Moving records from manual/ paper to EPR
  • HR establishment control form
  • Merging patient records
  • Off-boarding & onboarding
  • Adding users to shared folder
  • Adding user to distribution list in exchange
  • Active directory report
  • Video conferencing
  • NHS object library – ESR
  • NHS.net account deprovisioning
  • Patient referrals
  • System synchronisation
  • Read NHS emails
  • Social care NHS mail access requests
  • Daily status report
  • System access
Operations processes
  • 52 week breaches in Datix
  • Allocate UK Healthroster
  • Communication service form
  • Debtor process – clinic
  • Moving to new patient record system
  • Processing of low value requisitions
  • Reminders and invoicing
  • Running a care group report
  • Running a referral report
  • Running a sedation report
  • System synchronisation