The Digital Safety Net is Here. Do we have what it takes to implement it?
By Professor Kevin Moore
At the Integrated Care Delivery Forum hosted by Public Policy Projects in January 2026, some of the most important voices in NHS policy and clinical leadership asked an urgent question: is our healthcare system ready to move complex care into the community?
The short answer, as Professor Kevin Moore put it clearly, is that the mandate is simple; "Be bold to do what's right." The forum describes precisely the problems that we design our software to solve.
A 'Digital Safety Net'; From Concept to Reality
Read the harrowing clinical examples: a patient with cirrhosis whose monitoring appointments were cancelled until his cancer became inoperable; the young woman who nearly died of neutropenic sepsis because she could not obtain a paper blood form – these cases are not outliers. They are the outcome of our reliance on outdated, analogue processes for life-critical monitoring.
The scale of this problem is well documented; a peer-reviewed study using NHS primary care data from over 1.4 million patients found that fewer than 40% of patients on azathioprine received blood tests in every required three-month period (2). On a related note, surveys estimate that there are around 240 million medication errors in England annually, with almost 40% occurring in primary care (3).
These are not obscure or experimental medicines; they are drugs with long-established, guideline-mandated monitoring requirements. That regulators condition their approval of many medicines on safety monitoring speaks to how seriously they take this risk. Reality tells a different story. This is not a luxury we are talking about; it is a clinical necessity.
Fewer than 40% of patients on azathioprine received blood tests in every required three-month period. An estimated 240 million medication errors occur in England annually: almost 40% in primary care. ONE Monitor exists to close that gap: automatically, reliably, and at scale.
Medicines Monitoring: Keeping Patients Safe in the Community
The forum rightly highlighted the growing ambition to move treatments such as immunotherapy and hormone therapy out of acute settings and into the community (10). This shift is clinically sound and patient-centred, but it introduces a critical question; who checks that the monitoring requirements of these medicines are met, wherever the patient is?
Many of the medicines now considered for community administration carry significant monitoring obligations. These include:
Immunotherapy agents (e.g. checkpoint inhibitors): requiring regular LFTs, thyroid function, and immune-related adverse event surveillance
Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and leflunomide: requiring FBC, LFTs, and renal function at defined intervals
Hormone therapies (e.g. tamoxifen, aromatase inhibitors) with monitoring for bone density, lipid profiles, and endometrial changes
Anticoagulants (e.g. warfarin): requiring regular INR monitoring, with dose adjustments based on results
Azathioprine: mandating weekly to monthly FBC monitoring to detect potentially fatal agranulocytosis
Lithium: requiring monitoring of serum levels, thyroid, and renal function
Antiepileptics (e.g. sodium valproate, carbamazepine): requiring LFTs, FBC, and drug level monitoring
We need new tools for clinicians who Initiate patients on these types of medications. It should automatically schedule blood test requests, track their completion, and check that clinicians review the results and take any necessary action. A cloud-based safety protocol means that community pharmacists and clinicians could access requests and results regardless of location (5,9).
Design With Clinicians, For Clinicians
Dr Adrian Hayter's caution that "digital solutions must be co-designed with patients and practitioners to ensure they enhance, rather than obstruct, clinical workflows" (8) speaks directly to a risk we have worked hard to avoid. Poorly designed technology adds burden to an already overstretched workforce. It can become yet another system to log into, another alert to dismiss, another reason clinicians disengage.
At Salutare, clinicians are not consulted for advice. They are integral to our team. We build our software with active NHS clinicians who understand the daily reality of care delivery. The result? Tools that are fast, easy to use, and designed to reduce cognitive load rather than increase it. Our partners describe it as software that "doesn't look like healthcare software" That is entirely intentional.
ONE: build a digital safety net
The forum's discussion of the multidisciplinary team as the engine of community care resonates strongly with our work on ONE. We designed ONE is so that MDTs function well regardless of whether team members are co-located in an acute trust or geographically distributed across community settings.
The forum highlighted that district nursing has nearly halved: from over 7,600 to around 4,300 and that community nursing is the "forgotten layer" connecting hospital and home (6,8). ONE addresses this fragmentation by enabling structured, asynchronous MDT collaboration; clinicians can contribute to a referral discussion, flag risks, and progress patient decisions without every team member needing to be in the same room, or even the same building.
ONE also automates the entire monitoring cycle; requesting blood tests, tracking results, alerting clinicians when action is needed, and keeping patients from silently falling through the cracks.
For a workforce that is burnt out, time-poor, and geographically dispersed, the ability to work asynchronously, safely and with full audit trail is not a minor efficiency gain. It is a structural requirement for the shift to community care to work at all.
What We Can – and Cannot – Fix
We are realistic about the limits of technology. We cannot rebuild the district nursing workforce. We cannot resolve the commissioning paradox that keeps care trapped in hospitals. We cannot create the funding flows needed to support pharmacy-led phlebotomy or community oncology at scale.
What we can do is help the workforce that does exist to work as safely and efficiently as possible. Every hour saved automating a monitoring request is an hour a community nurse can spend with a patient. Every referral that reaches the right clinician first time with all the relevant information is a step towards the seamless pathway the forum's panellists described. Every blood test result that is automatically tracked and acted upon is a patient who does not become a clinical incident.
The "Five Cs" framework offered by Jill Lockett: Chronic conditions, Covid lessons, Commissioning, Cash, and Care rightly identifies the systemic levers that need to move (1). Salutare's role is to build digital infrastructure that makes the clinical part possible, even while the NHS addresses the structural challenges.
Be Bold. The Infrastructure Exists Now.
The clinical case for shifting care into the community is not in doubt. The technology to support it safely; the digital safety net, the automated medicines monitoring, the connected referral infrastructure exists today. What remains is the institutional courage to commission it, implement it, and trust it.
As Professor Moore said, be bold to do what's right (9). At Salutare, that is the mandate we work to. We are here to keep patients from being lost in the shift to community care and that the clinicians making that shift are equipped with technology that works for them. Not against them.
References
1. Public Policy Projects. How prepared is the health system for complex community care? Integrated Care Delivery Forum Report [Internet]. London; Public Policy Projects; 2026 Jan [cited 2026 Mar]. Available from; https;//publicpolicyprojects.com/how-prepared-is-the-health-system-for-complex-community-care/
2. Fraser SD, Lin SX, Stammers M, Culliford D, Ibrahim K, Barrett R, et al. Persistently normal blood tests in patients taking methotrexate for RA or azathioprine for IBD; a retrospective cohort study. Br J Gen Pract. 2022;72(720);e528-e537. doi; 10.3399/BJGP.2021.0595.
3. Elliott RA, Camacho E, Jankovic D, Sculpher MJ, Faria R. Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Qual Saf. 2021;30(2);96-105.
4. National Patient Safety Agency. Improving compliance with oral methotrexate guidelines. London; NPSA; 2006.
5. NHS Specialist Pharmacy Service. Methotrexate monitoring [Internet]. NHS SPS; 2020 [updated 2025; cited 2026 Mar]. Available from; https;//www.sps.nhs.uk/monitorings/methotrexate-monitoring/
6. Palmer W, Dodsworth E, Julian S. District nursing; Understanding the decline and mapping the future [Internet]. London; Nuffield Trust; 2025 [cited 2026 Mar]. Available from; https;//www.nuffieldtrust.org.uk/research/district-nursing-understanding-the-decline-and-mapping-the-future
7. Avery AJ, Rodgers S, Cantrill JA, Armstrong S, Cresswell K, Eden M, et al. A pharmacist-led information technology intervention for medication errors (PINCER); a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet. 2012;379(9823);1310-1319.
8. Hayter A. Comments at; Integrated Care Delivery Forum, Medicines and Care Pathways theatre; 2026 Jan; London. Royal College of General Practitioners.
9. Moore K. Comments at; Integrated Care Delivery Forum, Medicines and Care Pathways theatre; 2026 Jan; London. University College London.
10. Havercroft Dixon V. Comments at; Integrated Care Delivery Forum, Medicines and Care Path
About the Author
Dr.Kevin Moore is a Liver Expert for the Courts, where he provides an independent opinion on the care provided by other doctors. As a Professor of Hepatology and Clinical Pharmacologist at University College London, his expertise in drug safety monitoring and adherence to national guidelines provides a unique perspective on the healthcare system's successes and failures. With over two decades of specialized experience in liver transplantation and general hepatology, he brings substantial clinical and academic authority to both patient care and medical-legal evaluations, along with a keen understanding of the practical challenges facing modern healthcare delivery.
Kevin Moore at UCL, Royal Free has authored over 100 research papers with an H index of 64 and is the author of the Oxford Handbook of Acute Medicine.
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