Digital front door technologies to gather service user information for NHS Talking Therapies for anxiety and depression assessments: early value assessment

Digital front door technologies are defined in the NHS Talking Therapies for anxiety and depression manual (2024) as 'pre-assessment digital front doors, which can collect advance screening information about possible presenting problems that will help inform and facilitate the assessment'. NHS Talking Therapies for anxiety and depression (from now, NHS Talking Therapies) offer mental health support for mental health conditions. The manual also states that: 'It is important that problem descriptors are not allocated until a full clinician-led assessment has taken place'. So, functions of technologies that go beyond that of a digital front door, such as diagnosis (including assigning problem descriptors), treatment and remote monitoring, were not included in this early value assessment. Three technologies were identified for this early value assessment. Recommendations were made for 2 technologies. No recommendation was made for AskFirst because there was no information to support its inclusion in this early value assessment. The company (Sensely) did not provide any information, and no relevant information was identified by the external assessment group.

Limbic Access (Limbic) is a UKCA Class IIa artificial intelligence (AI) chatbot designed to help guide someone to the right service through a conversation and clinical decision making. It streamlines the referral and triage process for common mental health conditions like anxiety and depression. It collects key information, including:

• eligibility criteria

• contact details

• demographics

• presenting symptoms (minimum data set)

• assessment scores from the Patient Health Questionnaire 9 (PHQ‑9), Generalised Anxiety Disorder‑7 (GAD‑7) and the Work and Social Adjustment Scale (WSAS)

• additional screening responses.
  
  Limbic Access generates a clinical report summarising concerns, risk levels, clinical notes, disorder-specific measures and diagnosis predictors to aid healthcare-professional assessments. It captures all the activity in a dashboard, providing insights into engagement, referrals and staff efficiency. It also suggests problem descriptors using anxiety disorder-specific measures, but this functionality is outside the scope for this topic. It is fully interoperable with cloud-based electronic health record (EHR) systems by enabling seamless data integration into these systems. Currently, it is used by about 40% of NHS Talking Therapies services. Limbic Access has no fixed costs, and its licensing fee is charged for each digital front door technology referral. The cost decreases as the volume increases, ranging from £6.59 to £4.20 (including VAT) for each referral.

Wysa DRA (Wysa) is a UKCA Class I AI‑supported e‑triage chatbot for NHS Talking Therapies services. It collects referral data, including demographic questions. If the referral is accepted, it gathers clinical information such as the PHQ‑9 questionnaire, GAD‑7 and WSAS, and other minimum data set elements. It provides immediate signposting for people who do not meet eligibility criteria based on age or GP location. The system flags people based on service-specific criteria for review by a healthcare professional while engaging users with mindfulness exercises during e‑triage. Wysa DRA generates a report based on service-specific criteria for review by a healthcare professional. This summarises key findings and transfers referral data directly to the NHS Talking Therapies EHR system, automatically creating a record when relevant data fields exist. The chatbot is currently live in several NHS Talking Therapies services. Wysa DRA has a one-time implementation and setup cost for each service of £10,180 (including VAT) in the first year. The licensing cost varies based on the number of digital front door technology referrals. The cost decreases as the volume increases, ranging from £3.90 to £1.39 (including VAT) for each referral.