Chronic illness drives demand across the NHS and shapes budgets, workforce planning and service design. People living with multiple long-term conditions account for around half of hospital admissions, outpatient visits and primary care consultations, and a large share of prescribing costs. Multimorbidity is rising, with projections of substantial growth in major illnesses by 2040. This creates pressure to deliver effective care at lower cost while improving access and outcomes. In this context, Digital Therapeutics NHS initiatives have moved from pilot projects to commissioned services that complement medicines and conventional therapies. They are not generic wellness apps. They are regulated software interventions that deliver evidence-based treatment, often with measurable effects on symptoms, quality of life and healthcare utilisation. This feature examines the 2025 UK landscape, the regulatory and assessment pathways, the state of the evidence in core conditions, the realities of commissioning and implementation, and the unresolved challenges around equity, privacy and sustained use.
Real fact: People with two or more long-term conditions account for around 50% of hospital admissions, outpatient visits and primary care consultations, and over half of NHS costs.
Defining digital therapeutics in UK practice
Digital therapeutics are software-based interventions that prevent, manage or treat a medical disorder. They are designed to deliver structured therapeutic content such as cognitive behavioural therapy, pulmonary rehabilitation or behaviour change protocols. In the UK, products that make diagnostic or therapeutic claims generally fall under MHRA SaMD regulation, with classification rules and conformity assessment similar to other medical devices. Developers must demonstrate safety, performance and clinical effectiveness and register devices appropriately. Post-market surveillance and clinical evaluation are required across the lifecycle.
Clinical legitimacy within the NHS depends on more than a device mark. NICE uses a digital health framework to set out standards for clinical and economic evidence, including study designs, comparators, outcomes, and real-world performance. Commissioners use these standards to appraise technologies and to judge value for money. Meeting the standard does not equal NICE endorsement, but it clarifies what good evidence looks like and supports consistent decision-making across systems.
NICE also conducts health technology evaluations for specific products when appropriate, producing guidance that informs commissioning, procurement and clinical pathways. For digital tools that function as therapies, these evaluations draw on both randomised trials and real-world evidence, with explicit attention to resource impact on NHS services.
Where digital therapeutics are gaining traction
Across the NHS, adoption clusters in conditions with significant backlogs or limited access to face-to-face therapies. Insomnia, respiratory disease and cardiometabolic risk have seen the most visible progress. Mental health triage and supported self-management services have also expanded, with digital tools used to free clinical time and widen access. These patterns reflect demand, established behavioural interventions that translate to software, and comparatively straightforward integration points with primary care and community services, promising a positive impact on patient care.
Evidence in practice of insomnia
Sleepio, a fully automated digital CBT for insomnia, was the first digital therapeutic to receive NICE guidance. NICE found good quality evidence from randomised trials showing improvements in insomnia severity and sleep indices versus usual care, alongside economic modelling suggesting potential cost savings in primary care. Subsequent analyses and service evaluations have reinforced clinical benefits and quality-adjusted life year gains. The product is used in NHS pathways where local commissioning supports access, offering a promising avenue for cost-effective care.
Mechanistically, the programme delivers structured CBT for insomnia modules, sleep restriction, stimulus control and cognitive restructuring, with automated personalisation. The evidence base includes trials with intention-to-treat analyses addressing attrition, and pragmatic studies in UK primary care settings. While access varies by locality, the case illustrates how a digital therapy can achieve formal guidance and integration into general practice.
Evidence in practice: chronic obstructive pulmonary disease
For COPD, digital self-management and remote pulmonary rehabilitation support aim to reduce exacerbations, improve technique and increase activity. myCOPD has been evaluated in UK trials and real-world studies, showing improvements in inhaler use, exercise capacity and symptom control compared with usual care. NICE updated its guidance in 2024 through two health technology evaluations covering self-management and pulmonary rehabilitation use cases, replacing earlier medical technologies guidance. This signposts commissioners to the specific contexts where evidence and value are strongest.
The clinical evidence spans a randomised controlled trial in primary care and multiple local evaluations within NHS services. These include comparative studies and service audits across Integrated Care Systems, providing generalisable findings on uptake, adherence and resource impact when embedded in routine care.
Evidence in practice: cardiometabolic risk and hypertension
Digital interventions for hypertension and cardiovascular risk focus on home blood pressure monitoring, behaviour change, medication adherence and feedback loops to reduce therapeutic inertia. Systematic reviews and meta-analyses published in 2025 report modest but meaningful reductions in systolic and diastolic pressure, with consistency across age groups and settings, albeit with heterogeneity in product design. These findings support use as part of stepped care strategies rather than as standalone replacements for clinician-supervised management.
Type 2 diabetes programmes in England have also adopted digital components. While not all are classified as therapeutics, NHS-commissioned lifestyle and remission pathways now leverage remote coaching, app-based tracking and structured curricula, with outcomes drawn from large trials such as DiRECT and subsequent service roll-outs. Digital delivery improves reach and supports weight loss and glycaemic control at scale.
NHS integration: how systems are commissioned and deployed
Commissioning decisions for digital therapeutics sit within Integrated Care Boards, often supported by Academic Health Science Networks and regional digital teams. Systems weigh NICE evaluations, the evidence standards framework, local needs, procurement rules and information governance. Case studies published by NHS Confederation show variable but maturing practices, with digital self-management and remote monitoring deployed to move care closer to home and free clinical capacity. Scaling depends on workforce readiness, training and alignment with core NHS platforms such as the NHS App, electronic prescribing and shared records.
Procurement decisions for digital therapeutics are influenced by national policies such as the MedTech Funding Mandate and the evolution of the MedTech pathway. The MedTech Funding Mandate historically focused on devices with NICE guidance and material cost savings. However, the same logic applies to software therapies when robust guidance and budget impact cases exist. The MedTech pathway, on the other hand, is a framework that guides the adoption and integration of medical technologies within the NHS. Systems are encouraged to use best value frameworks and align investments with national data platforms, ensuring that the procurement of digital therapeutics is both cost-effective and in line with national health priorities.
Pharmacists play a central role in the implementation of digital therapeutics. The Royal Pharmaceutical Society has identified digital capability as a core professional competency, with pharmacy teams supporting patient onboarding, adherence, and safety monitoring for digital tools. Community pharmacy is also becoming a practical touchpoint through electronic prescriptions and prescription tracking within the NHS App, creating opportunities to integrate digital therapeutics with dispensing journeys and medication reviews.
Clinical workflows from prescribing to data use
In practice, digital therapeutics are prescribed or recommended within primary care and specialist clinics, typically via secure referral portals, activation codes or app stores with NHS licensing. Clinical teams set expectations for use, explain data sharing and monitor progress through dashboards. Pharmacists and nurses often provide the first line of technical and behavioural support. Integration with record systems varies by product. When FHIR-based interfaces or NHS Login are supported, onboarding is faster, and data flows to care records more reliably.
Workflows must account for data governance. NHS England has aligned the Data Security and Protection Toolkit with the National Cyber Security Centre’s Cyber Assessment Framework, raising the bar for cyber assurance and incident response. Developers working with NHS organisations are expected to meet DSPT requirements and adopt secure development practices, with clear data processing agreements and patient consent models. This is particularly important when digital therapeutics generate continuous data streams that clinicians may feel obliged to review.
Benefits and limits of what the evidence says
Across conditions, benefits cluster in three areas. First, there are improvements in symptoms and functions that mirror face-to-face therapies, such as reduced insomnia severity or better inhaler technique. Second, access and convenience gains that reduce waiting list pressure and enable care outside clinic hours. Third, potential resource savings through fewer GP appointments, avoided prescriptions, or reduced exacerbation-related admissions, though the magnitude depends on adherence and targeting. The limitations are apparent. Evidence is strongest where behaviour change protocols are well defined and digitised faithfully. Effects attenuate with poor engagement or in populations facing digital barriers. For hypertension and metabolic risk, heterogeneity across products complicates generalisation, and longer follow-up is needed to confirm sustained impact.
The pharmacist’s role is patient-facing and system-facing
Pharmacists can operationalise digital therapeutics at scale because they sit at the junction of prescribing, medicines optimisation, and supported self-care. Activities include identifying eligible patients, explaining activation steps, reinforcing correct use, monitoring adverse events, and triaging non-responders back to clinicians. At a system level, pharmacists contribute to formulary decisions, product evaluation, and post-market surveillance by feeding structured data into governance forums. Professional bodies call for digital skills to be embedded through education and continuous professional development to keep pace with the growing portfolio of digital tools.
Equity and digital inclusion: closing the participation gap
Digital exclusion risks widening health inequalities if services assume universal access to smartphones, stable connectivity and digital skills. Research from The King’s Fund highlights barriers across confidence, trust and usability that affect not only those with low digital literacy but also digitally active groups. NHS frameworks now emphasise inclusive design, co-production with communities and targeted support to bring people online safely. Evaluations should report outcomes by deprivation, age, ethnicity, and disability to expose differential effects and to guide mitigation, such as offering devices, data vouchers, or in-person alternatives.
Commissioners should require vendors to evidence accessibility, user testing with diverse populations and language support. They should also check that product onboarding does not depend solely on email addresses or complex sign-up flows. For COPD and insomnia services, this may involve assisted registration in primary care or community pharmacies, and printed materials that mirror in-app instructions. The aim is parity of access between digital and non-digital routes rather than the displacement of choice.
Privacy, cybersecurity and clinical safety
Healthcare software sits within a regulated environment where clinical safety standards, cyber resilience, and information governance are non-negotiable. NHS England provides guidance on incident management, assurance and training, while local organisations use DSPT assessments aligned to the CAF to evaluate suppliers and internal processes. The shift towards integrated data platforms and app features, such as prescription tracking, adds value but also expands the attack surface. Therefore, commissioners must require clear data minimisation, encryption, audit trails, and third-party risk management. Public scrutiny is increasing, and media reporting continues to highlight weak points in data handling across health settings. Digital therapeutics must demonstrate proportionate data collection and transparent governance to retain trust.
Workforce and cultural readiness
Deploying digital therapeutics is not just a technology purchase. NHS culture, training, and capacity determine success. Parliamentary and think tank analyses cite fragmented infrastructure, risk aversion and workload pressure as barriers to adoption and scale. The policy response centres on strengthening the NHS App as a digital front door, improving interoperability and supporting rapid evaluation methods to shorten the cycle between pilots and spread. Pharmacy-specific programmes include investment in digital developments and community pharmacy IT, with practical guidance on consent, clinical safety and integration.
Economic signals and commissioning incentives
Evidence of cost effectiveness drives commissioning. NICE guidance that includes resource impact modelling carries weight in budget-constrained contexts. Where savings accrue to different parts of the system than the commissioning budget, progress slows. National policies such as the MedTech Funding Mandate create clearer routes for centrally supported spread when products demonstrably reduce costs or improve capacity. For digital therapeutics, robust health economic analyses that capture changes in GP appointments, prescribing and admissions are decisive, as shown in published cases for insomnia and COPD.
Case examples: lessons from adoption
Insomnia services that integrated Sleepio through primary care pathways reported reductions in hypnotic prescribing and improvements in patient-reported outcomes when practices embedded referral flows and follow-up. Respiratory pathways that deployed myCOPD within pulmonary rehabilitation saw better completion rates when patients received early coaching and remote prompts, coupled with clear escalation protocols for symptom deterioration. At the system level, NHS Confederation case studies show digital tools contributing to closer-to-home care, although scale depends on sustained clinical leadership and IT support.
What stakeholders say
Regulators stress that software delivering therapy is a medical device when it claims to treat or manage a disease, and that it must meet device regulations, clinical evaluation, and post-market duties. NICE emphasises that its evidence standards framework guides developers and commissioners but does not equate to product endorsement; formal guidance follows separate evaluation routes. Professional bodies argue that digital capability is now a core competency for pharmacy teams and that leadership from pharmacists is needed to ensure digital medicines and therapeutics improve safety and outcomes rather than add workload.
The road ahead is a hybrid model of care
Digital therapeutics will not replace medicines or clinicians. The most credible future is hybrid, where drug therapy, prescribing digital therapeutics and human support combine to deliver outcomes that neither could achieve alone. Policy plans to expand the NHS App’s role, integrate shared records and strengthen cyber assurance can support this shift if coupled with investment in workforce skills and evaluation capacity. Adoption should focus on conditions with strong evidence, clear pathways and measurable benefits to patient experience and NHS resource use. Pharmacists are well placed to lead safe scale-up through practical onboarding, adherence support and data-informed optimisation.
For 2025, the credible priorities are consistent. Use NICE frameworks to target interventions where evidence and value are strongest—commission for inclusion, with explicit actions to reduce digital barriers. Demand transparent data governance aligned to DSPT and CAF. Equip pharmacy teams with the skills and time to deliver digital care safely. Tie the spread to outcome and cost metrics that matter locally. The goal is simple to state and hard to achieve. Chronic care that is more accessible, more personalised and more sustainable, powered by regulated software working alongside medicines and multidisciplinary teams.
