A unified digital solution driving smarter primary care & population health for South East London

Ardens Manager is a single, digital solution that transforms how population health insights are generated, shared and actioned across an area, including ICBs, PCNs and GP practices. By deploying Ardens Manager at scale, Ardens has supported NHS South East London to unify data in an approach that contributes to improved care delivery, reduced inequalities, and substantial cost savings.

What drove the change?

SEL ICB faced a complex and fragmented digital landscape. Across Primary Care in South East London, population health intelligence, demand and capacity planning, prescribing analytics and operational reporting were delivered through multiple tools and local arrangements, limiting consistency, scalability and the ability to act on insights in real time.

Alongside this, the system needed to respond to increasing demand, workforce pressures and health inequalities. SEL ICB required a long-term digital solution that could:

• Support local and national service delivery

• Enable strategic and operational planning across PCN, borough and ICB levels

• Translate population-level insight into direct, patient-level action in Primary Care

• Enable safe, compliant data sharing and collaboration across PCNs, Federations and INTs

• Improve access and continuity of care

• Deliver value for money

What changed?

Using Ardens Manager across GP practices, PCNs and the ICB addressed these challenges and implemented:

• A unified digital tool for Primary Care - a single source of truth and a proactive, joined-up approach to healthcare delivery and population health management

• Simplified Primary Care operations, replacing multiple tools with an integrated solution to support national contracts and locally commissioned services

• Consistent functionality across areas, reducing variation in data insights and clinical areas

• 40% cost savings through a coordinated, multi-year procurement, including projected savings of £650,000 in medicines optimisation

• Reduced clinical and administrative workload, through ‘do once’ workflows that eliminate manual searches, spreadsheets and duplication

• Improved ability to target care proactively, supporting earlier intervention and addressing health inequalities

How was this done?

Working in partnership with the borough's Primary Care and commissioning leads, Ardens delivered an onboarding programme for users, including webinars and regular progress check-ins. A new Data Sharing Agreement enabled secure access to population-level data at borough and ICB level, with patient-level data accessible to GP practices, unlocking South East London-wide population health management in Primary Care, and supporting key initiatives such as delivery of the SEL Medicines Optimisation Plan, cancer services, and the Clinical Effectiveness South East London Programme.

Ardens Manager now provides SEL ICB, PCNs and practices with:

• Advanced visual analytics covering population health, disease prevalence, prescribing, long-term conditions, and cancer screening, with segmentation by demographics, risk and inequalities

• Proactive care insights aligned with national guidance and local contracts, enabling clinicians to identify and support patients benefiting most from intervention

• Comprehensive appointment and access analytics, including DNAs, continuity of care, reattendance and avoidable contacts

• Workforce planning insights to optimise resource deployment and enhance efficiency of care delivery models

Conclusion

By implementing Ardens Manager with South East London ICB, Ardens has demonstrated how a single, digital solution can transform population health management, improve care delivery and deliver significant financial efficiencies.

This approach provides a replicable model for integrated care systems nationwide, combining advanced analytics, clinician usability and system-wide collaboration to improve outcomes for patients, practices and populations.

Highlight: The Dulwich Medical Centre

Prior to the introduction of Ardens Manager, The Dulwich Medical Centre faced challenges including limited access to real-time data, reliance on disconnected reporting systems, and time-consuming manual searches. Significant management time was spent on reporting and maintaining CQC compliance.

The ICB-led procurement and safety assurance process reduced duplication of effort for practices and provided confidence in the solution. Real-time data feeds, integration with EMIS Web, and automated reporting enabled rapid adoption, with features including palliative care registers, DMARD monitoring, repeat prescription management, safeguarding alerts and CQC dashboards becoming invaluable tools for the practice.

A nominated practice champion led implementation, supported by online training, responsive live chat support and regular updates shared through clinical and practice learning meetings. This ensured consistent engagement across clinical and administrative teams.

Since adopting Ardens Manager, the practice has benefited from real-time visibility of performance metrics through clear visual dashboards that simplify CQC inspections and highlight areas for improvement. Monthly senior clinician reviews have strengthened proactive oversight, enhancing patient safety and reducing clinical risk.

Ardens Manager is now integral to daily operations, demonstrating how a scalable, ICB-wide digital solution can deliver meaningful improvements in efficiency, compliance and patient safety at practice level.

Highlight: Medicines Optimisation Plan

This year, NHS South East London transformed their approach to medicines optimisation oversight by integrating Ardens Manager to monitor their Medicines Optimisation Plan for the first time. Moving away from retrospective manual audits, this digital integration allowed for real-time visibility into prescribing patterns across the board. Previously, some Boroughs relied on ePACT2 data for scheme monitoring; however, the inherent two-month reporting lag meant practices were often working from retrospective insights rather than current clinical realities.

Ardens Manager has bridged this data gap, moving from delayed reporting to real-time visibility. This digital integration allows proactive identification of patient cohorts requiring medication reviews and tracking of best-value prescribing metrics with immediate precision. This shift hasn't just improved administrative efficiency, it has fundamentally enhanced patient safety by ensuring evidence-based prescribing is a continuous, measurable reality, allowing clinicians to act on the patient in front of them today rather than the data from two months ago.

This, coupled with the ability to overlap additional datasets such as IMD, has helped practices stratify their cohorts based on the wider determinants of health.

Vanessa Burgess, Chief Pharmacist, NHS South East London said “By using Ardens Manager, we have been able to simplify multiple systems and digital products into one system. This has enabled us to share secure data more easily, reduce duplication of processes and reduce expenditure on digital solutions to support Medicines Optimisation across South East London. This has reduced the work for practices while enabling us to better use the resources available to us to support patients.”