Research and analysis

Essex and Hertfordshire GP PSBU Case Study

Published 10 September 2026

1. Overview of the Essex and Hertfordshire LFFN project

The Essex and Hertfordshire Local Full Fibre Network(LFFN) project centred on upgrading fibre connectivity to GP surgeries and associated NHS premises using the Public Sector Building Upgrade(PSBU) model. Delivery was coordinated through the Essex and Herts Digital Innovation Zone (DIZ), a cross-authority and cross-sector partnership involving 17 partner organisations across Hertfordshire and Essex.

Healthcare sites were identified early as the most suitable group of buildings to include within the project. The upgraded infrastructure was intended to support changes in primary care delivery, including increasing use of online appointments, video consultations, integrated telephony systems and cloud-based clinical services.

The final approved project delivered new fibre connections to 74 GP surgeries. The fibre build was delivered by Openreach, operating through the Essex and Hertfordshire Health Partners’ contracted service providers. The project was completed in September 2021.

The design created local connection points that could in principle support further network expansion by commercial or public providers, although no information on subsequent build-out was available to the partnership.

2. Focus of this case study

This case study focuses on site-level benefits for GP surgeries connected through the Essex and Hertfordshire LFFN project. Evidence is drawn from three main sources:

• One interview with a regional NHS IT lead responsible for GP practice IT across Hertfordshire and West Essex

• A detailed case study produced by the DIZ partnership documenting project delivery and outcomes

• Publicly available evidence from local authority and health sector sources

An interview was also conducted with the DIZ lead at Epping Forest Council, however they could provide limited insight on the main benefits for GP surgeries which is the main focus of this case study.

Because the PSBU project connected only GP surgeries, the analysis focuses on how upgraded connectivity supports the delivery of digitally enabled primary care services. The case study considers the following areas of impact:

• Technical improvements in speed, reliability and capacity

• Enablement of digital primary care services, including online triage systems, video consultations and remote access to clinical systems.

• Support for healthcare delivery during the COVID-19 pandemic

• Capacity for future digital demand, including the planned move from locally hosted servers to NHS cloud-based storage.

2.1 Evidence limitations

The evidence base for this case study has important limitations and should be interpreted with caution. Direct interviews with individual GP practices were not conducted. According to the NHS interviewee, frontline staff would be unlikely to identify infrastructure-related changes directly, as the services they were using before the upgrade were already functioning adequately on existing connections. An invitation to participate in interviews was circulated to all upgraded GP surgeries where contact details were available, but none agreed to take part. Given the pressures on clinical time, this was not pursued further.

To address these limitations, the evaluation has supplemented the stakeholder interview evidence with the DIZ case study, which provides detailed technical data and project outcomes, and with publicly available evidence from local authority and health sector sources. However, the findings still reflect primarily a system-wide perspective rather than the direct experiences of practice staff.

3. Site-level benefits: GP surgeries

3.1 Previous challenges with connectivity

Before the LFFN upgrade, GP practices already had functioning broadband connections that generally met their operational needs at the time. The NHS interviewee indicated that there were not widespread connectivity failures or severe performance problems: “I think at the time there wouldn’t be an experience in any particular issues.”

However, these connections had significant limitations in terms of capacity for future demand. According to the DIZ case study, average download speeds at GP surgeries before the upgrade were approximately 40-54 Mbps, with upload speeds of only around 1 Mbps.

The NHS interviewee explained that the previous connections would not have supported the expansion of digital services that has since taken place in primary care:

“There’s no way that today they would be able to operate [as they currently do] with the lines they had then. I don’t think it’s the case [that] everything was falling apart, and this solved it. It wasn’t that kind of scenario.”

In this sense, the main challenge was not immediate connectivity failure but rather the lack of infrastructure capable of supporting the digitisation of primary care that was already anticipated. The upgrades were therefore introduced as a proactive step to prepare practices for increasing digital demand, rather than to address an immediate connectivity problem.

3.2 Improvements enabled by the Essex & Herts LFFN project

The upgraded fibre connections delivered substantial technical improvements and enabled the rollout of new digital services across the connected GP surgeries.

Technical improvements and cost savings

According to the DIZ case study, the project delivered both dramatic improvements in connectivity performance, and at a lower cost than what surgeries were paying before the upgrade. Average download speeds increased to 260 Mb/, while average upload speeds increased from 1 Mb/s to 40 Mb/s. It also shows that the annual recurring connectivity costs decreased by approximately 25%. 

The NHS interviewee described network reliability as “exceptionally good” following the upgrade, with loss of connectivity now “a rarity”. This represents a clear improvement in service stability:

“I think our uptime now is exceptionally good. So it really is a rarity for any site to lose any connectivity and that’s clearly as a result of work we’ve done with LFFN.”

Digital service enablement

The upgraded connections have supported the rollout and routine use of digitally enabled primary care services. The NHS interviewee noted that practices have been able to run online triage systems at scale and provide video and online consultations:

“Subsequently, they’re now doing things like more video consultations and more online consultations, which they can do now, which they wouldn’t have been able to do if they’d had those lines.”

Online triage systems have become particularly significant. The NHS interviewee explained:

“More and more practices are doing that and this increasing capacity facilitates that move… [At] my practice, you cannot phone them, you cannot phone and speak to them at all. If you phone them, we’ll just point you at the online triage bit.”

The DIZ case study reports that a number of GP surgeries have been able to begin their digital innovation journey based on the capacity of the new network, including through the delivery of a pilot programme to test integrated telephony systems. According to the DIZ,

“The pilot was dependent upon a fibre infrastructure to make it feasible and the resulting integrated platform has enabled call times to surgeries to be cut, improving the patient experience and freeing up invaluable practice time.”

The upgraded infrastructure has also supported increased remote working by GP practice staff. The NHS interviewee noted:

“We do have lots of GPs, we do have… lots of technologies where GPs and other clinicians are accessing systems remotely, so it absolutely has supported remote working.”

This capability has become increasingly important for workforce flexibility and service continuity.

3.3 COVID-19 preparedness and response

A significant benefit of the upgraded infrastructure was its role in supporting healthcare delivery during the later stages of the COVID-19 pandemic and in establishing post-pandemic ways of working. This benefit emerged strongly from the DIZ case study and public domain evidence, though it was not explicitly highlighted by the NHS interviewee.

The project was delivered on a rolling basis, with the final completion in September 2021. According to the DIZ case study, the fibre infrastructure “immediately was able to underpin the local response to the COVID-19 pandemic.” For surgeries that received upgraded connections earlier in the delivery programme, this support came during the height of pandemic pressures. For those connected later, the infrastructure helped consolidate new digital service delivery models that had emerged during the pandemic and supported the transition to post-pandemic working practices.

The DIZ case study identifies several specific ways in which the upgraded connectivity supported pandemic response:

• Secure remote connections for staff who were isolating, ensuring continuity of clinical services

• Supporting remote working through Teams and other collaboration platforms, enabling staff to work from home while maintaining access to clinical systems

• New ways of serving patients such as video consultations, which became essential when in-person appointments were restricted

The DIZ case study emphasises the criticality of the upgraded infrastructure during this period:

“The bandwidth and resiliency provided by the fibre network was critical to ensuring these new ways of working were effective and reliable throughout a period of high pressure and challenging demand.”

This assessment is corroborated by public domain evidence. East Herts District Council’s announcement of the project completion in December 2021 noted that the full-fibre network enabled “virtual GP appointments and remote monitoring of patients at home – capabilities whose importance was highlighted by the COVID-19 pandemic.” Similarly, NHS West Essex CCG reported in its 2021/22 annual report that improved digital infrastructure enabled pilots of remote-working capabilities for GP practice staff, allowing them to work from home or outside the main surgery to ensure continuity of care.

The NHS interviewee’s comments about remote working and video consultations, while not explicitly linked to COVID-19 in the interview, align with this picture. The interviewee noted: “There is a lot more remote work… it was, you know, post COVID, there was a lot of that kind of thing.”

In this sense, while the LFFN project was designed to future-proof GP surgeries for anticipated digitisation, it proved immediately valuable for practices that received connections during the pandemic and helped establish sustainable post-pandemic working models across all connected sites. The upgraded infrastructure provided the capacity and reliability needed to support remote and digital service delivery models that would have been difficult or impossible on the previous connections. Many of these digital ways of working, including video consultations, remote staff access, and online triage, have now become embedded in routine primary care delivery, with the upgraded infrastructure continuing to underpin these services.

3.4 The counterfactual: What would have happened without LFFN funding

For GP surgeries not included in the LFFN project, the cost of civil engineering works to install full fibre was described as prohibitive. The NHS interviewee explained:

“It’s too expensive to do those digs ourselves. So we had to, we’ve had to use different technologies which aren’t as future proof as what we have with LFFN.”

These alternative technologies provided connectivity upgrades but lacked the capacity and longevity of full fibre. The interviewee noted that non-LFFN sites would likely require further upgrades within five years, “whereas the LFFN was done at this point in time and that’s going to see us all the way through.”

Without LFFN funding, GP surgeries would likely have received connectivity improvements, but these would have been less capable, less resilient, and would have required replacement sooner. The LFFN programme enabled the delivery of genuinely future-proof infrastructure that would otherwise have been unaffordable within NHS capital budgets.

3.5 Enabling factors

Two factors enabled GP surgeries to realise benefits from the upgraded connectivity.

Technical enablers: The provision of new routers was an important enabling factor. The DIZ case study reports that all 26 Hertfordshire GP surgeries connected to the new network received replacement routers to enable them to access the faster speeds immediately upon connection. This meant that

“each of the surgeries was able to access greatly enhanced download and upload speeds which open up the potential for a range of innovations and technological improvements.”

The NHS interviewee’s role in managing IT systems for GP surgeries also facilitated smooth adoption. Because the NHS funds and manages all GP practice IT systems centrally, practices did not need to navigate procurement or technical decisions independently. The interviewee explained:

“All of their networking, all of their PCs, all of their software, all of their hardware, all their licenses are funded for them, so in my role I manage that for all of the GPs.”

Training and system changes. New digital services did require some staff training and changes to practice workflows. The NHS interviewee confirmed that online triage systems required “new systems and training… et cetera,” though noted that “they would have had to do that anyway” as part of wider NHS digitisation programmes.

The NHS interviewee could not identify any barriers that have prevented GP surgeries from making full use of their connectivity or maximising benefits.  They noted that GP surgeries are “not yet approaching the capacity of the connectivity that they have”. This suggests that the upgraded infrastructure provides substantial headroom for future growth in digital activity without requiring further investment in connectivity.

The interviewee contrasted this with non-LFFN sites, where less future-proof technologies were used:

“When we’re looking again for the next five years, we’re going to probably have to do some work to upgrade them again, whereas the LFFN was done at this point in time and that’s going to see us all the way through.”

3.6 Future use and outlook

Looking ahead, interviewees and project documentation identify substantial future benefits from the upgraded infrastructure.

NHS cloud storage migration

The most significant anticipated change is the migration from locally hosted servers to NHS cloud-based storage. The NHS interviewee described this as “an absolute fundamental change from where we are now to where we’ll be” and stated that the LFFN infrastructure “would be absolutely key” to enabling this transition.

According to the interviewee, this migration will begin in the next 18 months and will deliver multiple benefits:

• Elimination of local server costs and licensing fees

• Removal of daily backup costs for individual practice servers

• Storage in a secure NHS cloud system accessible from anywhere

• Improved backup and disaster recovery capabilities

Crucially, the interviewee emphasised that this transition would not have been feasible using the previous connections: “They actually wouldn’t have been able to do that on their old connections.”

The DIZ case study similarly notes that “the built-in resilience provided by the full fibre network as well as the capacity and speed of connectivity provided means that the local strategic healthcare partners are now able to explore… the potential for fully cloud-hosted services.”

Evolution of digital services

The NHS interviewee expects that online triage systems and other digital tools will “continue to evolve” as practices adopt new capabilities. The DIZ case study suggests that integrated telephony and other innovations piloted on the upgraded network will expand further.

Public domain evidence indicates that the infrastructure enables capabilities such as virtual appointments and remote patient monitoring, which are expected to become more prevalent as primary care continues to digitise.

4. Conclusions

4.1 Site level benefits: GP surgeries

The Essex and Hertfordshire case study reinforces findings from previous BDUK‑commissioned evaluations, including the Gigahubs and LFFN Wave One evaluations, as well as the Shetland case study, on the role of improved connectivity in enabling digitally enabled healthcare. While the evidence base for this case study is more limited, particularly due to the lack of direct input from frontline GPs, the available evidence consistently points to improvements in reliability, capacity and performance, which have supported the rollout of online triage, video consultations and remote access to clinical systems.

A key insight from this case study is the importance of future‑proofing. The upgraded fibre infrastructure has left LFFN‑connected GP surgeries significantly better equipped than non‑LFFN sites to respond to the COVID‑19 pandemic and to adapt to ongoing NHS digital transformation. Interview evidence indicates that while earlier connections were sufficient for previous models of care, they would not have supported the current level of digital service delivery. The LFFN upgrade therefore played a critical enabling role, ensuring that GP surgeries had the capacity and reliability needed to sustain new ways of working and accommodate future developments. As digital demand continues to grow, the benefits of this infrastructure are likely to become more pronounced over time, particularly when compared with less future‑proof connectivity solutions used elsewhere. *[LFFN]: Local Full Fibre Networks *[BDUK]: Building Digital UK *[SEND]:Special Educational Needs and Disabilities *[WAN]: Wide Area Network *[LoRaWAN]: Long Range Wide Area Network *[PSBU]: Public Sector Building Upgrade *[PSAT]:Public Sector Anchor Tenancy *[PSAR]: Public Sector Asset Reuse *[GMCA]: Greater Manchester Combined Authority *[TfGM]: Transport for Greater Manchester *[5GIR]: 5G Innovation Region *[SME]: Small and Medium Enterprises *[SD-WAN]: Software-Defined Wide Area Network *[LGR]: Local Government Reorganisation *[DIZ]: Digital Innovation Zone