The NHS accepts our recommendations for improvements to GP reporting and billing infrastructure

Addressing CQRS infrastructure issues, user needs and business needs with service design, user research and architecture


NHS England commissions South Central West (SCW) – as part of the CSU collaborative – to provide the Calculating Quality Reporting Service (CQRS) system to more than 6,000 GP practices across England. The system processes data which supports GP payments of up to £1billion per year.

With its current infrastructure, CQRS has issues with scalability, flexibility, interoperability and maintainability (with some software components soon reaching end of life). Users – including commissioners and GP practices – experience usability issues, which means it is more time-consuming and resource-intensive than necessary to complete their jobs.

The objective for this project was to support the organisation in their strategic planning and decision-making on the future service, through the delivery of an options appraisal at the end of the 10-week project.

The deliverable would enable the organisation to:

  • choose the best option for the future CQRS infrastructure
  • inform prioritisation of short- to medium-term work
  • make recommendations to NHSE on how to better support service providers using CQRS

What we did

We supplied a multidisciplinary team, including architects, service designers and user researchers.

Through a series of targeted technical and service design workshops, we delved into strategic areas that promised significant potential outcomes, as well as those with relatively smaller impact but more straightforward solutions. Throughout the process, we maintained an ongoing feedback loop with the teams, facilitating adjustments and refinements as needed.

We also conducted in-depth user research with commissioners and GP practice managers, data analysis and an expert infrastructure review to understand and map the 'as is' ecosystem, and to identify pain points and opportunities. 

We used this baseline to propose three options that address infrastructure issues, user needs and business needs. Our recommendations included an ideal future state as well as transitional models to enable an informed approach to decision-making by the client. 


The client was very pleased with the work, and they are moving ahead with our recommendations for technical system changes. This enables them to make critical and time-sensitive infrastructure changes that will ensure service continuity when parts of their tech stack reach end-of-life.