AI Digital Back Pain clinic

Context

NHS Lothian is the first NHS organisation in the UK to make the Flok Health AI clinic available to patients across a range of community healthcare settings. The service was deployed as a collaboration between NHS Lothian, Flok Health and HISES.

Flok has developed an automated digital clinic to deliver multidisciplinary MSK pathways at population scale. Its technology includes a UKCA-marked software medical device and streams interactive, generated video appointments directly to patients through a smartphone app.

Aim & Methodology

The aims included evaluating overarching feasibility, clinician and patient engagement, service integration, additional healthcare utilisation and economics. By embedding the digital tool into routine care pathways, the project sought to generate early insights into its potential to improve access, reduce demand on traditional services, and support scalable innovation across the health system.

During the pilot, patients could have accessed Flok’s digital clinic via the following routes:

1. When requesting an appointment from a participating GP practice for low back pain. Patients were offered access to Flok’s digital clinic as an alternative to a face-to-face appointment at the practice, and those that agreed received an SMS from their practice with registration instructions.

2. When a GP or Advanced Practice Physiotherapist (APP) determined that a patient would benefit from referral to physiotherapy services for low back pain. Patients were offered access to Flok’s digital clinic as an alternative to a referral to NHS Lothian’s MSK service, and those that agreed received an SMS from their practice with registration instructions.

3. Via self-referral, in response to posters displayed at participating GP practices or on existing self-referral portals. The posters displayed a URL and QR code linking to the registration instructions.

Solution

Patients use a smartphone app to attend interactive video appointments with an AI physiotherapist. The service includes automated digital triage, with back pain assessment that covers red flag and yellow flag screening and signposting to alternative services. The app also offers prescribed exercises between appointments.

Evaluation

A service evaluation ran from July 2024 to March 2025 to assess the effects of Flok Health on the healthcare system for direct patient care. It examined:

• effectiveness

• safety

• health economic benefits

• patient outcomes

• patient experience

Results

Flok Health's AI back pain clinic closed to new patients in March 2025, as the trial has come to its planned end, with over 600 NHS Lothian patients taking up the offer and the system providing automated triage in over 90% of cases. Individuals who engaged with the Flok digital back pain service were invited to provide feedback on both their experience and outcome through in-app and email surveys.

The pilot allowed anyone registered with one of the 116 GP practices within NHS Lothian to take advantage of Flok’s digital MSK clinic. All registered Flok Health patients will continue to receive access to their personalised assessment and treatment programme for up to 6 months.

The uptake for this trial has been excellent, and the feedback has been overwhelmingly positive. Analysis of the evaluation data has commenced, and the findings will be circulated to all participating practices once completed. Self-referral has been the biggest driver for uptake to the app, followed by clinical sign up then clerical signposting. Therefore, we would see this product fitting into existing MSK pathways as an enhancement to current offerings.

Health economic modelling suggests that the automated digital clinic will also represent significant time savings when operated in parallel with existing MSK services. The digital service may also be less expensive to deliver than traditional appointments and is expected to significantly decrease both capacity strain and waiting times for existing/traditional MSK services.