NHS Online Trust What It Means for Locum Doctors

On 1 June 2026, a new kind of NHS trust came into existence one with no wards, no car parks, and no waiting rooms.

The Online NHS Trust is the first national, digital-first NHS trust in history. It was formally established this month as the organisational home for NHS Online, a service launching in 2027 that will allow patients to receive planned specialist care through the NHS App from a consultant anywhere in England without setting foot in a hospital.

It is one of the most significant structural changes to secondary care in decades. And for doctors working flexibly across the NHS, it opens up a set of possibilities that simply did not exist before.

The concept is straightforward even if the execution is ambitious. When a patient sees their GP and needs a specialist referral, they will have the option to be referred to NHS Online instead of a local hospital trust. From there, they can book a virtual appointment with a specialist anywhere in the country through the NHS App, attend via video consultation, and if they need a scan or procedure, book that separately at a Community Diagnostic Centre closer to home.

NHS Online will deliver the equivalent of up to 8.5 million appointments and assessments in its first three years four times more than an average NHS trust.

The service will initially be available for conditions where evidence shows digital care works well and where current waiting times are long, including:

More specialties will be added over time. The NHS Online website is expected to launch in summer 2026, with the patient-facing service going live in 2027.

The Online NHS Trust's chair, John Browett  who was appointed in early June  brings a background in consumer technology. Dame Ruth May, former Chief Nursing Officer for NHS England, has joined as Strategic Advisor.

Doctors will have new levels of flexibility, managing their time in a way that works better for them and their patients. That line from NHS England's announcement is worth pausing on.

For most of NHS history, hospital specialist work has meant a specific trust, specific rotas, and a specific geography. NHS Online breaks that link. A consultant in Leeds can see a patient in Exeter. A doctor who wants to work part-time or remotely can take on specialist sessions without being tied to a local trust's scheduling system.

This has direct implications for the locum and sessional workforce. Radiology services will be particularly transformed, with remote reporting and digital imaging becoming central to the patient pathway. Dermatology, ophthalmology, gastroenterology, and cardiology are all flagged as areas where the online model creates new opportunities for consultants working flexibly including those working through locum arrangements. Pathology, histopathology and digital diagnostics are also expected to shift significantly.

The model builds on things already working at scale. University Hospital Southampton cut waiting times by 62% for gastroenterology patients using virtual follow-ups, reduced clinic visits by 66%, and managed over 80% of patients digitally. Moorfields Eye Hospital has run an online referral system linking GPs and optometrists with eye specialists. These are not experiments they are proof of concept for what NHS Online is now attempting nationally.

The impetus behind NHS Online is not hard to find. The waiting list for hospital treatment has fallen from a record of 7.7 million in September 2023 to around 7.1 million in March 2026  but remains vastly above what the NHS was designed to manage, and the 18 week treatment target has not been met since 2016.

NHS Online is explicitly designed to address this by creating additional capacity that does not require new buildings or new full-time permanent posts. It is, in part, a workforce flexibility play the NHS industrialising remote specialist care in the same way that banking and retail industrialised digital services.

For doctors, that creates a new kind of NHS work: nationally commissioned, digitally delivered, and entirely compatible with portfolio, part-time, or locum working patterns.

It is worth being clear about what NHS Online is not. It will not replace in-person care for patients who need or prefer it. Tests, scans and procedures will still take place at physical sites. The service is launching with a deliberately limited set of conditions where remote care is clinically appropriate and evidenced.

But the direction of travel is unmistakable. The NHS is building the infrastructure for a permanent, large-scale remote specialist workforce  and is doing so inside a formal trust structure, with governance, clinical accountability, and the ability to employ or contract with clinicians directly.

Whether you work in secondary care, diagnostics, or a specialist outpatient setting, the NHS is expanding the range of ways doctors can contribute  including through flexible and remote arrangements.

Sources: NHS England, Online NHS Trust, National Health Executive, Pulse Today, House of Commons Library. Published June 2026.