Authors' objectives: NHS Talking Therapies for anxiety and depression is a service that provides people in England with psychological support. There are several referral routes into the service, digital front door technologies being the most recent addition. In England, every week, one in six people experience a common mental health condition (e.g. anxiety and depression). The NHS Talking Therapies for anxiety and depression programme (formerly known as Improving Access to Psychological Therapies) was developed to improve the delivery of, and access to, evidence-based, National Institute for Health and Clinical Effectiveness (NICE) recommended, psychological therapies for depression and anxiety disorders within the NHS. In this report, NHS Talking Therapies for anxiety and depression programme are referred to as NHS Talking Therapies. In 2023–4, there were 1.83 million referrals to NHS Talking Therapies (an increase of 4% from 1.76 million in 2022–3). NHS Talking Therapies offer a range of interventions including cognitive–behavioural therapy, counselling and self-guided help; these are delivered in a variety of different formats. Digital front door technologies are a new way of collecting NHS Talking Therapies referral information. The digital front door technologies automatically populate current patient management software systems (e.g. improving access to psychological therapies user system, primary care management information system, or an NHS Talking Therapies provider’s bespoke patient management system) with referral information. Limbic Access is the only digital front door technology that has been externally audited by the Medicines and Healthcare products Regulatory Agency (MHRA).

Authors' results and conclusions: Systematic literature review evidence Evidence was only available for two digital front door technologies: Limbic Access and Wysa Digital Referral Assistant. Literature meeting the systematic literature review eligibility criteria comprised two published peer-reviewed studies, six unpublished studies and five requests for information responses. The strongest evidence related to accessibility and overall satisfaction with Limbic Access. Results from one peer-reviewed study showed that Limbic Access increased the number of referrals to NHS Talking Therapies versus services that did not implement the technology (odds ratio = 1.10, 95% confidence interval 1.075 to 1.131); this included an increase in access for some minority groups [Asian (odds ratio = 1.29; confidence interval 1.163 to 1.422), Black (odds ratio = 1.35, confidence interval 1.183 to 1.551) and non-binary (odds ratio = 2.95; confidence interval 2.065 to 4.206)]. Overall satisfaction reported by users who completed the Limbic Access referral process was high (≥ 89%). Resource impact evidence was provided by one peer-reviewed study; results showed that Limbic Access reduced clinical assessment duration by 12.7 minutes. No relevant information on quality and accuracy was identified. Further evidence is required to better understand the benefits and costs of digital front door technologies for NHS Talking Therapies. Clinical effectiveness evidence about current NHS pre-assessment referral practice for NHS Talking Therapies with and without digital front door technologies was only available for two digital front door technologies (Limbic Access and the Wysa DRA). This included information provided by the companies (RFI responses and additional data). For simplicity, in this report, all reports and publications are referred to as studies. Thirteen studies met the systematic literature review inclusion criteria; 10 studies reported Limbic Access evidence, and 3 studies reported Wysa DRA evidence. Only two (Limbic Access) peer-reviewed studies provided relevant comparative data (digital front door technology vs. alternative referral methods); all other information was unpublished and/or was provided by Limbic or Wysa. Most of the studies focused on the strengths and weaknesses of the digital front door technologies. In some studies, the strength of the evidence was difficult to determine due to small populations, weak methodologies and a lack of transparent reporting. Published evidence was not available for most of the outcomes listed in the NICE scope; no relevant information on quality and accuracy was available. The basis for asserting clinical benefit varied depending on outcome. Overall, available study data were positive; none of the identified evidence reported any harms from the adoption of the Limbic Access or Wysa DRA digital front door technologies. The Limbic Access evidence was more robust than the Wysa DRA evidence. The strongest evidence related to accessibility and overall satisfaction with Limbic Access. Results from one published peer-reviewed study showed that Limbic Access increased the number of referrals to NHS Talking Therapies versus other methods of self-referral [+ 15% vs. + 6%; odds ratio (OR) = 1.10, 95% confidence interval (CI) 1.075 to 1.131, p 

Authors' methods: The External Assessment Group carried out a systematic literature review (December 2024) to gather evidence relating to Limbic Access (Limbic), Wysa Digital Referral Assistant (Wysa), Censeo Digital (Psyomics) and AskFirst (Sensely). Information was collected across four broad outcome categories: accuracy and acceptability, resource and system impact, patient-reported outcomes, and costs. All study types were eligible for inclusion in the systematic literature review, along with evidence provided by the manufacturers of digital front door technologies (via requests for information). In addition, the External Assessment Group interviewed and sent questionnaires to stakeholders, including National Institute for Health and Care Excellence Specialist Committee Members, and carried out exploratory analyses of costs and benefits. Most published evidence was non-comparative. The strength of the evidence provided by the technology companies was difficult to assess due to limited detail. Data sources Searches were conducted between 8 December 2024 and 13 December 2024. The following sources were searched: MEDical Literature Analysis and Retrieval System (MEDLINE) All (via Ovid), Excerpta Medica dataBASE (EMBASE) (via Ovid), APA PsycInfo® (American Psychological Association, Washington, DC, USA), Cochrane Database of Systematic Reviews (via Wiley), Cochrane Central Register of Controlled Trials (via Wiley), EconLit, Cost-Effectiveness Analysis Registry, World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, Google Scholar (Google Inc., Mountain View, CA, USA), Lens.org, web pages supported by the companies. Additional information was obtained from NICE and External Assessment Group (EAG) requests for information (RFIs) from the companies and reference lists of included studies. Stakeholder interviews and questionnaires were implemented to explore five key topic areas: understand current referral pathways into NHS Talking Therapies (with and without digital front door technologies) explore the impact that the introduction of digital front door technologies has on resources required to complete the pre-assessment and assessment process estimate the costs associated with implementing and operating a digital front door technology identify quantitative and/or qualitative data relating to accuracy of information provided for the pre-assessment and clinical assessment describe the equality considerations associated with adopting digital front door technologies. The EAG carried out exploratory economic analyses to compare the benefits and costs of standard NHS pre-assessment referral practice to NHS Talking Therapies with and without digital front door technologies.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/NIHR171847

Year Published: 2026

URL for published report: https://www.journalslibrary.nihr.ac.uk/hta/GJAB1822

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/GJAB1822

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk