All posts by Dominic Gilroy

A Pay per View project

Examining the efficacy of a pay per view system as opposed to subscriptions for journal access in an NHS healthcare library setting.


In the Autumn of 2015, Jo Thomas, Trust Library Services Manager at Northern Lincolnshire and Goole NHS FT (NLaG) and Jacqui Smales, Knowledge Services Manager at Hull and East Yorkshire Hospitals NHS Trust  (HEY) discussed submitting a bid to David Stewart to fund a ‘Pay per View’ project within the LKS of our respective Trusts. It led to discussions with Richard Osborn in 2016, under the ‘Discovery’ remit of the KfH strategy that  ultimately bore fruit in the form of some funding from Health Education England, enabling us, after some hitches setting up, to carry out the project from October 2017 until the end of February 2018. Jo and Jacqui enlisted the help of their staff members, Chris Lawton, Specialist Librarian for e-Resources at NLaG and Tim Staniland, Outreach Librarian at HEY, to run the project.

We wanted to see if we could build upon the work that Jenny Lang, Head Librarian at Salisbury NHS FT, had carried out in 2013 regarding Pay per View.


We could see that article requests were declining to a degree within our services, subscription bundles of e-journals were ever increasing in price, and the ‘bundle’ nature of them meant that they always included a considerable percentage of content that we felt we did not need or want.

Although NLaG still subscribed to e-journal bundles, HEY didn’t, meaning that we were potentially good comparison sites to run such a project. We wanted to know if it would be cheaper for our users to access content of journals on a pay per view basis which would mean that we, as librarians/knowledge managers, would only be paying for what was actually being used. We thought that the results of our project may also help inform the procurement decisions surrounding the National Core Content.

Different Approaches

It was decided that we would take a different approach to the project at each site, with NLaG using a debit card to purchase articles online on behalf of our users, therefore taking a mediated approach. HEY purchased a ‘bundle’ of articles/book chapters using Elsevier’s ScienceDirect ArticleChoice®service with the intention of letting their users ‘loose’ in terms of acquiring their own online journal articles via ArticleChoice®

Our Findings

At NLaG we had to promote our PPV article request service regularly to get any uptake, and ultimately used PPV to satisfy our regular article request service.  For the duration of the project we logged ease of access or any difficulties encountered when purchasing articles for our users.

At HEY only 2 people took up the offer of being given access to ArticleChoice® and only towards the very end of the trial, one of those individuals then got in touch to say they were having difficulty using the service.

It was decided at HEY not to open up the project to satisfy regular article requests. However, in order to understand the experience of the individual having difficulties, we tried the ArticleChoice® service ourselves and realised that it could be quite cumbersome for users not regularly searching databases or online journals themselves to access articles via this particular method.


From our small study, it became clear that pay per view using a debit or credit card, albeit a mediated approach, is a viable economic option for LKS with a small budget. However, the drawback of the mediated approach is of, course, that it can only occur during the staffed opening hours of the LKS. The ScienceDirect ArticleChoice®approach can be both a little cumbersome and relatively narrow in scope compared to using a debit/credit card, but has the advantage for the end user of being available outside of normal working hours.


A combination of maintained ILL lending groups that have well thought through subscription plans, spreading the costs across different sites, whilst maintaining access for as many libraries as possible combined with pay per view, British Library On Demand and Open Access, would be an excellent step forward.

Full report can be found here

Chris Lawton, Jacqui Smales, Tim Staniland and Jo Thomas

Update from HEE LKS Leads

A few points of feedback for LKS managers and teams from the meeting of the HEE Library and Knowledge Service Leads Group on 26 February:

  • Developing and making the case for an equitable funding model for NHS LKS is a current high priority. We hope to be able to engage with Trusts on our proposals during this year.
  • With the Department of Health, we are currently negotiating extension of the CLA Licence Plus for the NHS in England for a further five years from April 2018.
  • With NICE, we are progressing re-procurement of a new national core content collection from April 2019, and also exploring options for extended collaborative purchasing of e-resources. Our thinking informed by feedback from the 90% plus LKS teams who responded to our survey and provided information about local investment in e-resources – thank you!
  • Work continues on development of the new national LKS quality assurance process, which will feature a much reduced number of quality standards with associated evidence requirements, and graded levels of attainment. The process will be piloted by a small number of LKS this year.
  • Building on the work to date within the Knowledge for Healthcare Public and Patient Information work stream, it has been agreed that the role of health librarians in supporting health literacy will be the focus of this work stream for the next two years. A blog post about this will follow shortly.
  • The Workforce Planning and Development work stream has identified CPD priorities for the LKS workforce for the next two years, drawing on feedback from recent development needs analyses and a review of strategic priorities. Meanwhile, we are submitting a response about the healthcare LKS workforce to the consultation on ‘Facing the Facts, Shaping the Future’ (the draft national workforce strategy for health and care for England to 2027).
  • Three more STEP literature searching e-learning modules are now available, and a new set of knowledge management e-learning modules are in development, with the design of the knowledge management postcards being refreshed to match.
  • More #AMillionDecisions social media cards are being created, featuring quotes about the role of library knowledge specialists from senior national NHS leads. An HEE LKS presence at June’s NHS Confederation Conference will provide a further opportunity for high level advocacy, and we are delighted that a number of Knowledge for Healthcare-related papers have been accepted for this year’s HLG and EAHIL conferences.

If you have comments or queries relating to this bulletin, please contact your HEE LKS Lead.


Emerging Technology Group updates will be produced every 2 months, as members of the group take it in turns to update the wider NHS library community on key topics. This time, we will be discussing blockchain and its implications for health libraries.

Blockchain: what is it?

Bitcoin and other cryptocurrencies such as Ethereum have been prominently featured in the media over the past 6 months or so. They are all based on the same technology: blockchain. Simply, blockchain is a secure digital record keeping system that is spread out across a large network. Information is stored in encrypted blocks which are then chained together. Information cannot be changed once it has been added to the chain, and because the chain is distributed across the whole network, it is very secure. There are more detailed explanations available on Wikipedia or from the LSE Business Review blog.

Implications for healthcare

There are a number of different ways in which blockchain could be applied in healthcare. One option which has seen significant interest is using blockchain to manage the storage and sharing of medical records, as is being explored at MIT. Till et al (2017) have also argued that blockchain could potentially be used to finance universal health coverage. Other potential applications of blockchain in healthcare could be in securely storing and tracking research metadata, global health patterns, or administrative and financial information (Gordon et al, 2017). This is an area that is seeing a lot of research and there are numerous startups exploring the opportunities available.

What about libraries?

Hoy (2017) argues that the blockchain could be used as a digital rights management (DRM) tool to aid in copyright protection. Blockchain could even potentially be used as a library management system to keep track of circulation in a decentralised way (Cabello et al, 2017). Another potential could be in the creation and maintenance of authority records for cataloguing and metadata. The project Blockchains for the Information Profession by San Jose State University is a good source of information and probably the best way to stay up-to-date in this field.

There’s always a but…

The long term viability of blockchain remains to be seen. One of the concerns that has been raised relates to the wider environmental impact of these distributed networks, which is already consuming more energy than the whole of the Republic of Ireland, although this estimate is also up for debate. In addition to this, there remain numerous barriers to the more widespread adoption of blockchain in healthcare or in libraries, not least technical issues relating to the interoperability of metadata, as well as a current lack of clarity around governance, regulation, and wider economic impact (Deshpande et al, 2017).

What can we do?

Keeping abreast of developments in this field so that we can have informed discussions with others within and outside our organisations would be a good place to start. I would argue that the proliferation of private companies leading the way in implementing blockchain in healthcare is an issue of concern. For any solutions to be sustainable in the long term, we need to be playing an active role in conversations around emerging technologies such as this.



YiWen Hon
Knowledge Resources Manager
Royal Marsden NHS Foundation Trust.