A comprehensive reference for Surgery Admin users. This guide covers every admin feature available in the Signposting Toolkit.

Surgery Admins can manage symptoms, users, appointments, clinical reviews, settings, and more for their surgery. Superusers have the same access plus cross-surgery and system-level controls.

Symptom Management

Admins manage the symptom library for their surgery from the main Signposting page and the Admin Dashboard.

Creating Custom Symptoms

Custom symptoms are surgery-specific and completely independent of the base library. They are marked as “Practice Created” in the symptom list.

To create a custom symptom:

1. Open the Admin Dashboard and go to the symptom management section.
2. Click Create Symptom.
3. Enter the symptom name, age group (Under 5, 5–17, or Adult), brief instruction, and full instructions.
4. The slug is generated automatically — you do not need to enter one.
5. Save the symptom. It enters clinical review as Pending by default.

Custom symptoms are managed entirely by your surgery and are not affected by base library updates.

Editing Overrides

Any base symptom can be customised locally without affecting the central library. An override lets you change the name, age group, brief instruction, full instructions, or highlighted text for your surgery only.

To create or edit an override:

1. Find the base symptom in the library.
2. Click Customise Instructions (or the edit action).
3. Modify the fields you want to change. Only non-null override fields replace the base values.
4. Save. The symptom shows a “Practice Customised” badge to indicate it differs from the base.

When editing instructions, update all three format fields (markdown, ProseMirror JSON, and HTML) to maintain consistency.

Hiding Base Symptoms

If a base symptom is not relevant to your surgery, you can hide it. This sets the isHidden flag on the override without deleting the base record.

Hidden symptoms are excluded from the symptom library for your surgery but can be restored at any time by removing the override.

Clinical Review

All symptoms must pass clinical review before they become fully available to staff. This ensures every piece of guidance has been checked by a clinician.

See the Clinical Governance page for the full governance framework.

Review States

Each symptom has a review status per surgery:

• Pending — Awaiting clinical review. Visible in the library but shows a pending indicator.
• Approved — Reviewed and approved by a clinician. Fully available to staff.
• Changes Required — Reviewer has flagged issues. Needs correction before re-review.

Submitting for Review

When you create or edit a symptom (custom or override), it automatically enters Pending status if clinical review is enabled for your surgery (controlled by the requiresClinicalReview setting).

Approving and Rejecting

Admins and superusers can review symptoms from the Clinical Review page:

1. Navigate to Clinical Review in the admin navigation.
2. You can see symptoms grouped by status: Pending, Approved, and Changes Required.
3. For each pending symptom, review the instructions for safety and accuracy.
4. Click Approve to mark it as approved, or Request Changes to flag issues with a review note.
5. Bulk approve is available to approve multiple symptoms at once.

The review records who approved each symptom and when, creating a clear audit trail.

User Management

Admins manage users for their surgery from the Users section in the surgery admin area.

Creating Users

1. Go to Admin → Users for your surgery.
2. Click Add User.
3. Enter the user’s name, email, and password.
4. Assign a role: Surgery Admin or Standard.

Roles

• Surgery Admin — Can manage symptoms, users, settings, clinical reviews, and all admin features for the surgery.
• Standard — Can view the symptom library, appointments, workflows, and handbook (if enabled). Cannot access admin features unless explicitly granted (e.g. Practice Handbook per-item editing).

Multi-Surgery Memberships

Users can be members of multiple surgeries. Each membership has its own role, so a user can be Admin in one surgery and Standard in another.

Password Resets

Admins can reset a user’s password from the Users management page. The user will need to use the new password on next login.

User Activity

The Users list shows when each user was last active, helping you identify inactive accounts.

Appointment Directory Management

The Appointment Directory stores your surgery’s appointment types so that signposting instructions can reference the correct local services.

See the Appointment Directory page for more detail on the user-facing features.

Creating and Editing Appointment Types

1. Go to Appointments in the admin area.
2. Click Add Appointment Type to create a new one.
3. Enter the name, duration, description, and assign a staff type category.
4. Edit existing types by clicking on them in the list.

Staff Teams

Staff types categorise appointments by who delivers them (e.g. GP, Practice Nurse, HCA, ANP). You can create and manage staff type categories from the Appointments admin area.

CSV Import

For bulk setup, appointment types can be imported from a CSV file:

1. Go to the Appointments admin area.
2. Click Import.
3. Upload a CSV file with the required columns.
4. Review the import preview and confirm.

This is useful when initially configuring a surgery or migrating data from another system.

Highlight Rules

Highlight rules automatically colour key phrases in symptom instructions to draw attention to important information such as appointment types, urgency levels, and services.

See the High-Risk & Highlighting page for the full highlight engine reference.

Built-in Highlight Slots

The system includes built-in highlight colours:

• Orange — Standard appointments requiring booking
• Red — Urgent appointments
• Pink/Purple — Specific service types
• Green — Community or pharmacy pathways

Built-in highlights can be enabled or disabled per surgery using the enableBuiltInHighlights setting.

Custom Highlight Rules

Admins can create surgery-specific highlight rules:

1. Open the Highlight Rules section in the Admin Dashboard.
2. Click Add Rule.
3. Enter the phrase to match (case-insensitive).
4. Choose a text colour and background colour.
5. Save. The rule applies immediately to all instructions containing that phrase.

Rules can be edited (change colours or phrase) or disabled. Each rule must have a unique phrase per surgery. If a phrase already exists, you will be prompted to edit the existing rule instead.

Quick Access Buttons (High-Risk Links)

Quick access buttons appear at the top of the staff home screen, providing one-click access to urgent or frequently used symptoms.

Configuration

1. Go to Quick Access in the Admin Dashboard.
2. You can configure up to 6 buttons.
3. Search for a symptom and select it to add as a quick access button.
4. Optionally set a short custom label for each button. Leave blank to use the full symptom name.
5. Drag to reorder buttons. Changes auto-save.

Default High-Risk Buttons

The system comes with pre-configured default high-risk buttons (e.g. Anaphylaxis, Stroke, Chest Pain, Sepsis, Meningitis). These can be enabled or disabled per surgery using the enableDefaultHighRisk setting.

Feature Flags

Feature flags control which optional modules and AI features are available for your surgery and users.

See the Multi-Surgery & RBAC page for the full feature flag reference.

Surgery-Level Flags

Superusers control which features are enabled for each surgery. The available flags are:

User-Level Overrides

When a surgery-level flag is enabled, admins can further control AI features at the user level. This allows individual users to have AI features enabled or disabled independently.

User-level overrides only apply to AI features (ai_instructions, ai_training, ai_surgery_customisation). Module flags (workflow_guidance, admin_toolkit) are surgery-wide only.

Managing Flags

Surgery admins can view which features are enabled for their surgery in Practice Settings → Module Access. To change surgery-level flags, contact a superuser.

AI Setup and Customisation

The AI Surgery Customisation feature rewrites symptom instructions to match your surgery’s local terminology, appointment types, and workflows.

See the AI Features page for the full AI reference.

Prerequisites

Before using AI customisation:

1. Complete the Onboarding Wizard — the AI uses your onboarding profile (appointment model, team structure, escalation pathways, local services, and communication preferences) to tailor instructions.
2. The ai_surgery_customisation feature flag must be enabled for your surgery.

Using the AI Setup Page

1. Go to Admin → AI Setup for your surgery.
2. The page shows a summary of your configured appointment model (which appointment types the AI will use when rewriting).
3. Choose a customisation scope:
   • Customise ALL symptoms — Process every enabled symptom. Keep the browser tab open until complete.
   • Select symptoms manually — Pick specific symptoms from a searchable list.
4. Click Generate AI-customised instructions.
5. The progress tracker shows which symptom is currently being processed, along with running counts of processed and skipped symptoms.
6. When complete, all customised symptoms enter Pending clinical review. Visit the Clinical Review page to approve them.

If any symptoms are skipped (e.g. no instructions to customise), the results panel shows which symptoms were skipped and why.

Analytics

The Analytics dashboard provides aggregated usage data to support onboarding, governance, and service improvement. It is designed to show visibility over surveillance — the focus is on whether modules are being used, not individual performance.

See the Analytics page for more detail.

Analytics are accessible to Surgery Admins and Superusers from the admin navigation.

Surgery Settings

Several surgery-wide settings control how the toolkit behaves for your practice.

Clinical Review

• requiresClinicalReview — When enabled (default), all new and edited symptoms enter Pending review status. When disabled, symptoms go live immediately.

Visual Features

• enableDefaultHighRisk — Show the pre-configured high-risk quick access buttons (Anaphylaxis, Stroke, etc.) on the staff home screen.
• enableBuiltInHighlights — Apply the built-in highlight colour rules (orange, red, pink, green) to symptom instructions.
• enableImageIcons — Display phrase-triggered image icons on symptom cards and instruction pages.

Image Icons

Image icons are visual indicators that appear on symptom cards and instruction pages when the brief instruction text contains a matching phrase. They provide quick visual context — for example, a pharmacy icon next to pharmacy-related symptoms.

How they work:

• Each icon is linked to a trigger phrase (e.g. “pharmacy”, “physiotherapy”). When a symptom’s brief instruction contains that phrase, the icon is displayed automatically.
• Icons have separate size settings for symptom cards and instruction pages (small, medium, or large), so they can be compact on cards but larger on the full instruction view.
• All icons include alt text for screen readers and accessibility.

Who manages them:

• Superusers create and manage icons globally — uploading the image, setting the trigger phrase, configuring card and instruction sizes, and adding alt text.
• Icons can be created as global (available to all surgeries) or surgery-specific.
• Surgery admins can toggle the enableImageIcons setting to show or hide all image icons for their surgery.

User Suggestions

Staff can submit improvement suggestions for symptoms using the Suggest a change option on symptom pages. This creates a feedback loop between reception teams and admins.

How Suggestions Work

1. A staff member views a symptom and clicks Suggest a change.
2. They enter their suggestion text and optionally their email.
3. The suggestion is saved with the symptom name and surgery context.

Reviewing Suggestions

Admins can review suggestions from the User Suggestions section of the Admin Dashboard:

• Summary cards at the top show counts for Total, Pending, Actioned, and Discarded suggestions.
• Filter by status using the dropdown to show All, Pending, Actioned, or Discarded.
• For each suggestion you can see the symptom name, submitter email (if provided), submission date, and current status.

Actioning and Discarding

For each Pending suggestion, two actions are available:

• Mark Actioned — Indicates the suggestion has been addressed (e.g. the symptom was updated).
• Discard — Indicates the suggestion was reviewed but not needed.

Both actions record who took the action and when, creating a lightweight audit trail. If you change your mind, click Undo to return a suggestion to Pending.

Individual suggestions can be permanently deleted, and a Clear All button (with confirmation) removes all suggestions for your surgery.

Superusers can see and manage suggestions across all surgeries.

Setup Checklist & Surgery Health

The Setup Checklist helps track your surgery’s onboarding progress. It is available from the Admin Dashboard and is split into essential and recommended sections with a progress bar.

Essential steps:

• Practice questionnaire — Complete the onboarding questionnaire.
• Appointment model — Configure appointment types and clinicians.
• Team members — Add at least one reception or care navigation user.
• High-risk buttons — Configure quick-access buttons for urgent symptoms.
• AI customisation — Run AI customisation (if the feature is enabled for your surgery).
• Clinical review — Bring pending reviews below 10.

Recommended steps:

• Appointment directory — Add local services and appointment types.
• Highlight rules — Enable colour-coded highlights for urgent phrases.
• Practice Handbook — Add internal guidance pages (if the feature is enabled).

Once all essential steps are complete, the checklist transitions into a Surgery Health dashboard with three metric cards:

• Clinical Governance — Pending reviews, changes requested, last review activity.
• Usage (last 30 days) — Active users, symptom views.
• Content Health — Approved symptoms, recently updated content.

Quick action buttons provide direct links to clinical review, practice profile, AI setup, and user management.

Managing Workflow Guidance

Administrators can enable Workflow Guidance per surgery using the workflow_guidance feature flag.

Admin users can:

• Create and edit workflows on the visual canvas
• Customise Global Default workflows for their surgery
• Approve workflows for staff use (draft → approved lifecycle)

Only approved workflows are visible to non-admin staff.

See the Workflow Guidance page for the full reference.

Practice Handbook

Previously referred to as the “Admin Toolkit”. The user-facing name is now “Practice Handbook”.

The Practice Handbook is an optional module for storing surgery-specific guidance pages for admin and reception workflows (for example: “how we process documents”, “post route”, or “task buddy system”).

The Practice Handbook admin page is split into Items (day-to-day content editing) and Structure & Settings (categories, pinned panel, and rota) tabs for clarity.

Enabling the Module

• The module is controlled by the admin_toolkit feature flag (superuser-controlled).
• When enabled, a new Practice Handbook link appears in the top navigation.

Global Defaults Starter Kit (Templates)

We keep a special surgery record, global-default-buttons, as the template source for Practice Handbook starter content.

• A seeding script can populate it with a lightweight starter kit (categories + example pages).
• Surgeries can then be populated by copying from this global defaults surgery (without copying rota or pinned panel text).

Write Access (Who Can Edit)

• Any signed-in member of the surgery can view Practice Handbook pages (as long as the category and item are visible to them).
• Surgery Admins and Superusers can always edit all Practice Handbook items and manage settings.
• Standard users can only edit an item if they have been given an explicit grant for that item.

Permissions (Visibility and Editing)

The Practice Handbook uses two separate controls:

• Category visibility (who can see categories and the items inside them)
  • Everyone
  • Roles (Admin / Standard)
  • Specific people
  • Roles or people
• Per-item editing grants (who can edit a specific item)

Category Visibility

• Category visibility is set in Structure & Settings → Categories.
• Visibility is enforced server-side:
  • Restricted categories do not appear in search results.
  • Restricted items cannot be opened via a direct link unless the user has access.

Per-Item Editing Grants (Standard Users)

• Standard users cannot access the Practice Handbook admin dashboard.
• To let a standard user edit a specific item, an admin can set Additional editors for that item.
• Admins can also optionally allow all standard users to edit a given item.
• Standard users edit from the staff-facing item page using the Edit button (which opens a dedicated edit screen).

Pinned Panel and Rota

Practice Handbook pages show an always-visible pinned panel at the bottom, including:

• GP taking on (from a simple rota)
• Task buddy system (editable text)
• Post route (editable text)

The operational info panel is collapsible and remembers your preference. It automatically expands when the on-take GP changes.

What’s Changed (Handbook)

The Practice Handbook has a dedicated What’s Changed page (accessible from the Handbook navigation) that shows recently modified handbook items, following the same pattern as the symptom library’s What’s Changed view.

• Items are shown within a configurable time window (default: 30 days), or since a baseline date if one has been set.
• Each item is tagged as New or Updated with a badge and shows when it was last changed.
• Any surgery member can view handbook changes (the page respects the admin_toolkit feature flag — it is only available when the Practice Handbook module is enabled).

This helps staff stay aware of updated guidance without needing to check every page individually.

Related Pages

• Clinical Governance — Full governance framework
• Multi-Surgery & RBAC — Roles, permissions, and feature flags
• Symptom Library — Symptom management for staff
• AI Features — AI tools reference
• Analytics — Usage analytics
• Workflow Guidance — Workflow feature reference
• Appointment Directory — Appointment management
• High-Risk & Highlighting — Highlight engine reference

Last updated: February 2026