By Adam Hatherly, Chief Architect, Graphnet Health 

The CIPHA programme currently supports more than 17 million citizens, bringing together information from 1,800 GP practices, 98 acute hospitals, 26 community trusts, 17 mental health trusts and 33 local authorities. Around 150,000 health and care professionals access these records to support direct patient care. The programme also includes population health and analytics capabilities that underpin more than 100 use cases, from waiting list management and long-term condition support to remote monitoring and preventative care.

Importantly, CIPHA is not unique. Similar shared care record and population health platforms operate across England, reflecting more than a decade of investment in interoperability, information governance and clinical engagement. Collectively, these programmes demonstrate that many of the foundations required to support a more connected patient record and population health system already exist.

The ambition behind a more connected patient record is one that most people working in health and care would support. If a patient receives treatment in an emergency department, attends an outpatient appointment away from home or is supported by multiple organisations across a care pathway, the professionals involved should be able to access the information they need to provide safe and effective care.

That ambition sits behind much of the current discussion around interoperability, data sovereignty, the Single Patient Record and the future of NHS data architecture. The debate is not really about whether information should be shared more effectively. It is about how that should be achieved.

Much of the conversation has focused on what needs to be built next. Yet across England, organisations have already spent more than a decade developing shared care records, population health platforms and interoperability frameworks that are delivering value every day. Clinicians are already accessing information across organisational boundaries. Population health teams are already using linked datasets to identify vulnerable residents and target interventions. Remote monitoring programmes are already demonstrating measurable improvements in outcomes and resource utilisation.

The NHS is therefore not starting from a blank sheet of paper. The foundations for a more connected patient record already exist, and that should shape how we think about the next phase of development.

Building on what already exists

Across England, shared care records bring together information from GP practices, hospitals, community services, mental health providers, social care organisations and other partners. These programmes represent years of technical integration, governance work, clinical engagement and relationship building.

In Greater Manchester, more than 27,000 professionals access the shared care record every month, viewing over 400,000 patient records. In Thames Valley and Surrey, clinicians can access information across multiple Integrated Care Systems through a shared regional record designed to support continuity of care. Across Cheshire and Merseyside, linked datasets are being used to identify vulnerable residents earlier and support preventative interventions that reduce the likelihood of deterioration and crisis.

Graphnet-powered systems alone support more than 17 million citizens across England, but the broader point extends beyond any individual supplier. The NHS has already invested substantial time, effort and public funding in creating regional assets that bring information together safely and effectively.

These programmes have also solved many of the hardest problems associated with interoperability. They have established governance arrangements, developed trust between organisations, agreed data sharing frameworks and demonstrated that information can be brought together across organisational boundaries to support both direct care and population health.

The next challenge is different. Rather than bringing information together within individual regions, the focus now needs to be on enabling information to move more effectively between regions when there is a genuine clinical need to do so.

This approach also preserves an important principle that has underpinned NHS digital transformation for many years: local choice. Different regions have different priorities, populations and existing investments. A standards-based approach allows organisations to select solutions that best meet local needs while still supporting national interoperability objectives. It avoids creating unnecessary dependency on any single platform and enables suppliers to continue innovating and competing in ways that ultimately benefit the NHS and patients.

Interoperability is more than adopting a standard

Standards are a critical part of interoperability, but they are not interoperability in themselves.

FHIR has become the dominant international standard for healthcare information exchange and UK Core FHIR provides an increasingly important foundation for consistency across the NHS. However, anyone who has worked on interoperability programmes understands that standards alone do not solve the problem. Information can still be structured differently, coded differently and exchanged differently, even when organisations are technically compliant with the same standard.

This is one reason why the work already undertaken around UK Core FHIR is so important. NHS England has invested years of effort in developing a national approach. Rather than creating alternative frameworks, the priority should now be ensuring consistent adoption, refining implementation guidance and addressing gaps identified through practical use.

Suppliers need confidence that if they invest in implementing national standards, those standards will be used consistently across the wider system. NHS organisations need confidence that today's investment decisions will support future interoperability requirements. Both objectives become much easier to achieve when the sector aligns around a common direction of travel.

Consistent standards also help create a more open and competitive ecosystem. When interoperability is defined through nationally agreed standards rather than proprietary approaches, organisations have greater flexibility to adopt solutions that meet their requirements without compromising their ability to participate in wider national and regional initiatives.

Start with use cases

One area where interoperability discussions sometimes become unhelpful is when they focus on architecture before they focus on outcomes.

The most successful interoperability programmes tend to begin with a problem that needs solving rather than a technology platform that needs building.

Frailty, maternity, urgent and emergency care, medication safety and care planning all present opportunities to improve information sharing in ways that deliver immediate clinical value. Focusing on these use cases provides a practical route forward because it allows standards, governance arrangements and technical approaches to evolve around real-world needs.

It also creates a more realistic delivery model. Large-scale transformation programmes often struggle because they attempt to solve every problem at the same time. Incremental progress built around high-value use cases is often less dramatic, but it is usually more achievable and more sustainable.

Governance remains one of the most important enablers

Technology receives much of the attention in discussions about interoperability, yet governance is often the factor that determines whether information sharing succeeds in practice.

One of the reasons shared care records have gained traction is that organisations have invested years in establishing governance frameworks, audit processes, security controls and data sharing agreements. These arrangements provide confidence that information is being accessed appropriately and for legitimate purposes.

As interoperability expands across regional boundaries, there is an opportunity to introduce greater consistency into these arrangements. This does not necessarily require new legislation. The legal basis for sharing information to support safe and appropriate care already exists. The greater challenge is reducing variation and ensuring that organisations are not repeatedly addressing similar governance questions in different ways.

A more consistent national approach would help reduce complexity while supporting wider interoperability ambitions.

A connected patient record does not necessarily require a national repository

One of the assumptions that occasionally appears in discussions about a connected patient record is that information must ultimately be brought together into a single national repository.

I am not convinced that follows.

The NHS already has many of the building blocks required to support a more connected model. The NHS number provides a trusted national identifier. CIS2 offers a route towards more consistent authentication and access management. The National Record Locator provides a mechanism for identifying where information exists across organisational boundaries.

In practical terms, clinicians often need to know where relevant information can be found before they need the information itself. Once that information can be located, standards-based services can be used to retrieve what is required. That approach aligns more closely with the way health and care services operate today and builds on capabilities that already exist rather than replacing them.

It also allows innovation to continue at a regional level. Local systems can evolve to meet changing clinical and operational needs while remaining connected through common standards, identity services and record location capabilities.

Evolution rather than revolution

The future of NHS interoperability is often presented as a choice between fragmented local systems and a single national platform. In reality, there is a far more practical route available.

The NHS can continue building on the shared care records, population health platforms and interoperability capabilities that already support millions of people every day. It can combine national consistency around standards, identity and governance with local flexibility around implementation, ensuring regions retain choice while remaining connected as part of a wider national ecosystem.

Most importantly, it can do so incrementally, building on proven foundations rather than attempting another large-scale reset.

By 2030, success should not be measured by the size of a technology platform or the volume of information stored in a central repository. It should be measured by whether clinicians can access the information they need when patients receive care away from home, whether that access is secure and auditable, and whether patients can have confidence in how their information is being used.

Those are the outcomes that matter, and they can be achieved by building on what the NHS has already spent years creating rather than starting again.