Sharing with the wider NHS
A destination being “inside the NHS” is neither sufficient nor necessary for lawful direct-care sharing. The relevant questions are purpose, current care relationship, controller authority, confidentiality, need-to-know access, applicable standards and controls.
The Executive summary places this direct-care route alongside other purposes. The directional summaries distinguish Information sharing out of primary healthcare from Information sharing into primary healthcare and link the corresponding legislation, regulations and standards.
Common patterns
| Pattern | Minimum concern | Higher-assurance implementation |
|---|---|---|
| Shared-care record | Role- and purpose-specific views, patient expectation/objection, current identity and access, audit, data quality. | Core content mapping, structured GP data, context-sensitive views, strong authentication, break glass, hazard log and correction feedback. |
| Acute referral/discharge | Applicable transfer/referral standard, correct patient, recipient and timely clinical content. | Structured, coded, acknowledged, reconciled exchange with closed-loop error handling. |
| Community, mental-health or ambulance care | Current care relationship, relevant subset, sensitivity and local context. | Interoperable summaries and granular access rules tested against real workflows. |
| Pharmacy and medicines | dm+d, applicable community-pharmacy standard, accuracy and reconciliation. | Structured two-way medicines/events workflow with clinical-safety monitoring. |
| ICB or regional platform | Controller/joint-controller position per use case; direct-care access separated from planning analytics. | Policy enforcement by purpose, role and care relationship; separated data planes and end-to-end audit. |
National Imaging Registry (NIR)
The National Imaging Registry API is a named NHS England integration service and product API, not legislation, a regulation, an Information Standards Notice or a general sharing authority. Its present use is direct-care discovery and retrieval of imaging history, reports and selected images from participating imaging networks. For an eligible, onboarded primary-care consumer, that is an Information sharing into primary healthcare viewing/retrieval flow. If a primary-care organisation is accepted to publish locally held diagnostic imaging, that is a separate outward direct-care flow with its own controller, supplier and deployment decision. It is not the original test order, a generic results-ingestion route or the DAPB4101 pathology-reporting leg. SRC-077
Treat NIR as limited beta infrastructure rather than nationwide PHC availability. The API catalogue describes a production-beta API, while the service page describes movement towards private-beta go-live, live use across three imaging networks and planned 2026–2027 rollout. Eligibility and use case are confirmed during onboarding. The current API implements IHE XCA/XCA-I discovery and retrieval over SOAP; MHD/FHIR R4 access is roadmap work rather than a current general endpoint. SRC-077
The Digital Interoperability Platform Directions 2019 support NHS England’s operation of the service; they do not provide each participating organisation’s purpose, data-protection basis or confidentiality route. Before live use, providers, consumers and suppliers must complete the applicable onboarding and agreements, confirm direct-care-only scope, local controller and processor roles, DCB0129/DCB0160 work, DSPT status, DPIA and privacy information, role and need-to-know access, mTLS and user-assertion controls, PARS/local audit, patient matching, duplicate handling, incident response, availability and safe fallback. NIR’s bronze support level makes local downtime design material even though the service is intended to be available continuously. SRC-077
For each use case, identify the candidate instruments in the directional workflow table, then apply the Decision guide, Direct-care sharing route, Minimum-to-maximum requirement model, NHS standards applicability register, and Clinical safety and security controls. Finish by using Record a sharing decision.
For neighbourhood working, NHS App, Single Patient Record, FDP and digital-by-default proposals, also apply 10 Year Health Plan and digital-first implications. Those programmes do not collapse direct-care, operational/planning and research purposes into one sharing route.
Where the design cites a named Chapter 3 product or promise, use the Chapter 3 analogue-to-digital commitment map to distinguish live feature, limited rollout, roadmap target, future procurement and legislation-dependent capability before selecting a sharing route.
Evidence: SRC-007, SRC-014, SRC-015, SRC-024, SRC-025, SRC-031, SRC-038, SRC-039, SRC-077.