GP Connect Access Record: Structured - FHIR API

Use this API to access structured information from a patient's registered GP practice record. Structured information is patient data in a coded format that a consuming system can import and process.

The API accesses GP principal supplier systems, provides a consistent interface and data model, and is brokered through Spine. 

You can retrieve data from GP practice records for the following areas:

• medications
• allergies

Data is available for the following clinical areas:

• immunizations
• consultations
• problems
• investigations
• outbound referrals
• diary entries
• uncategorised data (other clinically coded items that are present in the record)

These clinical areas are still in development; there is enough data to test, but it is subject to change as GP systems suppliers go through the development process.

It does not include:

• extended demographics information - for example, about carers
• flags and alerts
• templates
• test requests

Common use cases include:

• access GP medications on admission to secondary care, reducing transcription errors
• active checking of a patient's prescription in unscheduled care
• out-of-hours GP accesses patient's medications, allergies and problems
• midwife views patient record before visiting a patient
• community cardiac nurse accesses GP record before visiting a patient

For more details, see the GP Connect Access Record: Structured specification.

You cannot currently use this API to:

• create patient-facing views of a medical record
• create reports for secondary use, such as care planning
• write back to the GP record

Retrieving documents

To retrieve documents from a patient's registered GP practice, use GP Connect Access Document - FHIR API. After you've found the relevant document references within Access Record returns, use GP Connect Access Document to retrieve the documents. All documents can be requested separately.

This API can be used by developers of clinical systems that support clinicians delivering direct care.

Before you start development, read the GP Connect API 1.5.1-beta specification and the prerequisites listed below.  

Prerequisites

Technical

The technical prerequisites are as follows:

• you must have access to the Health and Social Care Network (HSCN)
• you must be Personal Demographics Service (PDS)-compliant or capable of performing a PDS search via NHS Digital or a third-party provider

Information governance (IG)

The IG prerequisites are as follows:

• your organisation must be compliant with the GP Connect Direct Care API Information Governance Model

• you must manage access to your system locally using local role-based access control (RBAC) (this does not need to be compliant with the national RBAC model and GP Connect products do not require smartcards to control access, though they can be used if already implemented)

• the GP Connect APIs are for direct care purposes for NHS patients in England

Clinical safety

The clinical safety prerequisites are as follows:

• you must have a clinical safety officer (CSO) who is responsible for DCB0129 and, if necessary, DCB0160 (for more on clinical risk management, visit Clinical risk management standards)

If you are confident that you can meet the prerequisites, please express an interest with the GP Connect team (see 'Onboarding' below).

The following APIs are also related to this API:

• GP Connect Access Document - FHIR API - use this API to retrieve unstructured documents from a patient's GP practice record
• Personal Demographics Service - FHIR API  - use this API to search for patients, retrieve patients by NHS number and update patients
• Personal Demographics Service - HL7 V3 API  - use this if you want to use functions that are not yet available on the FHIR API
• Spine Directory Service - FHIR API  - access accredited system information and messaging endpoint details

The current working version is 1.5.1. The API status is:

• in production (out of beta) for medications and allergies - there will be no breaking changes
• in production, beta for other aspects of the clinical record - there might be breaking changes, but we will let you know in advance

It may not be fully supported by all providing systems. See GP Connect supplier progress for details of provider rollout.

The previous version (1.5.0) does not include the ability to access deceased patients' documents, but is available for system suppliers who have started to develop against it.

Roadmap

The next planned version is 1.6.0, which is currently in production, beta. The 1.6.0 specification contains the full scope of 1.5.1, but additionally it introduces a new message to support GP2GP transactions. It is important to understand that the GP2GP transactions do not affect the consumer build. 1.6.0 will be backward compatible with the 1.5.1 specification.

This API is a silver service, meaning it is operational 24 x 7 x 365 but only supported during business hours (8am to 6pm), Monday to Friday excluding bank holidays.

For more details, see service levels.

This is a synchronous API. It conforms to the FHIR global standard for health care data exchange. Specifically, it is aligned with FHIR UK Core, which is built on FHIR Release 3. 

It uses a FHIR Operation that requires you to make a HTTP POST of a FHIR Parameters resource to the provider endpoint. The resource contains parameters that correspond to the requested clinical information - for example, medications, allergies or problems.

We use this approach instead of a resource-based RESTful API in the interests of clinical safety. The provider system constructs a response that contains all clinical information relating to the request to ensure that the clinical information is interpreted safely.

You can access this API via the Health and Social Care Network (HSCN).

The API is not currently available over the internet, but we plan to enable public internet access in the future.

For more details, see Network access for APIs.

Security

Access to the GP Connect APIs is controlled and protected by the Spine Secure Proxy (SSP), a forward HTTP proxy.

It provides a single security point for both authentication and authorisation for consuming systems. Additional responsibilities include auditing of requests, checking data sharing agreements and transaction logging.

All HTTP communications are secured using TLS MA. This includes both legs of the request, from consumer system to the proxy and then from the proxy to provider system.

Authorisation

Authorisation takes place in two locations: 

• the consumer system
• the SSP

The consumer system must have local RBAC in place and restrict GP Connect APIs to authorised users. With each request, a JSON Web Token (JWT) must be included with the following information:

• details of users, including role
• where smartcards are used in the consumer system, including SDS user and role IDs
• details of the consumer system
• details of the consumer's organisation, including ODS code

The information in the JWT is retained for audit purposes.

The SSP checks data-sharing agreements to ensure that the consumer system is authorised to communicate with the provider system.

We have 2 testing streams:

• clinical testing
• technical testing

Each stream is complicated in its own right and we've designed them to run in parallel to help you to work with us more easily and to consider your system design in a holistic way, rather than having to complete one stream before the other.

Clinical testing

The aim of clinical testing is to ensure the safe interoperability of information exported from GP systems and then processed or displayed in a consuming system. 

To help you test that your consuming system is clinically safe, we have created the following resources:

• a patient record or, for some more complex areas, 2 records that can be requested from the GP Connect demonstrator
• a description of each of the data items, what it is intending to test and the hazards that it is intended to mitigate
• notes and guidance about each clinical area that describe how to process and display the data that it contains in a safe way

See Clinical test data.

Technical testing

The purpose of technical testing is to help you assure the messaging capability of your system via the Spine with GP Connect provider FHIR endpoints. It ensures the consumer requests conform to FHIR standards as per the specification. In addition, it maintains the integrity of the data displayed to the user and assures pertinent functional requirements. It does not assure the message payload, which is covered in clinical assurance.

See Consumer Supplier Test Assurance for achieving Technical Conformance (PDF) for full details of the technical conformance process and relevant artefacts.

Expressing an interest

If you meet the prerequisites and have a product that can integrate with GP Connect, you should express an interest with us by submitting a use case.

The main purpose of the use case is to help us understand how you plan to use GP Connect APIs and the business issue you are looking to address. Submit your use case to us by completing a use case submission form.

Once we receive your use case, we'll respond within 14 days.

Consumer assurance process

On approval of a use case, we will support you through the assurance process through to go live. We will discuss the assurance process and artefacts with you to help you understand the requirements.

Start your development work within 6 months of use case approval. If you miss this date, a review or new submission of the use case will be required. Changes or additional development will also require a review or new use case submission. For full details of the technical conformance process, see GP Connect Consumer Supplier Test Assurance for achieving Technical Conformance (PDF).

Clinical assurance process

We are here to support you to develop clinically safe systems in line with your responsibility to achieve the relevant DCB0129 or DCB0160 clinical safety standards. 

We host a series of meetings to help you develop clinically safe systems:

• initial meeting
• clinical safety process readiness review meeting
• clinical evaluation of readiness for deployment meeting

For more information, see Clinical assurance process details.

For a full list of interactions for this API, see GP Connect API v1.5.1-beta, which contains Access Record: Structured.

For details on the general structure of the interactions, see FHIR.

Clinical safety approach

Your organisation must have a clinical safety officer. Information standards underpin national healthcare initiatives from the Department of Health, NHS England, the Care Quality Commission, and other national health organisations. They provide the mechanism for introducing requirements to which the NHS, those with whom it commissions services and its IT system suppliers, must conform.

The following two standards relating to clinical safety are accepted for publication under section 250 of the Health and Social Care Act 2012 by the Data Coordination Board (DCB). In line with current DCB practice, each standard comprises:

• a specification, which defines the requirements and conformance criteria to be met by the user of the standard - how these requirements are met is the responsibility of the user
• implementation guidance, which provides an interpretation of the requirements and, where appropriate, defines possible approaches to achieving them

Compliance with DCB0129 and DCB0160 is mandatory under the Health and Social Care Act 2012 (Clinical risk management standards - NHS Digital).

Clinical safety guidance 

The Guide for Access Record: Structured helps clinical safety officers assure GP Connect consumer systems into their own organisations. It includes details of the clinical safety standards that consumer suppliers and their commissioning organisations must be compliant with (DCB0129 and DCB0160).

Clinical safety principles shows you who is responsible for the clinical safety of GP Connect specifications and consumer systems.

Hazard log

The GP Connect Access Record: Structured generic hazard log shows you the clinical risks of using GP Connect functionality through a consumer system. Use it to identify the clinical risks of consuming clinical data and presenting it in your system, and record these in your own system-specific hazard log. If necessary, take mitigating action to ensure clinical safety.