The healthcare tech ecosystem

Just as we have an ecosystem of care providers in the NHS in England, we also have an ecosystem of healthcare IT systems.

As per Conway’s law, the arrangement of IT systems tends to reflect the boundaries between organisations, so we have GP systems for GPs, pharmacy systems for pharmacies, hospital systems for hospitals and so on.

And just as the care provider ecosystem is integrated, so too are the IT systems that support them.

We can group healthcare IT systems into three broad categories:

• healthcare worker-facing applications, also known as ‘point-of-care’ applications
• patient-facing applications
• back-end applications

Point-of-care applications:

• are used directly by healthcare workers in care settings
• are generally tailored to a specific use
• can be local, regional or national in scope

For example:

• a GP system serving a single GP practice
• a hospital patient administration system (PAS) serving a group of hospitals
• a regional 111 call centre system
• a pharmacy system serving a national pharmacy chain
• the National Care Records Service (NCRS)

Point-of-care applications are sometimes built by in-house development teams within NHS organisations, particularly if they are specialised applications. However, they are more commonly built by commercial software providers and bought in by the NHS organisations. For this reason, we commonly refer to healthcare tech software developers as 'suppliers'.

National point-of-care applications such as NCRS are generally built and managed by national bodies such as NHS England. There is usually no charge to use these applications.

Patient-facing applications:

• are used directly by patients to manage their own healthcare
• can be local, regional or national in scope

For example:

• a GP system’s patient portal - allowing patients to book appointments
• the NHS App - a national mobile phone app allowing patients to, for example, order repeat prescriptions
• the find your NHS number service
• the child health eRedbook

Back-end applications:

• are accessed by other applications via APIs, not directly by end users
• are usually national in scope
• often include a database
• usually enable integration between care providers

For example:

• the Personal Demographics Service (PDS) is a national database of NHS patient details such as name, address, date of birth, related people and NHS number
• the Summary Care Record (SCR) is a national database of summary-level care information such as medications and allergies
• the Electronic Prescription Service (EPS) sends prescriptions from prescribers such as GP practices to dispensers such as pharmacies
• GP Connect enables the sharing of GP records between care providers

Back-end applications often have people and business processes that support them. As such, we sometimes refer to them as 'services'. When they are national in scope we call them 'national services'. For example, a key part of PDS is the Demographics Back Office (DBO) - a team that handles data quality issues such as duplicate records.

Back-end applications are generally built and managed by national bodies such as NHS England. There is usually no charge to use these applications.

Here’s a list of some key back-end applications:

You can see a full list of our back-end applications in our service catalogue. If you are specifically interested in APIs, see our API catalogue.

‘Spine’ - or ‘National Spine’ - is the umbrella term we use for our collection of national applications.

The analogy is that the national applications are the backbone of healthcare tech in the NHS in England, enabling integration amongst local care providers.

These national applications are mostly back-end applications such as PDS and SCR, but also include national point-of-care applications such as NCRS.