Clinical information flows

The general practitioner (GP) record is both the practice's source account and the continuing primary record of care (PRC). Community and hospital source records contribute relevant reports and updates while preserving their own accounts of care. These overlapping record roles are defined in Foundations.

Maintaining the PRC does not absorb every provider's clinical responsibilities. Record transfer, clinical correspondence, shared access and transfer of care serve different purposes. COPPER TIGER's proposed architecture preserves those distinctions.

This page defines the responsibility attached to each flow. The clinical correspondence reference then specifies communication families and content. Exchange mechanisms and ADT events develop delivery and event behaviour. An administrative discharge event does not replace the clinical summary or resolve pending work.

This detailed reference informs the wider programme definition and internal Defence architecture. Apply its distinctions inside Defence and then at national/regional interfaces. It is not an exhaustive programme scope or blanket approval for any purpose.

Information and responsibility

The NHS Standard Contract defines transfer of care as movement of primary responsibility within a care pathway. This can involve another unit, hospital, clinician or provider. A discharge summary is a separate communication artefact. Delivering a message therefore cannot, by itself, demonstrate acceptance of clinical responsibility. The last statement is a design inference from those distinct concepts. ⁰¹⁸

This table is an analytical model. The applicable pathway, clinical judgement and contractual arrangements determine actual responsibilities.

Returning information to general practice

GMS regulation 67 requires adequate attendance and treatment records, including reports from professionals who treated registered patients. Schedule 3 paragraph 12 provides a narrower reporting route for contractors treating people outside their lists. That provision excludes private arrangements and specified out-of-hours services. These duties support record continuity; their direct legal scope is GMS contracting, not every Defence encounter. ^{015, 016}

The 2026/27 full-length NHS Standard Contract adds specific return communications. SC11.5 requires inpatient, day-case and A&E discharge summaries within 24 hours for the applicable service categories. SC11.6 uses the relevant protocol for other services. SC11.7 requires outpatient letters where prompt GP or referrer action is needed, as soon as practicable and within seven days. This maximum does not justify delaying urgent action. SC11.3–11.4 address transfer planning and applicable shared-care protocols. These are obligations within relevant contracts, rather than universal MOD reporting deadlines. ⁰¹⁷

For NHS 111, SC11.6A specifies a post-event message by 08:00 on the next Operational Day after transfer or discharge from the provider's care, subject to its recipient and guidance conditions. The 111 content standard distinguishes an information-only post-event message from a referral requiring action. Neither should be treated as a generic instruction to the GP. ^{017, 067}

Diagnostic and referral examples

For a GP direct-access scan, the request seeks a diagnostic test without consultant-led treatment. NHS England's elective access policy states that clinical responsibility remains with the GP. A straight-to-test pathway differs: consultant review and treatment may follow without an intervening GP review. The policy's February 2026 review date has passed, so local implementation needs current pathway confirmation. ⁰¹⁹

For a hospital-requested investigation, copying its result into the GP record does not itself transfer the result task. NHS England's imaging guidance places review, action and patient communication with the initiating referrer. Automatic release to the patient is an additional failsafe. An abnormal result still requires appropriate clinical action and communication. ⁰²⁰

For shared-care prescribing, a specialist letter proposes defined responsibilities rather than completing a unilateral transfer. NHS England's prescribing guidance describes patient-specific GP agreement and continuing specialist prescriptions until successful transfer. This older guidance must be read with current local protocols. ⁰²⁹

Proposed core clinical information sharing

The associated Integration Platform (IntP) would coordinate two-way exchanges and publish–subscribe notifications across the Defence Shared Care Record (DShCR), independent source systems and supporting tools. This includes returning core information—conditions, medications, vaccinations and allergies—to relevant specialist source systems to support their clinical decision support systems (CDSS). These are proposed flows, not confirmed interfaces or automatically synchronised clinical lists. ²²⁰

Each flow needs defined source authority, provenance, currency, correction and reconciliation rules. Receiving systems need to know which information can inform decision support and which needs review. A message must not silently overwrite an independent source account or turn unavailable information into a confirmed negative. The Enterprise Master Patient Index (EMPI) supports patient matching and shared demographics; the Healthcare Provider Directory (HPD) supplies provider context for access and routing. Their identity and directory functions are distinct from the clinical content being exchanged. ²²⁰

Proposed Defence workflow

COPPER TIGER proposes explicit records of delivery, patient matching, triage, filing, clinical review, action and closure. Pending tests, the responsible team and escalation route should remain visible across postings and civilian–Defence transitions. This is a proposed workflow, not a claim about current Defence capability.

The IntP is fundamentally a message broker with publish–subscribe services. Workflow, caseload and patient-flow processing may sit in other tools or system features. The primarily read-only DShCR should expose relevant care progress and outstanding work from those tools; exact coverage remains to be confirmed. Displaying a work item does not transfer its ownership to the DShCR or broker. ²¹²

The worked correspondence example shows these distinctions for an outpatient letter and a pending investigation. Its proposed fields include document versions, recipient roles and retained responsibility. Actual technical acknowledgements must be interpreted against the selected interface specification.

NHS messaging guidance supports the underlying safety needs: tracking outstanding tests, covering staff absence, detecting failed flows and maintaining continuity during outages. A shared care view alone cannot demonstrate that someone reviewed or acted on its contents. ⁰²¹

Deployed care and disrupted connectivity

The Medical Operating Concept envisages digital clinical pathways that can function in degraded conditions. It is a future operating concept, not an implemented system specification. ⁰³⁹

COPPER TIGER therefore proposes handovers that identify the receiving team, urgent actions and outstanding results across deployed and returning care. Continuity options include retained information for reading, consultation forms for temporary capture and later reconciliation. These options and their failure coverage remain to be assessed. ^{036, 039, 212}

If temporary capture is adopted, entries should retain authorship and event time. Recovery must address duplicates, corrections and pending tasks under the selected design. Retained data alone does not establish a usable continuity service. The architecture keeps storage, forms placement and recovery arrangements open.

Continue with clinical correspondence to identify the content and lifecycle of each communication. For the shorter reading path, go directly to governance for purpose, controllership and access.