Dr Minesh Patel
NAPC Senior Leadership Team
The Daily Reality
This week began with another system failure. It was not a minor glitch, but a core part of our infrastructure going down. Across my practice, and around 40 others in the same Integrated Care System (ICS), we have had four full outages in four weeks, alongside near‑daily minor failures. As a result, it has become routine for something critical to break every week.
This isn’t inconvenience; it’s operational fragility.
At the same time, there is a quieter but equally corrosive problem. Outdated tools waste time and money when they fail, but also when they simply underperform. Because procurement frameworks and long contract cycles make change slow and expensive, organisations stay locked into legacy systems even when better options clearly exist.
Ageing technology raises operational risk.
Information quality is also sliding. Discharge communications are often long, templated documents that run to many pages, yet only a small fraction is clinically useful. The rest is noise. Because this noise adds cognitive load, it increases safety risk and consumes scarce clinical time processing content that should not be there in the first place.
Meanwhile, if modern enabling tools such as ambient voice technology are added, practices could face costs of £50,000 to £100,000 a year simply to function well. That isn’t sustainable for primary care.
This is “digital transformation” on the ground.
The Underlying Challenges
None of this is new, but it is getting worse.
First, data provenance and trust remain unresolved. Clinicians hesitate because shared records often do not show clearly what the data is, where it came from, or who owns it. Since write‑back is only as safe as its inputs, inconsistent data increases risk and blurs responsibility.
Second, content proliferation is drowning attention. Template‑driven notes generate vast volumes of semi‑structured data. Some of it helps, but much of it hides the key clinical signal. As a result, it becomes harder, not easier, to see what truly matters.
At the same time, reliability is still poor, so workarounds have become normal. What used to be contingency planning has instead become day‑to‑day operating practice, and that shift adds further risk.
In addition, digital workflows often move work around rather than eliminate it. Teams and organisations pass tasks back and forth, but outcomes fail to improve. Instead of creating flow, these workflows create friction. As a result, clear accountability, grounded in strong working relationships, matters more than ever.
Too often teams separate information from action. Clinicians record important data, but when systems lack triggers, clear ownership, and tracking, they still miss it. This gap directly causes delays and missed care.
Patient access adds further complexity. When systems provide unmediated access to sensitive information, they introduce real risk. Transparency matters, but revealing serious diagnoses without context or support can cause significant ethical and psychological harm.
Structural barriers compound all of this. Procurement continues to lag behind technology, while outdated frameworks restrict access to better tools and lock organisations into old systems. Meanwhile, information governance remains heavy and duplicative, which slows care and stalls innovation rather than enabling it.
Perhaps most frustratingly, system design remains poorly aligned. We talk frequently about interoperability, but we do not require it in procurement. Unsurprisingly, the outcome is predictable. New systems still do not connect, and fragmentation is reinforced rather than fixed.
What Clinicians Actually Need From Our IT and Digital Commissioners and System Providers
So what does “good” actually look like?
First, a single, reliable view of the patient: a coherent narrative that brings together general practice, hospital, community, mental health, and social care—without gaps or conflicts.
Second, tools that drive action—not just documentation. Systems should show what needs doing, who owns it, and what is overdue. Work should not sit passively in records.
Documentation itself must improve. Today’s long and repetitive templates create overload rather than clarity. Clinicians need concise, structured information, supported by tools such as ambient voice capture and automated summarisation. Because of this, time can be spent thinking and caring for patients, not typing.
Team-based working across organisational boundaries is essential. Care happens in networks, not silos; systems should support shared visibility, communication, and clean handovers.
Safety must be built into workflows. Abnormal results and new diagnoses should trigger clear alerts, named ownership, and tracking through to completion. Information must lead to action.
Decision support must evolve. Clinicians need trusted, contextual guidance at the point of care—not noisy pop-ups, but real support for prescribing, pathways, and risk.
Up-to-date evidence and local pathways should sit inside the workflow, not across multiple sites and PDFs. Hunting for the “right version” should not be clinical work.
Reducing admin burden is critical. Systems should reuse data, avoid duplication, and align with coding, contracts, and reporting. Clinicians should not be forced to reconcile systems or re-validate the same data.
Beyond individual patients, we need population tools that enable proactive care: cohort finding that clinicians can trust and act on, not just risk scores. This is how we shift towards prevention instead of perpetual reaction.
That requires insight in daily workflows: who needs follow-up, who is deteriorating, and where attention is needed—without reliance on separate dashboards.
Patient information access must be designed safely. Openness matters, but sensitive results need context and support to avoid avoidable harm.
And underpinning everything is reliability. Fast, stable systems with minimal downtime are not a nice-to-have—they are the foundation. Without them, workarounds flourish and risk and disruption rises impacting on both teams and the people they are supporting.
Finally, we need less bureaucracy and better learning loops. Information governance should enable delivery, not block it. Systems should feed-back outcomes, helping clinicians calibrate judgement and improve over time.
Final Reflections for Decision Makers
If we are serious about integrated neighbourhood teams, and about wider systems improving population health, then NHS Digital, ICS commissioners, and local digital teams must align strategy with clinicians on the ground. We need to move from digital fragility to reliable infrastructure that genuinely enables high‑quality integrated care.
This isn’t about adding more tech. It’s about systems that support clinical work: stable operations, less friction, and safer, better care.
Reliability comes first. Without it, nothing else holds.
Interoperability, or genuinely shared systems, cannot remain aspirational. It must become the default, and procurement must follow system architecture rather than organisational convenience.
Information must be curated, not accumulated. Signal has to cut through noise.
The financial model must change. It is neither fair nor sustainable for individual practices or INTs to absorb the cost of system-wide digital inefficiency.
Digital could transform care. For many of us, it’s doing the opposite. Getting digital right isn’t optional—it’s essential.
