National Record Locator (NRL)

The National Record Locator (NRL) allows health or social care workers to find and access patient information shared by other health and social care organisations across England, to support the direct care of a patient.

It works like this:

1. 'Provider' organisations share 'pointers' to their patient records with NRL.
2. 'Consumer' organisations search NRL for record pointers - usually for a specific patient, using their NHS number.
3. The consumer uses the pointer to get the patient record directly from the provider.

Benefits of NRL are:

• Improved integration of care pathways across providers, including timely communication and collaboration between acute trusts, mental health providers, ambulance services, primary care, social care, public health (drug/alcohol services) and the voluntary sector.
• Patients spend less time in an inappropriate setting like Accident and Emergency (A&E) or police custody.
• Supporting more accurate understanding of local populations, allowing services to be designed more effectively around individual needs.
• Preventing unnecessary conveyances to A&E by giving paramedics more information about the individual when making clinical decisions.

For more details, see Benefits of the National Record Locator.

Here are some quotes from NRL users:

NRL is for use by health and social care workers in any care setting to:

• let NRL know which patients they have information for
• access a patient’s information regardless of where they were treated in England

For example, an ambulance service called to an accident in London can access information about a patient who is visiting from Preston.

NRL does not have a user interface - health or social care workers must access it indirectly via point-of-care applications, such as:

• GP software
• electronic patient record (EPR) software in a hospital setting
• the National Care Records Service

Point-of-care applications access NRL via the NRL APIs.

Health and social care workers must be suitably authenticated and authorised to access NRL.

NRL can only be used for direct care, and only within the NHS and approved social care settings in England.

Types of record

These record types are in active use:

• mental health crisis plans
• end of life plans
• emergency care plans

Other record types can be added on request.

For a list of NRL provider and consumer organisations, the patient record types shared and their purpose for sharing, see the Controller Catalogue spreadsheet.

Information held in each record

In each record, NRL holds:

• the patient's NHS number
• some basic information about the record, such as the care setting where the information was recorded and the record type
• a 'pointer' to the full record, held by the care provider
• the URL of a web page providing contact details for the care provider

Patient information is typically shared as unstructured information in PDF format.

NRL is the only service you should use for sharing pointers to patient records. This is because it integrates patient record access across the NHS and social care, without dictating where those records are stored.

it is mandated for use in Shared Care Records by the end of March 2024.

Common uses of NRL include:

• ambulance staff viewing the end of life care plan for a patient who has had an accident away from home
• care home staff viewing the end of life plan for a patient from a previous care home
• a maternity nurse viewing a mental health crisis plan for a patient giving birth in order to assess susceptibility to postnatal depression

1. Provider and consumer organisations sign up to use the service. Their point-of-care software must be integrated with NRL (although NRL consumers have the option to use the National Care Records Service).
2. Provider organisations use their point-of-care software to share a list of the patient records they have. For each record, they share the patient's NHS number, some basic information about the record and a 'pointer' to the full record.
3. On an ongoing basis, they notify NRL of any changes.
4. When a patient interacts with a consumer organisation, the health or social care worker uses their point-of-care software to retrieve a list of all patient records from NRL. This is usually based on the patient's NHS number, but it is also possible to search in other ways, for example by care provider.
5. If the worker wants to view a particular record, their point-of-care software uses the 'pointer' to access the full record directly from the provider. To keep things secure, the software usually retrieves the record via our Spine Secure Proxy (SSP). They might also need to look up some care provider details in our Spine Directory Service.
6. In some cases a record pointer isn't available. When this happens, the worker can instead view a web page with contact details for the care provider - using the URL included with the record pointer.

All interactions between point-of-care applications and NRL are via the NRL APIs.

For both providers and consumers, operations are restricted to the document types agreed when they signed up.

For an example of how NRL works for a consumer, see the NRL demonstrator system.

This service is live, and has been in active use since 2018.

As of June 2023, there are:

• over 450,000 active care plan records accessible through NRL
• 18 NRL providers, including:
  • 16 organisations providing mental health crisis plans
  • 1 care home providing end of life care plans
  • 1 organisation providing emergency care plans
• 12 NRL consumers, including:
  • 12 ambulance trusts and mental health trusts consuming mental health crisis plans
  • 7 ambulance trusts and mental health trusts consuming end of life plans
  • 7 ambulance trusts and mental health trusts consuming emergency care plans

All consumers are currently using the National Care Records Service to access records.

For an up-to-date list of NRL providers and consumers, see the Controller Catalogue spreadsheet.

NRL is a bronze service, meaning it is operational and supported only during business hours (8am to 6pm), Monday to Friday, excluding bank holidays.

NRL API v3 (NRL Futures)

A new version of the NRL API - v3, also known as 'NRL Futures' - is in development. The new version uses our API platform and will be easier to use. It is currently available for sandbox and integration testing. For more details, see NRL APIs.

The new version is expected to be a gold service, meaning it will be available and supported 24 hours a day, 365 days a year.

'NRL Futures' refers to the NRL APIs V3 currently in development.

To get access to the NRL service, an organisation must complete an assessment which looks at its:

• technical conformance
• data protection
• security
• clinical safety
• benefits measurement
• business process review and updates
• service operations

The assessment is based on whether the organisation is an NRL consumer, provider or software development organisation. For more details, see the NRL onboarding guide.

To access patient records available through NRL, a care worker needs to have the appropriate RBAC activity codes added to their NHS smartcard or modern equivalent, typically by the Registration Authority Manager for their organisation.