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National Record Locator (NRL)

The NRL (National Record Locator) enables authorised users to find specific patient records that are held on different health care systems.

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How the NRL works

The National Record Locator (NRL) is a national index of pointers to patient records.  It enables an authorised clinician, care worker and/or administrator, in any health or care setting, to access a patient’s information to support that patient’s direct care.

The NRL works by acting as a registry by pointing, or bookmarking, to show a user that a patient record exists and where it is held. The user can then use the information held on the NRL to contact the organisation where the record is held to request more information, or directly retrieve the record if the users system is enabled to allow this.

To make sure a record can be located a provider organisation adds a pointer, or bookmark, to the NRL when the patient record is created at that organisation.

  • a Provider (for example a care coordinator in a mental health trust) creates a medical record for a patient.  At the same time as creating the record an "NRL pointer" can be automatically added to the NRL which points to or bookmarks the existence of this new medical record. 
  • by adding this pointer users in other organisations (Consumers), for example a paramedic out on call treating the same patient, can then search the NRL to understand more about the patient's care. 

The NRL integrates patient record access across the NHS and Social Care without dictating where those records might be stored, thus realising a level of national interoperability across the service which has previously been unachievable.

NRL is NOT a central data store for patient records. It is an index that provides the location of records, the technical means to retrieve them, underpinned by an Information Governance (IG) framework to safely support sharing on a national scale. 

Example of care without the NRL

Artboard 1The patient / public calls 111 / 999 in need of care for a mental health issueIf required, the patient may have to be taken to A&E where paramedics do not have the information available to provide an alternative pathway. The crisis situation could also involve other emergency servicesThe call handler asks questions to determine the issue and level of urgencyIf the issue is deemed ‘Non-Urgent’, the patient will receive non-specific ‘hear and treat’ care from the call-centre clinicianNon-UrgentUrgentIf the issue is deemed ‘Urgent’, the patient will be forwarded to the dispatchers team who will co-ordinate an ambulance responseThe dispatcher is unaware a care plan exists for the patient and cannot inform the paramedic team. Unless there is a local arrangement through shared care records. A paramedic team will go to see the patient to administer ‘see and treat’ care (non-specific). They may try to make contact with the patient’s Mental Health team where possible.The paramedic is unaware a care plan exisits for the patient and therefore is unable to give patient-specific care.UrgentThe clinician is unaware a care plan exisits for the patient and therefore is unable to give patient-specific care. Unless there is a local arrangement through shared care records. Example of care without the NRL Diagram

Example of care with the NRL

Artboard 1The patient / public calls 111 / 999 in need of care for a mental health issueA mental health professional creates a care plan for their patientA pointer is created on the NRL that references the care plan. The existence of this pointer allows the ambulance service to know a care plan exist for the patientThe NRL service could help reduce A&E Admissions and additional emergency service involvementThe call handler asks questions to determine the issue and level of urgencyIf the issue is deemed ‘Non-Urgent’, the patient will receive non-specific ‘hear and treat’ care from the call-centre clinicianNon-UrgentUrgentIf the issue is deemed ‘Urgent’, the patient will be forwarded to the dispatchers team who will co-ordinate an ambulance responseNRL will allow the dispatcher to view whether the patient has a care plan and pass that information onto the paramedic teamA paramedic team will go to see the patient to administer ‘see and treat’ care (non-specific). They may try to make contact with the patient’s Mental Health team where possible.NRL will allow the paramedic team to view specific care plan information meaning that care provided can be patient specific and more timelyUrgentNRL will allow them to view specific care plan information meaning that care provided can be patient specific and more timelyExample of care with the NRL Diagram

The NRL beta

The NRL project (phase 1) started in October 2017 and went live with the beta version of the service in November 2018 connecting five mental health trusts (providers), two of which were through the local shared care initiatives, with four ambulance services (Consumers). 

Phase 2 of the NRL project started in December 2018 and went live in June 2019. This phase connected more mental health trusts and ambulance services directly to the service or through the local shared care initiatives.  

Phase one objectives were to: 

  • build a national record index for data providers and consumers
  • identify and review where the NRL can be integrated into existing clinical systems
  • provide the technical capability to locate records by creating a new digital interoperability platform
  • provide a national index to support the health care system
  • provide a standardised pointer to the record, so information about patient records can be seen in date order
  • allow users to locate patient records, including any additional supporting information.  

Phase two objectives were to:

  • enable the secure retrieval of patient records from Provider health care systems to consumer health care systems
  • enable the discovery and sharing of more types of patient records such as Digital Child Health records
  • enable new pointer management features giving provider organisations even more control over the pointers they create on the NRL.

Implementation

Before you are given access to the NRL service your organisation will have to complete an assessment.  The assessment will look at a range of criteria including:

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

You can learn more about the whole process by reading the NRL onboarding guide. This guide also provides examples of forms and documents you may need to support your assessment.  Your assessment will be based on if your trust is a consumer, provider or software supplier. 

Benefits

Some of the benefits of the National Record Locator for phase one include:  

  • 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 individuals’ needs

  • preventing unnecessary conveyances to A&E by giving paramedics more information about the individual when making my clinical decisions. 

Find out more by reading our benefits statement. This work will be expanded as the NRL project continues.  

Demonstrator

The NRL Demonstrator Application is intended for both technical and non-technical audiences to quickly understand the basic functionality of the NRL.

The demonstrator shows how the NRL could look to a user of a consumer system, using the layout of the Summary Care Record application (SCRa) as an example.

Contact details

For further information please contact the NRL and  NEMS live team.

Further information

internal National Record Locator for developers

The developer area shows you the code behind the Demonstrator (interactive guide) which will provide the details around the code construct of the demonstrator, code examples of how to connect to the NRL, and access to a reference implementation (stub) of the NRL API to allow quick and easy testing.   

internal National Record Locator for mental health trusts

A mental health professional may be responsible for creating a patient’s care plan.  If this care plan can be used and seen by ambulance service staff it may help them if they are treating a patient in crisis.

internal National Record Locator for ambulance services

National Record Locator (NRL) will be able to alert you to patients under your care who have certain records, for example a crisis care plan, created for them. This is done by your local health care system searching the NRL for pointers (or bookmarks) to patient records indicating that a specific type of record now exists for the patient. 

internal National Record Locator benefits

The National Record Locator (NRL) will bring many benefits to patients, organisations within the NHS and social care landscape as well as NHS frontline staff such as paramedics. This can be broken down in to three main groups.

Last edited: 16 February 2022 4:12 pm