When an organisation is failing to properly address challenges, you’ll likely hear it accused of “papering over the cracks”. When it comes to the NHS, you can take this literally.
In recent years, productivity has become a key metric by which NHS trusts are measured. Technology plays an important role in that productivity, touching everything from life-saving care to back-office admin. With the pressure that NHS staff are under, anything that can make their work easier is crucial.
The digitisation of physical processes is, therefore, a high priority. Sir Jim Mackay, the NHS’ chief executive, is unequivocal: “The NHS can, must and will move forward to match other sectors in offering digital services that make services as personalised, convenient, and flexible as possible for both staff and patients.”
Despite this, paper-led processes continue to undermine trusts up and down the country. Paper records can be lost, damaged, misunderstood, incorrectly filed or simply not recognised. Many Trusts do not have the resource or technology to comprehensively digitise them, despite almost all (95%+) of them now having an Electronic Patient Record (EPR). As a result, productivity stalls.
That’s not all. Trusts are also spending almost a quarter of a billion pounds annually on physical records. Productivity isn’t just a financial metric, either, with one in seven people failing to get the hospital care they need because their GP referral has been lost, rejected, or delayed.
This is unacceptable. At a time when the public expects healthcare services to operate efficiently and treat them as individuals, the financial burden and human impact of paper-based work are increasingly difficult to justify.
The role of the EPR
To understand how this problem perpetuates, we need to take a closer look at the EPR, and the Electronic Document Management System (EDMS) platform that feeds it.
The EPR is a centralised digital record of a patient’s medical history. In a perfect world, it records everything — everything from a simple prescription to complex surgery — to allow practitioners to make decisions about patient care with proper context and understanding.
The EDMS is a platform that allows physical documents to be fed into the EPR, as well as a means of storing and organising them. It can scan and digitise any form that a trust might use, allowing it to be incorporated into the EPR and for the physical copy then to be disposed of.
If this can be implemented, the benefits for patients are immense.
On the patient side, it prevents those needing care from repeating themselves to different staff members at each point in their care, which helps them feel recognised and cared for. It also allows patients to more readily access their own information.
For the trust, a comprehensive EPR reduces the complexity of handing over between practitioners, which brings down the chance for mistakes or confusion. It also reduces the time that processes and appointments take, making trusts more productive be default.
The difficulty here is consistent, robust data entry. Data should be captured at the point of care before being immediately uploaded into the EPR or EDMS. This gap is the most likely point at which important information can be lost or mishandled.
Addressing the paper problem
There are wider obstacles facing the entire NHS here, as well as problems unique to each individual trust.
Starting with the macro, the financial pressures facing the NHS are well known. Trusts and Integrated Care Systems are forecasting a combined deficit of around £6.6bn, while productivity challenges are estimated to cost the UK £20bn per year. In response, the government has prioritised value for money, with the NHS targeting annual productivity gains of 2%.
This places serious pressure on trusts to maximise value for money, and shapes how trusts approach EPRs. There is no single model. Systems vary widely between providers, as does the mix of legacy technology that trusts are already saddled with. Replacing or maintaining these systems is costly, with budgets already being pulled in competing directions.
The result is a fragmented landscape. Systems do not always integrate, data capture at the bedside is not guaranteed, and information that is recorded can be hard to access, duplicated or even lost. The paper problem perpetuates.
This inconsistency also affects staff. Clinicians moving between trusts cannot be expected to master different systems quickly, with time and budget constraints limiting effective training.
All of these competing pressures see staff fall back on paper — recording, sharing and explaining information manually. The EPR isn’t allowed to reach its full potential and is, instead, at risk of becoming just another touchpoint in a chaotic organisation.
From paper to progress
So, the question becomes: without a standardised, nationwide approach, how do trusts move forward in a productive way?
The answer is that perfection isn’t the aim here. It’s momentum.
The first step — still — is to establish the EPR within trusts. Given that 95% are already there, and with £13m invested in a ‘‘tiger team” to help those that are lagging behind the curve, this should happen in 2026.
With that foundation in place, attention turns to digitising existing paper records. Large physical archives must be scanned, structured and integrated into document management systems, with careful checks for duplication, gaps or inconsistencies. External specialists can play a key role in accelerating this process, given the constraints on the NHS itself.
As the backlog reduces, the value of the EPR becomes clearer. More complete, accessible data leads to steady gains in efficiency and reliability, improving day-to-day workflows for clinicians and outcomes for patients. The physical and mental benefits can be directed back into digitisation, which should accelerate as the backlog diminishes.
From there, trusts can focus on interoperability. Staff need practical training in EPR use, data quality, and document handling, while patients should experience the benefits through clearer communication and digital tools like the NHS App.
The way forward
Ultimately, for all of the structural reform and incredible investment that has gone into the NHS over the years, meaningful digital transformation still depends on getting the fundamentals right. That starts with a fully operational EPR, supported by a clear, consistent process for managing legacy records.
Paper-based processes are inefficient, costly, difficult to scale and lack the safeguards needed to support high-quality care. By digitising vast archives of patient information into accessible, standardised platforms like the EPR, trusts can ensure that clinicians have the insight they need at their fingertips.
Done well, this is more than a technical upgrade. It is a key foundation for safer, more informed and more effective care across the NHS.
