Case Study - Building the front door for healthcare APIs in the UK

Overview

In 2020, NHS Digital asked developers how easy it was to integrate with its APIs. The answer came back: two out of five. The feedback behind the score was blunt. Getting set up was hard, the process was complicated, and the learning curve was steep enough that suppliers were giving up before they had begun. Some of the APIs assumed you were already inside the NHS network before you could call them at all.

The answer was the API platform: a single front door for health and care APIs across England. Find an API, read its documentation in plain English, try it in a sandbox, onboard digitally, go live. Ordinary expectations anywhere else; a quiet revolution in healthcare software. And there was no quiet period to build it in. The platform came up while the health service was carrying the heaviest load in its history, with some of its earliest traffic serving the Covid-19 response.

Our part of it

Ologist engineers joined the consortium behind the platform, led by Aire Logic, and stayed from 2020 to 2023. Within a programme that built collectively, three things were ours to look after.

The first was the cloud infrastructure underneath it all: an estate spanning Amazon Web Services and Google Cloud Platform, with Apigee at the front. The second was identity. In healthcare, who is asking matters as much as what they are asking for, so we did much of the work connecting the platform to the Care Identity Service, which lets clinicians authenticate with smartcards or modern alternatives, and to NHS login, which does the same for patients and the public.

The third was the developer experience, and it is the one we still talk about. We made the OpenAPI Specification the source of truth, with documentation and deployment generated from the spec rather than maintained beside it. Documentation that is generated cannot drift. Documentation that is maintained usually does.

The idea that outlasted us

That approach outlived the engagement. After Ologist rolled off in 2023, NHS England built it out as Proxygen, working from a design we left behind. Today it is the standard route for publishing an API on the platform: one specification producing the proxy, the documentation and the onboarding, for every producer that walks through the door.

Five years on

The platform moved from prototype in late 2020 to a live national service, handling 1.6 billion transactions before it had even left beta. It has kept moving since. The nine APIs in production at beta exit are nearer fifty today, behind a catalogue of over 180 APIs and integrations, more than 100 of them in production. The platform runs at platinum service level, and much of its code is written in the open.

NHS Digital itself merged into NHS England in 2023. The front door stayed open.

That is what we mean by Digital Permaculture: systems that keep improving after the people who built them have moved on. We are proud of the infrastructure. We are prouder of what got built on top of it after we left.

What we did