When Lord Darzi published his independent investigation into the NHS in September 2024, the diagnosis was stark. Public satisfaction was at its lowest recorded level. Waiting lists for elective treatment stood at 7.7 million at their peak. The 18-week treatment standard had not been met since 2016. And despite billions invested across other public sectors, the NHS remained, in Darzi's own words, "in the foothills of digital transformation."
That phrase - written in a 163-page report commissioned by Secretary of State Wes Streeting within weeks of Labour taking office - has since become the lens through which NHS digital investment is being scrutinised. The question now is not whether the NHS needs transforming, but how that transformation is delivered at pace, and at scale.
What Darzi Actually Said About Digital Infrastructure
The report's findings on technology were pointed. Darzi identified a £37 billion capital spending shortfall over the preceding 15 years as a root cause of the NHS's structural problems. He was explicit that the "only sustainable solution" to congestion in acute hospitals was to build up capacity, infrastructure, and technology in community settings - general practice, community services, and mental health.
This is not a marginal recommendation. It is the central structural argument of the report. Darzi identified four interlocking drivers of poor NHS performance: constrained funding, the pandemic's legacy, a lack of staff engagement and patient voice, and - critically - management structures and information systems that fail to connect different parts of the system.
The implication for digital health providers is significant. The bottleneck is not in hospitals alone. It is in the interfaces between primary, community, and secondary care - the handoffs, the fragmented records, the systems that do not talk to each other.
From Report to Plan: The 2025 Ten Year Health Plan
The Darzi report was explicitly framed as the foundation for the government's forthcoming NHS strategy. That strategy - Fit for the Future: The NHS Ten Year Health Plan - was published in July 2025, and it operationalises Darzi's ambitions directly.
The plan sets out three strategic shifts:
- From hospital to community - moving care closer to home, expanding primary care capacity, and reducing dependence on acute settings
- From analogue to digital - with the NHS App becoming the primary patient interface, underpinned by a new Single Patient Record (SPR) and federated data platforms
- From treatment to prevention - using data and technology to intervene earlier in the care pathway
The digital shift is not presented as optional. The plan states that it aims for the NHS to become "the most AI-enabled healthcare system in the world" within a decade. Underpinning this is the Data (Use and Access) Act 2025, which introduces new statutory frameworks for patient data and strengthens interoperability standards across NHS systems.
For providers operating in primary care, this is the most consequential policy environment in a generation.
The Infrastructure Gap in Numbers
The scale of what needs to change is visible in the data:
- The NHS elective waiting list still stood at approximately 7.1 million patients as of early 2026, down from its peak but still more than double pre-COVID levels. The median wait for treatment is 11.3 weeks, against a pre-pandemic median of 6.9 weeks.
- The number of fully qualified GPs in England fell by 1.5% between March 2017 and March 2026 - from 29,331 to 28,906 - even as demand has risen sharply. General practice is now recording over 31 million appointments per month.
- A five-year, £774 million Microsoft partnership (announced 2023) is equipping 1.5 million NHS staff with cloud-based tools. Leeds Teaching Hospitals NHS Trust completed its migration of its entire electronic patient record to Microsoft Azure in 2024, using the platform to enable integrated care across its region.
- NHS England launched market engagement in May 2025 on a new £480 million digital primary care framework, replacing the expired GP IT Futures Framework, running from April 2026 to March 2029.
These figures make the case that investment is moving - but that legacy systems remain the single greatest blocker to integration.
Why Integration Is the Hardest Problem
Darzi's report was candid about why productivity problems persist: many of them are caused not by individual failing services, but by "interaction between different parts of the system." Islands of data, disconnected clinical records, and incompatible IT create friction at every handoff - between GP and specialist, between acute trust and community team, between clinician and patient.
This is not a new observation. But the policy consensus is now that cloud-native architecture - systems designed to integrate from the outset, rather than bolted together after the fact - is the only scalable answer.
The challenge for the NHS is that legacy primary care systems dominate the market. The two dominant platforms - EMIS and TPP - together hold the vast majority of GP practice contracts. Both were designed in a different era of IT. Both present significant interoperability challenges. And both are increasingly ill-suited to a policy environment demanding seamless data flow across care settings.
OX.DH's Approach: Cloud-Native, Incremental, Integrated
OX.DH's solutions are built on Microsoft Azure - the same infrastructure the NHS has committed to as part of its long-term digital strategy. This is not incidental. It means health and care providers can connect to OX.DH platforms without building new infrastructure from scratch, and without requiring a full system overhaul before benefits are realised.
The approach is incremental by design. Providers can begin their digital journey by pathway, by clinic, or by care setting a critical feature in an NHS where large-scale IT programmes have a well-documented history of overrunning, underdelivering, or both.
Our current deployments demonstrate what this looks like in practice:
Barnsley Hospital NHS Foundation Trust - OX.DH's virtual consultations platform supports over 300,000 outpatient appointments per year, enabling video and telephone consultations that reduce unnecessary in-person attendances and improve access for patients across the region.
The Male Fertility Clinic - OX.DH has digitised the assisted reproduction pathway end-to-end: online patient registration, electronic pre-health questionnaires, test results, and reporting. Previously manual administrative processes have been automated, reducing burden on clinical staff and improving patient experience.
NHS Tech Innovation Framework (OX.gp) - As an early adopter on the NHS Tech Innovation Framework, OX.DH's primary care platform is designed as an alternative to legacy GP systems. Built for the cloud, it is faster to deploy, easier to scale, and designed to interoperate with the wider NHS data ecosystem - including the emerging Single Patient Record infrastructure.
The Road Ahead
The policy direction is settled. The Darzi report, the Ten Year Plan, the Data (Use and Access) Act, and the new digital primary care procurement framework all point in the same direction: integrated, cloud-native infrastructure, with care closer to home and data flowing seamlessly across the patient journey.
The question for NHS leaders and integrated care boards is not whether to move, but how quickly and with which partners. The next procurement framework for digital primary care opens in April 2026. The window to shape how that investment lands is now.
If you are exploring how cloud-native platforms can support your integration ambitions - whether in primary care, outpatient services, or assisted reproduction - we would welcome the conversation.
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About the Author
John Kosobucki is CEO of OX.DH (Oxford Digital Health), a cloud-native digital health company focused on transforming NHS primary care. John leads OX.DH's strategic partnerships, NHS engagement, and the development of OX.gp — the company's next-generation electronic patient record system for GP practices. Learn more about OX.DH's founders.