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Registration State Model

This page formalises the patient and registration dimensions that drive the Guidance Decision Model. Use it before making any claim about NHS App continuation and/or adoption.

This is a composable classifier, not a single patient-state list. Classify the person across each dimension, then apply the feature route in the Guidance Decision Model.

NHS England registration during MOD registration

The project owner confirms that all Ministry of Defence (MOD)-registered patients are registered first with NHS England and retain that registration throughout their MOD registration. Secondary registration in Scotland or Wales, where applicable, does not replace it. Secondary registration in Northern Ireland is intended but is not yet in place. This explains the UK-wide cohort for the proposed NHS App enablement: residence in another UK nation does not end the underlying NHS England registration while the patient remains MOD-registered.

The NHS App is an NHS England service. Published general eligibility covers GP registration in England or the Isle of Man, and currently excludes people registered with Defence Medical Services (DMS). The MOD registration baseline therefore establishes the proposed cohort, while the access exclusion and each age, proxy and service condition still need to be resolved or tested. NHS App eligibility rechecked on 18 September 2026.

Record the NHS England registration, any secondary national registration, and the current GP/practice representation separately. Do not infer two simultaneous ordinary GP registrations or identical feature availability. Reassess the registration and access route when MOD registration ends; the MOD baseline does not establish continued access after that transition.

Dimension Model

Dimension Values to capture Key tests Why it matters
Registration context Ordinary NHS GP, DPHC Firmbase, DPHC Overseas [DPHC(O)] / Defence Global Practice, unknown Personal Demographics Service (PDS) registered GP state, Primary Care Registration Management (PCRM) registration state, Organisation Data Service (ODS) organisation identity, GP clinical system, practice capability enablement Determines whether NHS App dependencies see an ordinary registered GP context or an unresolved MOD context.
Transition state Steady state, transition into DPHC Firmbase, transition out of Defence Primary Healthcare (DPHC), overseas posting, return from DPHC(O), unknown PCRM completion, before/after PDS state, GP2GP or other medical-record transfer, feature continuity, registration restoration Prevents transition evidence from being treated as steady-state availability.
Age band Under 13, 13 to 15, 16+, adult, unknown Own-account boundary, GP-surgery setup, understanding checks, consent, safeguarding, age milestone review Determines own access, proxy access, linked-profile review, and under-13 exclusions.
Access mode Self, parent / guardian proxy, adult proxy, linked profile, invalid informal account sharing, unknown Account holder, cared-for person, GP-practice proxy setup, feature permissions Separates the user's own NHS App access from managed access for another person.
Family / proxy relationship Same GP practice, split ordinary NHS GP / DPHC practice, dependant with ordinary NHS GP registration, dependant with DPHC registration, carer/proxy relationship, not applicable, unknown Same-practice rule, dependant's own registration, proxy relationship, linked-profile setup Prevents dependant or armed-forces family from being used as a standalone eligibility category.

The patient-facing practice label is an observed output, not a sixth classification dimension. Project-owner direction reports the civilianised Medical Centre name and address as the DPHC registered-practice display. Confirm that output by cohort and transition state, but continue to classify the underlying PDS, ODS, supplier and practice-capability state separately.

Common Scenario Combinations

Scenario Registration context Transition state Age band Access mode Family / proxy relationship Current use
Ordinary NHS GP baseline Ordinary NHS GP Steady state Age-specific Self or proxy Same GP practice where proxy applies Public NHS App baseline.
DPHC Firmbase adult DPHC Firmbase Steady state Adult Self, adult proxy, or linked profile Not applicable or same/split practice depending on proxy route Main domestic UK MOD primary-care route.
DPHC(O) patient DPHC(O) / Defence Global Practice Steady state or overseas posting Age-specific Self or proxy Depends on family registration model DGP guide supports registered UK General Practice and record-management context, but NHS App / PDS / ODS / feature state is unresolved.
Under-13 DMS / DPHC child DPHC Firmbase or DPHC(O) Steady state or transition Under 13 Parent / guardian proxy; own access excluded under public baseline Same/split practice unresolved Direct annual-report NHS App appointment-booking signal exists, but root cause is unresolved.
13-to-15 DPHC young person DPHC Firmbase or DPHC(O) Steady state or transition 13 to 15 Self where GP surgery sets up access; proxy where permitted Same/split practice unresolved Ordinary NHS rules require GP-surgery setup; DPHC equivalence is unproven.
Dependant with ordinary NHS GP registration Ordinary NHS GP Steady state or family transition Age-specific Self or proxy Dependant's own registration controls the baseline Dependant status is not a standalone NHS App eligibility category.
Split ordinary NHS GP / DPHC family Mixed by person Steady state or transition Age-specific Proxy or linked profile Split ordinary NHS GP / DPHC practice Likely decisive for family and carer access.
Transition into DPHC Ordinary NHS GP moving to DPHC Firmbase or DPHC(O) Transition into DPHC Age-specific Self or proxy May create split-family state Tests continuation of use after registration change.
Transition out of DPHC DPHC Firmbase or DPHC(O) moving to ordinary NHS GP Transition out of DPHC Age-specific Self or proxy May restore ordinary same-practice assumptions Tests post-service or posting transition behaviour.

Registration Transition Map

This diagram shows only registration movement. Age band, access mode, and family / proxy relationship are overlays that must be captured separately.

stateDiagram-v2
  state "Ordinary NHS GP" as OrdinaryNHS
  state "Joining DPHC" as IntoDPHC
  state "DPHC Firmbase" as Firmbase
  state "DPHC(O) / DGP" as Overseas
  state "Leaving DPHC" as OutOfDPHC
  state "Return from DPHC(O)" as ReturnFromOverseas
  state "Overseas posting" as OverseasPosting

  [*] --> OrdinaryNHS
  OrdinaryNHS --> IntoDPHC: joins
  IntoDPHC --> Firmbase: Firmbase
  IntoDPHC --> Overseas: Overseas
  Firmbase --> OutOfDPHC: leaves
  Overseas --> ReturnFromOverseas: returns
  ReturnFromOverseas --> Firmbase: Firmbase
  ReturnFromOverseas --> OrdinaryNHS: NHS GP restored
  OutOfDPHC --> OrdinaryNHS: NHS GP restored
  Firmbase --> OverseasPosting: posting
  OverseasPosting --> Overseas: DPHC(O) / DGP

Decision Inputs

Input Values to capture Feeds
Registration context Ordinary NHS GP, DPHC Firmbase, DPHC(O), Defence Global Practice, unknown Guidance decision status, PDS / PCRM / ODS tests
Transition state Steady state, transition into DPHC, transition out of DPHC, overseas posting, return from DPHC(O), unknown PCRM completion, GP2GP / record-transfer, continuation-of-use, and restoration tests
Age band Under 13, 13 to 15, 16+, adult Own access, proxy access, safeguarding and consent checks
Access mode Own access, parent / guardian proxy, carer, formal adult proxy, linked-profile user, invalid informal sharing NHS account, linked-profile, proxy, age-band analysis
Family / proxy relationship Same GP practice, split ordinary NHS GP / DPHC practice, dependant ordinary NHS GP registration, dependant DPHC registration, not applicable, unknown Same-practice, dependant, proxy, and linked-profile analysis
Feature route NHS account, GP-linked feature, Secondary healthcare (SHC) route, Defence Medical Information Capability Programme (DMICP) Primary healthcare (PHC) visibility, DMICP PHC management, clinical correspondence, test results, CORTISONE patient data Architecture and evidence gates
Source system GP clinical system, DMICP, CORTISONE, e-RS, Patient Engagement Portal (PEP), trust booking system, NHS Notify Interface route and assurance checks
Organisation identity ODS code, GP practice status, DPHC organisation status, Defence Global Practice state PDS / ODS / Spine Directory Service (SDS) routing and GP Connect assumptions

PCRM Boundary

Primary Care Registration Management (PCRM) manages the formal change to the registered GP held in PDS. Current official NHS England Digital material explicitly includes DMS in PCRM's stated geographical scope and says the service is used by GP systems rather than by patients directly.

This narrows the infrastructure question: DMS is not outside the stated national registration service. It does not close the patient-state question. For every DPHC transition, capture the originating and destination practice, PCRM registration outcome, before/after PDS registered-GP state, GP2GP or other record-transfer outcome, exception handling, and NHS App feature behaviour. Do not infer a named DPHC practice configuration or mobile NHS App entitlement from PCRM service coverage.

ODS Boundary

The current ODS review narrows, but does not close, the DPHC Firmbase registration question. The ORD API identifies active MOD / DMS records such as DDG Defence Medical Services, XDM Ministry of Defence, S22029 Ministry of Defence as a Scottish GP Practice, and DMS-operated sites. The GP-practice reference data explains that commonly named GP Practice ODS codes are Prescribing Cost Centre codes and that actual GP Practice status is a subset identified by role. ODS default-code evidence also records a Ministry of Defence Healthcare commissioner code and default GP-practice codes.

Do not use these organisation identifiers as a substitute for the patient registration state. For NHS App GP-linked decisions, capture PDS registered-GP state, practice-level ODS code and role, supplier / GP clinical system, GP Connect PFS or Interface Mechanism 1 (IM1) enablement, local practice capability, proxy setup, and feature test evidence.

DPHC(O) / Defence Global Practice Boundary

The current Defence Global Practice guide supports a DPHC(O) registration-state boundary: DGP is presented as a registered UK General Practice and DPHC(O) practice for eligible overseas patients who are not served by a fixed DPHC medical centre. It also says DGP manages UK primary-healthcare records after registration and that patients are de-registered from their previous UK General Practice when registered with DGP.

Use that evidence to classify the registration context and transition state. Do not use it as proof of NHS App access or GP-linked feature availability. For DPHC(O), still capture PDS registered-GP state, practice-level ODS identity, supplier / GP clinical system, GP Connect PFS or IM1 enablement, linked-profile / proxy setup, and NHS App feature tests. Also keep host-nation care delivery, UK NHS referral, and DGP record-management roles separate.

Rules

  • Do not use DPHC patient as a single state.
  • Do not use dependant as a substitute for the dependant's own age, account, registration, and proxy state.
  • Do not use minor as a substitute for the child's registration context, access mode, and proxy relationship.
  • Do not treat transition states as equivalent to steady registration states.
  • Do not put age-band or proxy changes into the registration transition map; record them as overlays.
  • Keep DPHC Firmbase and DPHC(O) separate until direct evidence proves the same NHS App behaviour.
  • Feed every dimension-based claim back into Guidance Decision Model.