Electronic patient record rollouts hit contract friction in three regions

NHS electronic patient record programmes are facing growing commercial and legal friction, with major procurements delayed or disrupted after technology suppliers challenged decisions made by trusts.

The disputes highlight the increasingly complex relationship between NHS organisations and EPR suppliers as trusts attempt to complete the final phase of the national drive to put modern electronic records in place.

In several high-value procurements, suppliers have taken legal action against trusts over procurement decisions, forcing organisations to defend, reconsider or delay their plans.

£65m procurement abandoned after legal challenge

One of the clearest examples emerged at Mersey and West Lancashire Teaching Hospitals NHS Trust.

The trust had selected a supplier for a new EPR contract worth around £65m. However, incumbent supplier System C launched a legal challenge against the procurement, arguing that the trust had breached procurement rules.

The challenge went to the High Court.

Rather than continue with the procurement while facing potentially lengthy and expensive litigation, the trust withdrew its contract award in November 2024. The decision effectively forced the organisation to reconsider how it would proceed with its EPR programme.

The consequences extended beyond the original procurement.

By October 2025, HSJ reported that two trusts in the North West were exploring a joint EPR procurement after the abandoned process.

The case demonstrates how a procurement challenge can affect more than the immediate contract award. Once an EPR procurement is disrupted, trusts may have to revisit their procurement strategy, timetable and relationship with neighbouring organisations.

Liverpool procurement also challenged

Liverpool University Hospitals NHS Foundation Trust experienced a similar problem during its attempt to procure an EPR.

The trust's procurement was expected to be worth around £70m and involved three shortlisted suppliers.

Canadian supplier Altera challenged the process after being excluded before the evaluation stage. The company took the case to the High Court, arguing that its exclusion from the procurement was unlawful.

The legal challenge threatened to delay a programme that was already under pressure.

Liverpool University Hospitals was one of the trusts that had been expected to have an EPR in place by March 2026 under the national Frontline Digitisation Programme. The procurement dispute therefore created an additional risk for a trust already working against a national timetable.

The challenge was eventually dropped.

In April 2026, Liverpool University Hospitals announced that it had awarded a 10-year contract worth £53m to Nervecentre for a new electronic patient record. The contract is intended to provide a single integrated record across the trust's hospitals.

The sequence shows how a procurement can spend months in uncertainty before the trust is finally able to move to contract award.

A third £70m procurement also faced challenge

The Liverpool case was not isolated.

In March 2026, HSJ reported that a software company had dropped its legal challenge against another major trust's £70m electronic patient record purchase.

The challenge followed legal action against the procurement, with the supplier ultimately deciding not to continue the case.

Publicly available information on that case is more limited than the Liverpool and Mersey and West Lancashire disputes, but its existence adds to evidence that major EPR procurements are increasingly exposed to legal and commercial challenge.

The scale of the contracts makes the issue particularly significant.

A modern EPR can represent a decade-long relationship between an NHS organisation and a technology supplier, involving implementation, hosting, maintenance, upgrades, integrations and support.

A dispute at the procurement stage can therefore have consequences extending far beyond the initial award.

Integration creates another layer of commercial complexity

The procurement disputes are taking place against a wider problem.

Getting the core EPR installed is only one part of a trust's digital transformation.

The new system also needs to connect with pathology, radiology, pharmacy, theatres, community systems, patient-facing applications and other specialist platforms.

The National Audit Office has previously warned that achieving interoperability across NHS systems is extremely challenging. It noted that increasing the number of suppliers can itself make interoperability more difficult because more system-to-system integrations are required.

That problem has not disappeared as EPR coverage has expanded.

The Health Foundation reported in April 2025 that England was approaching universal EPR coverage, but warned that many trusts were still struggling to realise the full benefits of their systems.

The distinction between buying an EPR and creating a functioning digital environment around it is becoming increasingly important.

Contract management does not end at go-live

NHS Providers has warned trusts that supplier relationships need to be managed carefully throughout the life of an EPR.

Its guidance on EPR supplier relationships stresses the importance of transparency and clarity around how trusts and suppliers will work together, warning that poor management can create the risk of escalating costs.

This matters because EPR contracts are not conventional software purchases.

They typically involve major implementation programmes followed by years of support and development.

Requirements can also change during implementation as clinicians identify new workflows, trusts reorganise services or additional systems need to be connected.

That creates potential areas of disagreement over what the original contract included and what constitutes additional work.

For trusts, the commercial challenge is therefore not simply finding an EPR supplier.

It is establishing a contract that can cope with a complex implementation and a long period of technological change.

National timetable adds pressure

The disputes have also occurred as NHS organisations have been working towards the final stages of the national Frontline Digitisation programme.

NHS England's programme has supported trusts to implement their first EPR or replace, extend or optimise existing systems.

By February 2024, 189 trusts already had an EPR system in place, according to the Health Foundation, leaving the NHS close to its target of universal coverage.

But the final organisations have faced some of the most complicated procurements.

Liverpool University Hospitals was among the major trusts still without a modern EPR and had already experienced difficulties getting its procurement over the line.

The eventual £53m Nervecentre contract followed months of legal uncertainty.

Legal challenges can become part of the delivery risk

For NHS organisations, procurement law is designed to protect fair competition and ensure public money is awarded through a transparent process.

For suppliers, challenging a procurement decision can be an important way of protecting their commercial interests where they believe a process has been conducted improperly.

But the practical consequence can be significant.

A legal challenge can trigger delays, additional legal costs, management time and uncertainty for clinical teams waiting for a new system.

In the Mersey and West Lancashire case, the original £65m award was abandoned entirely.

In Liverpool, the procurement ultimately survived the challenge, but the final contract was not announced until April 2026.

That makes procurement risk an increasingly important consideration for trusts planning large-scale digital transformation.

The next challenge is making the contracts work

The NHS is now moving into a phase where the question is no longer simply whether every trust has an EPR.

It is whether those systems can be implemented effectively, integrated with surrounding technology and maintained at a sustainable cost.

The recent procurement disputes demonstrate that the commercial side of EPR delivery can be just as important as the technology itself.

For trusts, getting the specification right, maintaining a robust procurement process and establishing clear contractual responsibilities will be critical.

For suppliers, the challenge is equally significant.

EPR programmes are increasingly large, long-term partnerships with NHS organisations rather than straightforward software purchases.

As more trusts complete their procurements, the disputes seen in the North West provide a warning of what can happen when those relationships become contested before a system has even gone live.

The NHS may be nearing the end of its national EPR rollout.

But for many organisations, the difficult commercial negotiations may only be beginning.