Four questions for the single patient record

New powers for ministers to establish a ‘single patient record’ (SPR) in England was one of the headline-grabbing measures in the government’s new Health Bill, published earlier this month. The SPR was announced in the government’s 10-Year Health Plan last year. The aim is to bring together people’s NHS and social care data, like test results and letters, in one place to improve care. 

The ambition is good. Virtually every major NHS digital strategy since 2002 has called for patient data to flow more freely across the system – for instance, between GPs and hospitals – to make care faster and safer. The SPR is the latest and most legislatively ambitious attempt to deliver this, acknowledging that voluntary and standards-based approaches have repeatedly fallen short.

But making it happen is easier said than done. The Health Bill set out little detail about how the SPR will look and work in practice. And the experience of a long line of failed NHS IT programmes points to a mix of questions government will need to answer to build trust in the proposals. 

1. How will the SPR actually work?

The SPR is not set to replace existing records, but beyond this it is unclear what it will look like in practice. NHS England has previously described the vision as a set of ‘Lego bricks’ connecting existing electronic patient records (EPRs), shared care records and other platforms – with the intention to federate (link data across existing systems) rather than extract it into a single central database.

But what technical approaches will it use and how will it tackle existing fragmentation of electronic patient records, which remain inconsistent across trusts and systems? Our recent polling found that 1 in 3 NHS staff reported differences between EPR systems actively make their work harder.

The federated approach and phased rollout – starting with maternity and frailty – do suggest lessons have been learnt from the National Programme for IT. But questions remain: what standards will data need to meet, who will enforce them and by when? The bill creates legal powers to mandate standards but doesn't specify what these will be – a gap where previous programmes have foundered.

2. How can patient and clinician trust be earned? 

The bill makes several significant changes to current data sharing and confidentiality arrangements: overriding the duty of patient confidentiality for data flowing through the SPR and removing the existing rulebook governing how organisations should handle confidential patient information. Both will be replaced by new frameworks, but the detail – including patient controls, opt-outs and any right to restrict access to your record – is deferred to secondary legislation. The government has indicated patients will be able to request amendments to their record through the NHS App from 2028, but given the stated aim of giving patients more control and transparency over their data, the absence of this on the face of the bill is a significant omission. 

The comparison with care.data (a programme to extract data from GP surgeries into a central database for research and planning), which failed largely due to poor public communication, an unclear opt-out mechanism and weak governance processes, is hard to avoid. Although the SPR is framed as a direct care tool, questions about how access, oversight and public choice will be managed remain unanswered. For example, questions around GP liability for data they may no longer control will need to be addressed carefully and transparently.

Health Foundation polling shows public trust in the NHS with their health data is high but tiered: 68% trust GP practices with their data, falling to 61% for national NHS organisations. For national government, trust falls to just 33%. 

The bill transfers digital and data functions from NHS England directly to the health secretary, who is expected to become data controller for the SPR (the person or body that determines the purposes and means of the processing of personal data). This moves responsibility in the direction the public trusts least. Separately, the equality impact assessment acknowledges that several of the groups likely to benefit most from the SPR, including older people and disabled people, are among the most likely to be digitally excluded. Involving and engaging the public early to ensure their concerns have been heard and addressed will be critical. 

3. What will implementation look like?

The challenge of implementing complex IT systems has often been underestimated, as has the scale of investment required. Change management matters as much as the technology itself and NHS England’s reported commitment to spend half the SPR investment on this could represent a genuine break from past practice. But this will need to include protected time and training for NHS staff, while implementation will need to be sequenced according to digital maturity, with organisations that are genuinely ready going first to generate learning for others.

The milestones the government has set out – such as patients viewing their record through the NHS App from 2028 – will only be meaningful if the standards, governance and change management infrastructure are in place first. A record that goes live on time but aggregates poorly standardised data, or that clinicians don't trust enough to use, will not deliver the hoped-for transformation.

4. What kind of transformation will the SPR enable?

If EPRs have taught us anything, it's that ‘going live’ is by no means job done. Systems need to be continually improved. Getting the benefits requires people to fundamentally reimagine how they work, not simply digitise what they already do on paper. 

More convenient care may well follow directly from clinicians and patients having access to a complete record – but the bigger gains will come from thinking more ambitiously about what the data make possible. Can patients now be triaged more accurately before they arrive? Can appointments be shorter or replaced entirely in some cases? Does a clinician reviewing a comprehensive longitudinal record before a consultation change the nature of that consultation? 

These questions will require deliberate efforts to redesign care and meaningful consultation with clinicians and patients on what they actually want the SPR to look like in the first place. 

All four questions remain open and are likely to be at the heart of parliamentary debate on the bill. How the government answers them will determine whether the public and staff feel they can trust the SPR, and whether it will deliver what over two decades of NHS digital strategy has promised.