The Single Patient Record – the cornerstone of the NHS Modernisation Bill?

Responding to the King's Speech and the government's announced intention to pass the NHS Modernisation Bill in this parliamentary session, Joanna Lloyd, Head of our NHS Health and Care team, looks at the proposed Single Patient Record - described by commentators as a potential gamechanger. 

Under the NHS 10-year health plan, a single patient record was proposed to bring together information across care settings including primary care, hospitals and mental health services in England by 2028. This would give patients, and different health and care professionals, access to a single, shared record linking primary and secondary care information and social care data.

Immediately concerns were raised about the data controllership role, with Dr Mark Coley, BMA’s GP Committee for England IT lead, advocating that this should rest with GPs: “This data controllership role would allow us to act for the best interests of our patients, to advocate for them in any data sharing processes, to maintain confidentiality and, ultimately, to ensure we have the trust of our patients”. Sam Smith policy lead at medConfidential, went further, warning that the data controller role moving to DHSC risks the confidential relationship between doctor and patient being broken.

Another concern relates to legal liability for errors in data entered by other providers. If a hospital records information incorrectly and that error causes harm, the question of who bears legal responsibility will be significant. Clear legal protections will be needed to avoid a level of caution around data sharing which would undermine the SPR’s stated purpose.
The Nuffield Trust highlight concerns that a project which is ‘laudable and long overdue’ will fall apart if public trust is lost and unquestionably robust safeguards will be needed to protect patient data. Bernadette Wightman, Iron Mountain chief executive has commented that the SPR will only deliver on its promise ‘if it's built on foundations that can scale, remain secure, and support the innovations ahead.'

Notwithstanding this debate, Sarah Woolnough of the King’s Fund sees the proposal as ‘the greatest opportunity’ of the Bill – finally joining up health and care records, something promised by successive governments without getting it over the line. Her focus is on having the right safeguards in place and she highlights the views of patients and staff who can’t understand why it doesn’t already exist. Unquestionably its successful delivery in giving patients, and different health and care professionals, access to a single, shared record linking primary and secondary care information and social care data would be a hugely positive step for patient safety. 

Amandeep Doll, director for England with the Royal College of Pharmacy, has highlighted the benefits of the SPR for pharmacists given their increasing role on the delivery of clinical services.
“Too often, pharmacists must make decisions without full insight of a patient’s medical history, recent hospital admissions or changes to treatment, which creates avoidable risks. Having read-write access to a single patient record is critical to safer, better-informed decisions which will improve care for patients.”  

When things go wrong and come subsequently to be analysed under the lens of a clinical negligence claim or in the Coroner’s court, it is hard to bring to mind a patient story which has not involved an element of failure in terms of joined-up communication. Whether this is a missing discharge summary with critical information, or limitations in access to electronic systems such as BadgerNet so key elements of a patient’s history are overlooked, the patient stories have in common the tragedy of avoidable harm. 

For now, it is anticipated that parts of the SPR will go live as early as 2027 so the focus needs to be on addressing accountability concerns and putting in place safeguards and governance arrangements such that the many obvious benefits of the SPR can be realised.

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