The Department of Health and Social Care has published an equality impact assessment examining how proposed legislation for a Single Patient Record will affect patients across England, with findings that point to significant variation in who will benefit and when.
The Single Patient Record is intended to bring together a patient's full medical history into one accessible place. By 2028, patients are expected to be able to view their history, test results, appointments, medications and vaccinations through the NHS App. Clinicians across different care settings would also have access, removing the current situation where a GP, a hospital consultant and a community pharmacist may each hold only a partial picture of a patient's health. The government says this will reduce repeated history-taking, cut duplicate testing, and lower the risk of patient safety incidents caused by incomplete information.
Public engagement conducted ahead of the legislation received around 2,200 responses. More than three-quarters of respondents indicated support for the record. A separate exercise involving 76 people from seldom-heard groups, including older people with long-term conditions, people from ethnic minorities and disabled individuals, produced similar findings. Those who interacted frequently with health services were particularly likely to say it could improve continuity of care.
The assessment examines impact across nine protected characteristics. For people with disabilities and long-term conditions, it concludes the record offers meaningful improvement, precisely because this group tends to move between multiple care settings where fragmented information causes the most harm. The same logic applies in reverse when it comes to data security: those with the most information held on record face a greater impact should a cyber breach occur.
Women are identified as more frequent users of healthcare services and more likely to report longstanding health conditions, meaning they stand to benefit more from improved information sharing. The assessment also raises a specific concern about domestic abuse. Where a perpetrator controls a victim's phone or digital access, the NHS App could become another point of coercion. The department says guidance on safeguarding has been published that allows restrictions to be placed on clinical record access through the App, though it acknowledges this may reduce the personal benefits of the record for those affected.
For men, the picture is different. Men are less likely to seek help for mental health problems and make fewer GP appointments than women. The assessment suggests that access to their own health records through the App may encourage greater engagement with health services, including for conditions that often go unmanaged.
On ethnicity, the department notes that people from some minority ethnic groups are more likely to experience worse health outcomes and to develop multiple long-term conditions earlier than the white majority population. They are also more likely to face digital exclusion, language barriers when navigating the health system, and in some communities, fear about immigration-related data being recorded. That last concern, the assessment acknowledges, can lead to disengagement from health services altogether.
Digital exclusion is the most persistent thread running through the findings. Patients who cannot or do not use smartphones or the internet will still benefit if their clinicians have better access to their records. But the personal access element of the record, which the government considers central to giving patients control over their own health, will be less accessible to those groups in the near term. The department says mitigating digital exclusion is one of five priorities NHS England has asked Integrated Care Boards to address.
On costs, the assessment points to expenses across product development, technology integration, implementation and commercial contracts. Particular investment will be needed to ensure paramedics and community pharmacists have the same level of access as GPs and hospital staff. Translating clinical records into plain English for patients is also identified as a potential cost. The risks include over-reliance on a single technology provider and resistance from clinical staff to new data-sharing arrangements.
The government is clear that the record's effectiveness will depend on factors it cannot fully control, including patient trust, supplier capacity and the delivery of the broader NHS digital agenda. The assessment sets out a system that could genuinely improve care for people who currently fall through the gaps of a fragmented health service. Whether it does so equally will depend on decisions not yet made.
