The Single Patient Record is coming – will it benefit rural patients? 

The creation of a Single Patient Record (SPR) is a central commitment in the 10 Year Health Plan for England. It reflects the Government’s ambition to provide patients with real control over their data through a single, secure and patient-controlled record. In practice, this means that patients will no longer need to repeat their medical history at every appointment, and clinicians will have a comprehensive overview to make safer, faster decisions. Eventually, the SPR will integrate with tools like wearable technology, AI scribes, and proactive care models to create a fully integrated, patient-centred NHS. What does the SPR mean for rural residents? Jessica Sellick investigates. 

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Currently there is no centralised record of patient data within the NHS. Hospitals and GP surgeries independently collect and maintain data about the patients they treat, leading to inconsistencies in data sharing practices. This fragmentation results in challenges for patients, their care, and health research. In response, the Government plans to create a ‘Single Patient Record’ (SPR) through the NHS App. What does the development of the SPR entail, how will it impact data sharing practices, and what does this mean for rural patients? 

What patient information is currently collected, and how is it shared? Whenever you engage with the health service, whether through a GP appointment or a hospital visit, data about you, your health, and your lifestyle is collected. This data may include but is not limited to information regarding diagnoses, symptoms, observations, scans, test results, procedures, medications, allergies, immunisations, referrals, and appointments. Other specialists you see such as dentists, physiotherapists, and counsellors also create records. Data may also be collected from you for clinical trials or patient surveys. The patient record held by your GP is often considered to be the most extensive information about a person’s health in comparison with hospital or other health records. 

Since 2014, the NHS has committed to making patient records paperless. This led to the introduction of online or electronic health records. As of May 2025, 187 out of 206 secondary care trusts have an electronic patient record system. The Government has requested that all trusts have an electronic system in place by March 2026. 

Individuals have the right to access their own health records and, under certain circumstances, to access information about others. Since May 2018, this has been governed by the Data Protection Act 2018. There are specific situations where full access to a patient’s health record may be denied, such as when the release is likely to cause serious harm to the physical or mental health of the individual or another person. The records of deceased patients are protected under the Access to Health Records Act 1990. Access to these records is only granted to personal representatives of the patient who have a legally defined role (e.g., named executor in the deceased’s will) or those who have a claim resulting from the death.

Health and care professionals involved in patient care have a legal duty to share patient information when they consider it to be in the patient’s best interests. Patient information should not be shared if a patient objects, unless it is in the ‘overriding public interest’. However, there are circumstances where a health professional is required by law to disclose medical information regardless of a patient’s consent (e.g., notifiable diseases). Similarly, under the Mental Health Act 1983, there are situations where information can be shared without the patient’s consent (e.g., if the patient lacks the capacity to give or withhold consent, or if medical information needs to be shared with relatives to determine their best interests).

At present, when patients move within the health system, both individual patients and clinicians within NHS organisations encounter numerous difficulties in accessing and sharing data as it is dispersed across multiple platforms.   

What is the Single Patient Record (SPR)? The establishment of a SPR is a key commitment within the 10 Year Health Plan for England. The Plan marks a transition from analogue to digital, which will enable patients to ‘have a doctor in their pocket’ through the NHS App, and freeing staff from administrative tasks. This digital transformation aims to ensure that patients in good health can quickly access support, thereby freeing up physical access for patients with complex needs, and contributing to the NHS’ financial sustainability: 

“To make the move ‘from bricks to clicks’ we will: for the first time ever in the NHS, give patients real control over a single, secure and authoritative account of their data with a single patient record to enable more co-ordinated, personalised and predictive care…transform the NHS App into a world leading tool for patient access, empowerment and care planning”, (10 Year Health Plan for England, page 11).  

The Government envisions that by 2028, the NHS App will serve as a ‘full front door to the entire NHS’. Through the NHS App, patients will be able to get instant advice for non-urgent care, choose their preferred provider, book tests directly through My Specialist, manage their medicines through My Medicines, book vaccinations through My Vaccines, manage a long-term condition through My Care, manage their children’s healthcare through My Children, use digital tools to manage or treat conditions through building a HealthStore, and leave feedback on the care they have received. For NHS staff, the technology will introduce a single sign-on process and expand the use of tools like AI scribes to free up their time for patient care.  

Prior to the publication of the 10 Year Plan, NHS England engaged over 3,000 patients in a consultation on how health data should be used. More than 1,000 of these participants were specifically asked to provide feedback on a SPR, advising NHS England to:  

  • Proceed at pace: the SPR was seen as a long-overdue solution to many frustrations experienced across various health and care settings.
  • Include a record of access: an audit trail is necessary to reassure patients that access is subject to constraints and oversight.
  • Implement tiered access: constraints on access are essential for patients to trust the SPR.  
  • Ensure rigorous training in data use and security: patients need reassurance that their data is being used safely and appropriately.
  • Patient access is a must: this can help patients better manage their own health, and many felt they had the right to access data about themselves. 
  • Be transparent: from the start, during implementation, as well as in day-to-day operations. 

NHS England also engaged with suppliers and stakeholders, with the following SPR themes emerging: 

  • Modular approach: incremental changes are seen as more practical and less disruptive than a ‘big bang’ overhaul. 
  • Data ownership: there needs to be clarity on where data is held, who can access it, and who is responsible for updating it. 
  • Data normalisation: it is important to ensure that data is recorded in a consistent way across all systems. 
  • Interoperability: existing systems need to work well together so that when information is updated in one place, it is automatically updated everywhere else.  

To implement the SPR, the Government aims to introduce new legislation placing a duty on every health and care provider to make the information they record about a patient accessible to that patient. This will include provisions to ensure patients have default access to their SPR. It is the Government’s intention that patients will be able to view their SPR on the NHS App from 2028. In the meantime, in May 2025, NHS England sought suppliers to help design a SPR. A ‘testing phase’ is now underway which is exploring three options for how the SPR should be built: (1) Hub and Spoke: integrating existing Shared Care Records via a central API; (2) a Central Integration Model: a centrally managed data store for real-time access; or (3) Virtual Data Layer: connecting existing systems to provide a joined-up view at the point of accessing data. A prototype SPR is expected to be available by the end of 2025. 

What good practice and lessons can we draw from recent policies and reviews? In March 2023, the DHSC published a policy paper outlining the Government’s commitment to work with health and adult social care organisations and their supply chains to achieve sector-wide cyber resilience by 2030. The paper emphasised the need for the sector to withstand daily cyber threats, including phishing and malicious emails, automated scanning and attempted fraud. These threats pose significant risks not only to patient and staff safety but also to public trust in a health and social care system expected to safeguard people’s data. 

Despite these efforts, in June 2024, Synnovis – a pathology laboratory that processes blood tests on behalf of several NHS organisations – was the victim of a cyber-attack. The incident resulted in the cancellation of 10,152 outpatient appointments and 1,710 elective procedures at hospitals in South East London. In November 2024, a single cyber-attack affected Alder Hey Children’s NHS Foundation Trust, Liverpool Heart and Chest Hospital and Royal Liverpool University Hospital. While hospital services were unaffected and continued to run normally, the attackers published extracted data from impacted systems. 

The Government’s National Risk Register 2025 describes how the health and social care system remains a target for cybercriminals. It contains a reasonable worst-case scenario which would involve catastrophic systemic service disruption due to ransomware moving quickly across the health and care IT estate resulting in cancelled appointments, delays to medical procedures, and A&E diversions. In addition to having immediate direct clinical care impacts on patients, second-order impacts will manifest themselves over time as delays and cancellations result in medical conditions worsening or not being diagnosed promptly. The response to such as incident would include specialist IT support and the establishment of a Cyber Incident Response Retainer (CIRR) to address immediate impacts, and the phasing of a return to ‘normal service use’. The National Risk Register describes how “these impacts are likely to grow exponentially as the system deals with increased morbidity (both physical and mental health impacts) and, highly likely, increased mortality” (page 53). 

The Health and Care Act 2022 sought to enhance data sharing and promote the more effective use of data across the health and social care system, calling on the Department of Health and Social Care (DHSC) and NHS England to publish mandatory information standards. However, the Sudlow Review and the Darzi Independent Investigation, both published in 2024, found that the health data system in the UK is fragmented and complex. They included recommendations for more efficient data sharing practices to improve patient care and support research that could benefit the public. From the patient perspective, the national conversation to develop the 10 Year Health Plan for England revealed widespread frustration amongst patients having to repeatedly provide their medical history. Patients also expressed a strong belief in their right to access personal health data.  

The Data (Use and Access) Act 2025 was introduced to ensure that information standards are applied consistently across IT providers, IT services, and information processing services used in health or adult social care in England. Receiving Royal Assent in June 2025, the legislation aims to reduce data fragmentation and enable faster, more reliable access to information for staff – helping to prevent unnecessary duplication of laboratory tests and data entry.  

Research from the Digital Health Coalition (DHC) in 2024 on 600 patient experiences of using the NHS App found: 

  • 78% of respondents said they use the NHS App, with four out of five of this group finding it easy to use, and seven out of ten finding it of value. 
  • More than one-third of respondents would like the ability to access test results (36%) or personal health records (36%) through the NHS App, as they currently cannot. The survey found that some GP practices were preventing patients from accessing information which impacted their motivation to use the NHS App. 
  • More than one-fifth of respondents (23%) said they rarely or never used the NHS App. While some of this related to experiencing technical issues downloading the App, registration, and/or logging in; 36% of respondents said they did not see any benefit from using the NHS App and would prefer to speak to a person instead. 

The DHC recommended that developers of the NHS App work with those involved in healthcare delivery and patients to increase awareness of the App, provide universal access to information on it, make it easier to use, reassure people about data security, help patients find assistance using the App, and provide a clear explanation of the different healthcare apps in use.  

To develop the SPR, NHS England has been collaborating with global partners to gain insights from their experiences of developing digital patient records. This includes the National Health Information System (HIS) in Estonia, which since 2008 has connected healthcare providers nationwide and securely stored patients’ medical data on one centralised platform. Additionally, NHS England has looked at My Health Record in Australia, which contains clinical information, medicare documents, and allows patients to add their own information.  

While the scope of the SPR is currently being developed, it is intended to be safe by design, secure by design, built to the highest standards of data governance, interoperable by design, and cost effective. Ultimately, the true value of digital innovation lies in the SPR genuinely meeting the needs of both patients and clinicians. 

What does this mean for rural communities? Rural communities experience significant disparities in access to healthcare compared to urban residents. Data for England reveals that rural residents face a median GP appointment wait time of 2-7 days, compared to just 1 day in urban areas. While nearly 1 in 4 urban GP appointments are virtual, 8 in 10 rural appointments are face-to-face. Analysis also shows that 50.4% of rural postcode areas have no medical services located within them, and that people in the most rural areas travelled nearly twice as many miles in 2021 as in the most urban areas.  

The Parliamentary Inquiry into Rural Health and Care in 2022 highlighted digital health as a transformative tool for rural care: “Digital approaches can potentially improve the experience of patients in a wide range of contexts, from remote appointments, care co-ordination, multi-disciplinary working and virtual discharges. Social media, videoconferencing and mental health apps can help address isolation and loneliness and improve wellbeing. A particular benefit of technology in rural areas is improving access to services, where local availability or travel distances would otherwise cause difficulties. The lack of a critical mass of users and organisations in rural areas, however, may militate against the development of rurally focused digital products” (page 52). 

Ensuring rural uptake of the SPR requires overcoming four main barriers. Firstly, acknowledging that there is a lower starting base for tailoring digital products for rural areas. For example, evidence from NHS Digital to the Parliamentary Inquiry identified a deficit in the use of the Shared Care Records in rural areas. 

Secondly, it is essential to address poor broadband and mobile connectivity. Data on accessibility in England shows that superfast broadband is available for 89% of all premises in rural areas compared with near-total coverage in urban areas. Full fibre broadband is available to 55% of rural premises compared with 76% of urban premises. 4% of rural premises cannot access decent broadband (at least 10Mbits/s download speed). While 88% of the rural landmass has 4G mobile coverage from all four operators, this figure is 99% for urban areas. As of January 2025, just 2% of rural areas had outdoor 5G mobile coverage from any operator, compared to 26% of urban areas.   

Thirdly, some rural residents have low digital literacy and lack access to mobile devices. DHC’s research on the use of the NHS App with 600 patients identified the need for more support to enable rural residents to use the App independently: “They don’t own a mobile phone because they see no need for one when they have a desk top computer. Especially as mobile connection in our rural areas is very poor. Once again rural areas have been forgotten”. More recently, policymakers have highlighted the role of virtual wards in supporting healthcare in rural areas, but they also identified barriers including digital and broadband connectivity, and a lack in the digital skills required to use the technology. 

Fourthly and finally, it means overcoming the financial barriers that some rural residents face in purchasing digital equipment and connectivity services. Ofcom publishes trends in UK residential fixed broadband, landline, mobile phone and pay-tv service prices – with a survey of 1,100 UK households finding 8% of households reported having issues affording their home broadband service in October 2024, with 10-12% reporting difficulties affording a mobile service, and 24% reporting struggling to afford any communication service.  The analysis, and Ofcom more widely, do not offer rural and urban price comparisons. However, rural residents often face limited provider choice leading to reduced access to competitive deals, higher installation costs, and lower access to social tariffs.  

Where next? Will the 10 Year Health Plan for England lead to more proactive, personalised care by giving patients full access to their health information through tools like the NHS App? Can we create a system that truly puts patients at the heart of their care? The SPR team at NHS England believe patient engagement is essential to the success of the SPR; therefore, will the prototype developed at the end of 2025 be tested with rural patients, and  how will the NHS work with rural patients to ensure the SPR is delivered in every area by 2028? Watch this space. 

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Jessica is a project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). She is presently supporting an alliance of veterans charities in Scotland to evaluate and demonstrate their impact; developing a community masterplan; and evaluating a heritage skills programme. Jessica also sits on the board of a charity supporting rural communities across Cambridgeshire and is a member of her local Patient Participation Group. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk 

Websites: http://roseregeneration.co.uk/https://www.ncrhc.org/ 

LinkedIn: 🌈Jessica Sellick