In his latest column for Healthcare Leader, digital expert Dr Tom Micklewright explains the issues that will be faced by clinicians using the Single Patient Record
‘I saw the consultant last week and had my bloods done then. You should be able to see them.’
Ah, if only it were that simple.
The NHS remains hampered by data sharing issues. As frustrating as this was in my GP surgery last Tuesday, it is often far more challenging for colleagues in acute, mental health and community trusts who are effectively working blind to their patients’ GP-held records.
Shared care records have long promised a solution. Over recent years, they have evolved from basic summaries into much richer tools, allowing clinicians to view information held elsewhere in the system. Yet they have often been treated as optional extras—useful in a pinch, particularly when a patient cannot recall their history, but not embedded in day-to-day clinical workflow.
That is beginning to change.
With the 2026 Health Bill setting out the legislative framework for a future Single Patient Record, shared care records now sit within a much broader policy landscape. The ambition is clear: to bring health and social care information together in one secure, accessible place for patients and professionals. Crucially, the Bill signals that existing systems – electronic patient records and shared care records – will be connected and built upon, not replaced. Patients are expected to access a core dataset via the NHS App from 2028.
If this finally retires interoperability as a perennial talking point at Confed Expo, I will be delighted. But for ICB leaders, this new centrality raises an uncomfortable question: is the shared care record safe, trusted, usable and resilient enough to support decisions across organisational boundaries?
There has been real progress. Some regions now operate mature platforms, embedded across multiple organisations and even ICSs. Others have systems that are helpful but still variable in depth, coverage, social care integration, cross-border access and clinical adoption. The landscape remains uneven. And stitching this into a national infrastructure risks amplifying a familiar problem: shared care records may provide a single window, but not always a single truth.
Behind that window sits multiple data streams from different systems, refreshed at different intervals and held to varying standards. Some data is near-live; others are batch-fed, delayed, document-based or periodically updated. In my own ICB, batch feeds from providers can differ from live data via GP Connect. A medication list, discharge letter or diagnostic result may appear twice – and show different information.
This heterogeneity creates what might be called a ‘completeness illusion.’ The risk is not just missing data, but missing data within a system that appears comprehensive. A clinician may interpret absence as a clinical negative for instance. If a hospital-prescribed medication is not showing, I may assume it does not exist.
Data quality issues are not new. We have managed around them for years. But rather than solve these issues, shared care records are only going to amplify them. In our ICB, historical record merges at provider level have surfaced only recently through shared records, exposing errors that were previously contained within a single organisation. A clinician elsewhere may see that data without any awareness of the original context, system limitations or local issue that led to the error.
This is not an argument against shared care records – far from it. The benefits for safety, quality and productivity are well established. But it is a reminder that provider-level data quality is now system-wide critical infrastructure. Identity matching, duplicate records, incorrect merges and inconsistent coding are no longer just data housekeeping; they are now system-wide patient safety risks.
There is also a pressing question of accountability. If a clinician makes a decision using data recorded, coded or amended elsewhere, where does responsibility sit? The source organisation owns the originating data. The shared care record supplier determines how it is presented and updated. The viewing clinician remains responsible for interpretation. The ICB oversees governance, access and the clinical safety case.
Without clarity on provenance, acceptable use and responsibility, that chain becomes opaque.
This becomes more complex as shared care records evolve. Integrated Neighbourhood Teams will extend access to social care, local authority staff and potentially voluntary sector partners. This raises important questions about role-based access, technical controls and audit. Who needs to see what, when and why – and how do we evidence that?
The Health Bill also envisages patients interacting directly with their records: requesting corrections, suggesting amendments and potentially contributing data. This marks a shift from a read-only window into GP systems to a dynamic, interactive, shared record. Yet while read-only systems carry interpretation risk, write-back introduces accountability risk. Before shared care records become shared workflow tools, we must be clear on where the ‘legal’ record sits, what constitutes the single source of truth, who owns incoming tasks and how entry disputes are handled.
So what should ICB clinical leaders do now?
First, do not confuse visibility with reliability. Make data provenance, completeness and recency explicit.
Second, treat provider data quality as a system safety issue. Understand existing controls and work with CIOs, CCIOs and Clinical Safety Officers to manage the risks that increased visibility will inevitably expose.
Third, clarify accountability before expanding into neighbourhood use cases, write-back, tasking or shared care planning.
Fourth, treat the shared care record as critical infrastructure: map dependencies, test downtime arrangements and include it in business continuity planning.
The Single Patient Record may be the national ambition. But its safety and usefulness will be determined locally. The task now is to make shared care records trusted enough for neighbourhood care, robust enough for operational reality and safe enough to serve as core NHS clinical infrastructure.
Dr Micklewright works as a GP and a Clinical Lead with Cheshire and Merseyside ICB. He also works as Medical Director ORCHA Health, a private digital health company.
