Ethical Healthcare recently responded to NHS England’s request for information regarding a Single Patient Record for the NHS. Ethical’s Director of Consulting, Tracey Watson, shares the past missteps we need to learn from and the four core principles our response focused on.

The ambition for a Single Patient Record (SPR) across the NHS is not new – but this time, it feels different. NHS England and DHSC’s recent request for information signals a genuine intent to create a shared common understanding for patients and professionals alike – a joined-up view of care that could change the way we make decisions and coordinate care. 

But we’ve seen where similar programmes have struggled before: overly centralised thinking, a lack of user engagement, and underestimating the cultural shift required. 

The Promise of the SPR 

The benefits of an SPR are clear. It could: 

  • Reduce duplication and inefficiencies. 
  • Empower patients to take a greater role in their care 
  • Empower clinicians with timely, complete information. 
  • Support proactive, personalised, and safer care. 
  • Enable autonomous workflows that prompt action, not just reflection. 

However, as with all digital transformation at this scale, the real challenge lies not in the concept – but in the execution. 

The Pitfalls of Past Efforts 

As a digital health consultancy with deep experience across system integration, user-centred design, and change management, we’ve seen how similar initiatives have struggled when: 

  • Technology was prioritised over transformation. 
  • Solutions were imposed without local adaptability. 
  • Data was treated as a technical asset, not a cultural one. 

These lessons must inform the SPR programme from day one. This isn’t just an infrastructure project. It’s a fundamental redesign of how data enables care. 

Building More Than a Record 

Our response to the Request for Information focused on four core principles: 

  1. Federated, not fragmented: Local systems must be empowered within a common national architecture. 
  2. User-first design: The interface should serve clinicians and citizens – not burden them. 
  3. Data stewardship: Citizens must trust in how their data is used, shared, and protected. 
  4. Incremental delivery: Big-bang approaches will fail where iterative learning could succeed. 

We believe the SPR must be a platform for collaboration, not just a repository of information. And that its success will hinge on aligning incentives, standards, and behaviours across a complex ecosystem. 

How do we do this? 

The request for information marks a crucial first step. But it also opens a broader conversation: How do we ensure this transformation succeeds where others have faltered? How do we resolve national/local tension over who does what? How do we ensure that we don’t undermine the considerable amount already invested in existing systems? We need to move fast, but wisely, with the right foundations – modular architecture, open standards, federated control. An accelerated evolution, not a radical revolution. 

We’re ready to be part of that conversation. If you’re navigating similar challenges – whether at a system, supplier, or policy level – we’d love to hear from you. 

The SPR isn’t just a tech solution. It’s a rethinking of connected care. Let’s get it right.