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Kat James, managing director of Consultant Connect, argues that single patient records are key if the NHS wants to land the left shift.
A GP is 40 minutes into a Tuesday afternoon clinic. The patient in front of her has a complicated history and a long list of current medications: a hospital admission last year, blood results that look outdated, the latest specialist hospital letter missing. She can see that a recent scan was ordered, but she is missing the results. She doesn’t have time to locate all pieces of the puzzle before deciding what to do next. So she does what is safest with what’s at hand: she refers to hospital.
That moment, multiplied across millions of consultations every week, is the practical case for the single patient record. The NHS Modernisation Bill, debated by MPs for the first time this month, would require every hospital, GP practice and care provider in England to share patient data, so that wherever someone is treated, the clinician in front of them sees their full history. Ministers say it could prevent around 20,000 A&E attendances and 6,000 hospital admissions a year, and free up roughly 500,000 hours of doctors’ time lost to searching for information. Hard to argue with in principle. But the record will only deliver on those numbers if it solves the right problem at the right moment.
Thorough triage
The main challenge is to prevent patients ending up unnecessarily in A&E or even for a routine appointment. It requires thorough triage that relies on full patient history being available at the point of triage. The NHS 10 Year Plan is built on three shifts: from hospital to community, from analogue to digital, and from treating illness to preventing it. The single patient record is the infrastructure all three depend on. When a GP or specialist has the full picture at the point of triage, they can safely make the call to manage a patient in the community. When they don’t, the responsible default is to see a patient in hospital, because the risk of getting it wrong is too high. A unified record doesn’t just streamline admin. It’s what makes the left shift clinically safe.
The current system shows exactly what happens without it. NHS trusts spent £230.5 million on paper records in 2023-24, despite 94% having access to electronic records according to analysis by Future Health Intelligence. GPs spend 14% of their session time updating records and writing consultation notes, often eating into lunch breaks just to keep up. The technology exists. The information is locked in silos.
Changes can be made when information is available at the point of decision. NHS consultants working remotely as virtual locums, following the same local pathways as the in-house team, review referrals and waiting lists for trusts. When the clinical picture is clear enough to triage safely, patients are redirected to the right community pathway or returned to primary care with a management plan. When it isn’t, they go to hospital.
At Sheffield Teaching Hospitals, a dermatology backlog was tackled by texting more than 3,500 patients directly, asking whether they still needed their appointment and, if so, inviting them to describe their current symptoms and upload a photo from their phone, to be updated to their records. NHS consultant dermatologists reviewed each case, because with the right images and information, decisions could be taken safely: those who needed to be seen were prioritised, the rest returned to their GP with a clear management plan.
It isn’t a one-off. Across neurology alone, our consultants have reviewed more than 14,000 referrals nationally, safely returning more than half to primary care with a management plan instead of a hospital appointment. Across all specialities, the model has cut waiting lists by around a third on average. None of it depends on a patient repeating their history, because the images, notes and results travel with the referral rather than separately from it.
Upstream of referral
The same principle works upstream of referral, too. An Advice & Refer model lets a GP take a clinical image, add notes, and send it straight to a specialist for an opinion before a referral is even made. The moment that exchange happens, it can be saved directly into the patient’s own record, no extra admin required. That single step removes the need to process a referral manually in many cases. It’s exactly what a single patient record promises at a national scale: information that moves with the patient.
Clinicians clearly want this. The Health Foundation has found that electronic health records are among the technologies staff most expect to save them time over the next five years, yet the same staff are frustrated that the systems they already have are barely used to their full potential. That gap, between promise and practice, is the real risk facing the single patient record. Legislating for data sharing is necessary. Handing Trusts and ICBs a new database without clinical workflows, training and practical support is not sufficient. The question is not whether the NHS needs a single patient record. It does. The question is whether it gets one that actually makes it safe to say yes to community care, when right now the absence of information makes hospital often, and unnecessarily, the default option.
Get single patient records right, and the left shift will happen at scale and safely.
