Joe McDonald: ‘The single patient record is too big to succeed’
- 28 May 2025
The push for a single patient record is ill-advised and doomed to failure, writes Joe McDonald
I could not have been prouder when the Great North Care Record won Team of the Year at last year’s Digital Health Summer Schools.
When Dr Mark Westwood and I sat in a pub eight years earlier discussing how to emulate the Hampshire Health Record and produce a shared view of patients’ records for the North East, we initially called it The Great North Health Record.
But then we asked ourselves, “Why limit it to health? It isn’t just GPs and hospital doctors who need patient information”.
I wrote The Great North Care Record (GNCR) on a beermat and the rest is history. We persuaded 3.5 million citizens, 300 general practices and 12 trusts to share their records for direct care.
The GNCR is now viewed more than a million times a month and has saved millions of pounds and no doubt many lives.
Mission accomplished? Not really.
While it is great that healthcare professionals have better access to records, it hasn’t yet created a genuinely integrated care system. And I have firsthand experience of the problems created by this lack of integration.
I have become a frequent flyer in health and care settings over the last few years as my mother developed dementia and then went on to break her hip. Her psychiatrists, surgeons, anaesthetists, physiotherapists, nurses (acute and community), social workers and care workers have all been wonderful. They constitute the stars of what I call the ‘Constellation of Care’.
Shared care record 2.0
However, unfortunately, this constellation has shone a light on the dis-integrated nature of her care.
It took a year to bring together a multidisciplinary meeting of the key players. Frequently, one professional would come to see my mother while she was at an appointment with another member of the Constellation of Care.
So, far from resting on my laurels and basking in the success of GNCR, I’m energised to champion taking integration to another level. Shared care record 2.0, if you like.
A truly integrated care system doesn’t just share readable patient data, it informs members of the Constellation of Care that there is something to see, allows the coordination of appointments and facilitates teamwork across organisations.
Sounds like the single patient record (SPR), you might say. But the proposed plans make me nervous.
I was the medical director of the Lorenzo delivery team during the National Programme for IT (NPfIT). The proposed electronic patient record (EPR) was a single patient record project for all the citizens of the North Midlands and East of England: 30 million citizens, so not quite as ambitious as the SPR. Nonetheless, a massively ambitious project that notoriously failed. It was just too big.
Records aren’t the real issue anymore – it’s integration. And there are interesting examples of providers using tech to tackle this
There is a Goldilocks principle at work in IT projects, where something has to be just the ‘right’ size to succeed.
The NHS is now also in a place where most records are digitised. And social care is making progress too.
Records aren’t the real issue anymore. It’s integration. And there are already some interesting examples of providers using additional tech – in addition to their EPR – to tackle this.
For example, Shropshire Community Health Trust and Midlands Partnership University Trust are about to roll out an intelligent care platform that allows staff in the hospital and out in the community to see and use critical information that would otherwise be sitting in separate, inaccessible clinical IT systems.
We don’t need more records, we need a means of integrating care, connecting patients and care staff across organisations.
We need a Neighbourhood Integrated Care System – taking us to shared care records 2.0 rather than SPR.
The best place to scale these solutions are likely to be the communities that have shown themselves capable of the collaboration required by implementing a shared care record across a significant geography.
The challenges are not, for the most part, technical; they are social, legal and ethical. They have learned some hard-won lessons from NPfIT and applied them successfully.
These are the people, supported by the right tech, who can evolve the success of shared care record into, effectively, the answer that government is looking for and what we all need as patients and carers of our loved ones.
5 Comments
Thank you Joe for an interesting reflection. I would like to promote the concept of “practical interoperability”, ie how we work together across organisations and specialities. Even if we share patient records, we need to agree on which practitioner is responsible for what care, how handovers are done and who follows up. This is a huge task, often underestimated, and technical standards and regulations are often huge barriers against development and continous refinement. I agree that more records don’t solve this, and that “practical interoperability” is best solved locally. Solutions must be found between clinicians where the patients care is delivered.
Lorenzo, at the time of NPfIT was still a figment of iSoft’s PowerPoint presentations, was it not?! I’m not convinced by the Goldilocks argument – technology moves the figurative thermal boundaries very quickly, and that argument, at that scale, has been made for literally decades; often to support very effective, local/regional endeavours. There are many regional health records success stories, going back decades – though most have lacked sustaining power and strategic context. But what about the SCR? The intention back in the day was simply to grow it incrementally until the S could quietly be dropped. NHS IT has long been marred by lack of courage at the centre, and the perpetuation of fiefdoms!
Great piece & timely, too, from a veteran of the journey NHS has been led through the trenches of Informatics, data, digital & all things related.
The lack of institutional memory at the centre of policy decision is staggering. Only thing worse is the apparent lack of recognition for the depth & breadth of digital knowledge that already exists amongst NHS & UK academia.
Fair comment ,Ade. My view as a psychiatrist may be a little skewed because mental health had a good NPfIT with almost everyone getting a reasonably priced, home grown, designed for the NHS EPR 15 years ago.
Good piece Joe.
Only point I’d make is that saying records are not a problem any more kind of writes off that area. Like people who say the tech isn’t difficult.
Many organizations cannot feed good data to shared records for a variety of reasons. If those shared records are failing for that reason, the new thing will also fail for the same reason.
The lack of understanding from those who launch these projects is pretty mind boggling.