What will the Health Bill mean for general practice?

Pulse answers the burning questions GPs will have about the Health Bill – to the best of our current knowledge

The King announced new legislation to ‘modernise’ the NHS as part of his speech in the House of Lords last week, saying that ministers ‘will push forward with significant reforms to the National Health Service’. The following day, Wes Streeting resigned from his role as health secretary, leaving it up to his successor to oversee the implementation of one of the most important pieces of legislation for the NHS. It contains the foundations of the single patient record, new responsibilities for ICBs and the CQC, and it cements the Government’s commitment to abolishing NHS England. So what will it all mean for general practice?

What is included in the bill?

• The primary legislation contains the power to create the single patient record and the legal framework that will underpin it;
• It also contains legislation to abolish NHS England and create ‘a lean, agile centre’, by transferring NHS England’s functions into the Department of Health and Social Care or the wider system to ‘reduce bureaucracy and free up resources’;
• It will also make ICBs ‘strategic commissioners’ by transferring responsibility for all but the most specialised commissioning functions to ICBs, including primary care;
• It will extend the time limit for CQC to bring legal action against providers and transfer the Health Services Safety and Investigations Body (HSSIB) functions into the CQC, giving it new powers.

What data will be included in the single patient record?

It will initially cover data from primary and secondary care, expanding over time to include services such as adult social care. The Government said the single patient record will ‘encompass a patient’s medical history from birth’, including but not limited to:

• Diagnoses
• Physiological data (such as blood pressure, heart rate)
• Medical imaging
• Laboratory results
• Treatments and procedures
• Prescriptions and medications
• Personal care plans
• Key primary and secondary care NHS interactions

According to DHSC, by March 2027, clinicians in England will benefit from improved access to records for at least 80% of patients through the connection of existing shared care records, and from 2028, all patients in England will have access to a ‘core set of their data’ through the single patient record, viewable through the NHS App.

The Government has not decided yet on the technical solution which will be used for the single patient record, but it said that this will be ‘designed to integrate with existing architecture with minimal additional resource needed’ and will not make additional demands on providers to ‘digitise’.

Will legislation compel GPs to share data for the single patient record?

The bill will ‘require holders of patient data’, including GPs, to share the data with both ‘people other than a patient on the patient’s behalf’ and ‘people involved in the provision to patients of health care or social care anywhere in the British Islands’. 

It includes several conditions where the health secretary is allowed to ‘disclose personal information’ included in the single patient record, including ‘sharing with clinical trials or research’, sharing with private providers, and where the health secretary thinks it is a ‘proportionate means of achieving a legitimate aim’. The Government also said the legislation will ‘create an offence or other civil sanctions to enforce the regulations’.

Although the plan is for patients to have access to the SPR via the NHS App, the Government has not said exactly what level of detail will be available for them to view. In an op-ed provided to Pulse by NHS England, its GP adviser on the SPR Dr Phil Koczan suggested it would exclude sensitive information that the patient may not want to be shared; safeguarding information that should not be widely shared with the patient; and abnormal results or output from multi-disciplinary team meetings that have not yet been communicated or explained to the patient.

Who will be the data controller?

Before the bill was announced, Pulse revealed that GPs would not be the data controller of data within the single patient record, with controllership expected to be held by NHS England. This was revealed within minutes from NHS England, which were obtained via FOI and shared with Pulse. In May last year, NHS England’s Data, Digital and Technology Committee agreed it would ‘not be appropriate’ for GPs to act as data controller of this ‘multi-service record’. 

However, the bill and subsequent documents published by the Government did not specify who the data controller will be, and the Government has not clarified who the controller will be when asked.

What new responsibilities will ICBs get?

ICBs will be given legal responsibility for primary care commissioning via the bill, once NHS England gets abolished. ICBs have controlled the commissioning of primary care services (GPs, pharmacy, dental and optometry) since 2022 through a delegation agreement with NHS England. They have also controlled secondary dental services through a delegation agreement.

The Government has said that in giving ICBs legal responsibility for primary care commissioning, services will be ‘tailored’ to local needs and decision-making will be devolved ‘to a local level’.

All but the most specialised commissioning functions will be conferred to ICBs, with the exceptions of: public health services, where direct legal responsibility will remain with the health secretary; and high-security psychiatric services, where the direct legal responsibility will be conferred on the health secretary.

ICBs will retain their commissioning control of secondary care services (hospital and other accommodation, nursing and ambulance, and other services for the diagnosis and treatment of illness) which they have had legal responsibility for since their inception.

What happens when NHS England gets abolished?

As explained, ICBs will get legal responsibilities around commissioning with NHS England gets abolished, but many of NHS England’s functions will be transferred into DHSC by making them functions for which the health secretary is statutorily responsible. The Government said that the bill therefore creates a legislative framework for the health secretary to ‘ensure standards are upheld nationwide’.

NHS England currently sets and adjusts the annual funding allocations for ICBs, and these powers will transfer to the health secretary, who will take on NHS England powers to ‘impose financial requirements on ICBs’ so that they can be held to account for their financial performance. Alongside holding ICBs to account for financial performance, the health secretary will assume the power currently held by NHS England to direct ICBs to ‘ringfence funding for service integration’. 

The bill will also transfer statutory health and adult social care digital and data functions, currently exercised by NHS England, to the health secretary.

What about the CQC?

The watchdog will be given new powers to protect patient safety and more time to initiate proceedings against providers who fail to provide safe care. The bill will amend the Health and Social Care Act 2008 giving CQC up to five years to bring proceedings against providers ‘for failure to provide safe care or treatment or carrying out regulated activities without proper registration with CQC’.

It will also abolish the Health Services Safety Investigations Body (HSSIB) and transfer its functions to the CQC. Powers currently held by HSSIB safety investigators will be carried over to CQC, including powers of entry and the ability to demand and secure documentary and other evidence. 

However, the Government said that the legislation will not make these changes immediately, but will only bring into force the transfer when the Government is ‘satisfied CQC has improved’ and that it is being ‘supported and held to account to recover its effectiveness’. It follows two damning reviews of the CQC published in 2024, which said its ‘significant failings’ had led to ‘a substantial loss of credibility’. The CQC has since expressed concerns about the transfer, saying it could impact its ability to carry out its regular functions.

What do GP leaders think?

GP leaders have been vocal about their concerns surrounding the SPR and how the confidentiality of patient data would be protected under the bill’s proposals. Chair of the BMA’s GP Committee Dr Katie Bramall took to social media to suggest that ‘the [House of] Lords will stop this, and we will support them’, while urging GPs to ‘work together to make it right’.

A BMA spokesperson told Pulse that though the ‘concept’ of the SPR ‘may sound promising’, the bill’s details will need heavy scrutiny to ensure ‘established safeguards and governance arrangements’. They also confirmed that GPC England had ‘not been involved’ in discussions about the SPR, including what form it will take, who can access it, what it will be used for, or which company will operate it.

Dr Sarah Jacques, GP co-lead at Doctors’ Association UK (DAUK), said the bill showed a ‘total disregard’ for patient data. She told Pulse that she agreed in principle with a system which meant appropriate record-sharing was easier, but that the version being proposed here gave ‘unfettered access’ to third parties which do not need it – which was not what the SPR ‘should fundamentally be about’.

RCGP president Professor Victoria Tzortziou Brown told Pulse that although efforts to modernise the NHS were encouraging, the implementation of the SPR must be ‘carefully considered and evaluated’ with safeguards installed to ‘protect patient confidentiality and ensure public trust’.

What next?

The bill will have to go through all the stages in the Houses of Commons and Lords before it obtains Royal Assent and can become an Act of Parliament. If Dr Bramall’s suggestion that ‘the Lords will stop this’ has any merit, then it may take a lot of amendments and to-and-fro to get to that point.

The bill was the handiwork of Mr Streeting who has since left the post of health secretary. It seems unlikely that his successor James Murray will do anything to halt the progress of the bill, so there should be no changes expected on that side.

However the new health secretary has been left with the major task of NHS ‘neighbourhood’ reorganisation, as well as carrying out the 10-year plan and with its three shifts (analogue to digital; sickness to prevention; and hospitals to communities). Whether the Labour Party gets that 10 years, or indeed Mr Murray gets more than six months, to carry out these plans is anyone’s guess.