We have a new government, which has finally started to say what it wants to do.

Making new promises about your medical records while breaking past promises is a weird way to start governing. In his lust for control Wes Streeting forgets that all governments end and one day soon he’ll have been the future once, and others will have to pick up his pieces. We’ll be here then too.

Ripping up past promises

If Streeting tears up promises made in the last pandemic he will critically undermine any promises that are given by a future Health Sec about the next pandemic. This will come about partly because the Department of Health in England has failed to do the paperwork for normal times in the same way that it did, with consensus, for the pandemic. When Streeting undermines pandemic promises he will render meaningless any promises he makes about the new database he wants to create. The Health Sec should be able to overrule their predecessors. Indeed sometimes that may be wise, but this shouldn’t be mainly due to laziness of his staff.

Biobank have been lobbying hard to get access to data without having to explain themselves to data controllers, and doctors should just defer to the shared culture of Biobank and HDR so they can do whatever they want. A new SecState picked the path of least resistance which caused this Biobank to gloat because they’ve confused the supposed short term bung to them with the bigger long term plan. (We note the science media centre press release had one quote that wasn’t from people associated with Biobank or the GeL CEO – how weak is the supposed “support” for biobank?)

All your medical notes available wherever the NHS logo is seen, and you’ll have no idea who read them

The main announcement was that he’s taking control (video) of your medical notes. Streeting wants politicians, him, not doctors, will decide who can see and read your medical notes for what and where. This isn’t immediate as it’ll take a few years to grab, and then a few years more to close down GP as you know it afterwards, but once he has the data he can do what he likes. And you will not be able to do anything about it

The ability for anyone in the NHS to read any patient’s whole medical history, notes and all, will replace the existing local health and care records, the Shared Care Records scheme, Summary Care Records, and GP Connect. If the Department of Health in England believes this is a real proposal, then we’ll see those systems start to lose budget in the Comprehensive Spending Review. Having a fifth (or more?) way to lookup your GP records will not resolve the issues in the previous four methods. (As an aside, medConfidential has long argued the “regional SDE” programme is pointlessly ineffective, and we welcome secretary of State implying that it’s entirely irrelevant now, because once all data is copied into his national database, there is no need to have the “regional” systems which will have less data. Hopefully the Spending Review will scrap the lot, and it gives UKRI £18.2m back in the process).

Wes Streeting says it’s his 10 year plan, and then some bright spark will say Palantir should be challenged to do it in 4.

We know all the existing methods to lookup and access GP data for care are hidden away from patient view, and hence completely open to abuse when creepy single doctors decide to look up the medical notes of women they go on dates with or their partner’s ex. Streeting and Palantir could immediately solve this problem by saying loudly and clearly that every access to any single care record will be visible to the patient via the NHS app This would to prevent such abuses. instead the government is set to enable them.

If the Department of Health in England wish to build public trust and demonstrate that trust is meaningful, audit trails within the app could start tomorrow with GP Connect and the Summary Care Records – system logs that the NHS already has but hide from you. New systems should demonstrate accountability to the patient and since promises get broken, they should start with the systems that there are today.

As it stands, the new planned database of your medical notes about you and your family will deny you the basic right to know who is accessing your record and why. This plan replicates the recklessness of the previous governments where you have no idea when/where your records are accessed and so you can’t know whether they’ve been misused, or when they should have been checked and weren’t. If that is going to change, it should change today where it already can before promises get made for tomorrow.

Wes’s “innovation” is that the existing GP IT systems all go away to leave only his new record. So Labour are exacting revenge on Frank Hester by destroying his health records business but they are also diminishing the role of GPs who they claim they want to empower.  The Family Doctor will lose control of your personal health record just as they have lost control of their phone lines to NHSE and their appointment book to 111.. Care will get progressively worse as the Department of Health in England rather than your doctor manages demand and waiting lists by gaslighting you. A visit to your GP will increasingly be like going to the job centre. Your GP may want to help you, but their systems wont let them, the same way GPs already have no mechanism to get improvements to the NHS app for GP services.

The oft trialled proposals that you must call 111 (or 999) to ask permission to go to A&E will be extended to calling 111 to get a same-day GP appointment. When the chatbots behind 111 can see your full medical history, you may not even need to have a GP at all, which will be an excuse to close your local GP surgery in the second half of the ten year period because, as Wes said to RCGP “one in every 5 of you are working in buildings older than the NHS itself.”

The details will start to appear around the 10 year plan for Palantir the NHS expected to be published in the new year, and it will be curiously vague about the GP estate in the second half of the time period…

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If you’d like the slightly weird audio summary of this blog post from Google’s NotebookLLM, it’s here (it only hallucinates a bit).

The next 10 years of the NHS might include dissolving your GP practice and replacing it with a chatbot, but all of that will depend upon data. To ensure every use of your data is consensual, safe, and transparent for the next decade, we expect it will cost medConfidential about £100k a year to scrutinise these plans and find the gaps. If you can help find that sort of money down the back of the sofa, we’d love to hear from you.