Karin Smyth
MP for Bristol South · Labour · United Kingdom
“Absolutely, and I am committed to working with my hon. Friend and many other hon. Members across the House. I was pleased to meet my hon. Friend the Member for Manchester Withington (Jeff Smith) to discuss his amendments concerning medicines.”
“As the hon. and learned Gentleman knows—we have spent many long hours in this place discussing the arrangements with regard to our leaving the European Union—there are different regulations, as a result of Brexit, between Great Britain and Northern Ireland.”
“They provide a clearer legal framework for the Medicines and Healthcare products Regulatory Agency to share information with UK health systems, organisations and trusted international partners.”
“I thank my hon. Friend for her best wishes and commend the work that she and many other Members are doing directly with their trusts to understand the impact of the work that we are doing to bring down those waiting lists and improve access for patients.”
“Member for Gosport (Dame Caroline Dinenage), who spoke powerfully on behalf of the whole House; I commend the work that she has done. My hon. Friend the Member for Kingston upon Hull West and Haltemprice (Emma Hardy) has spoken to me in great detail about this issue, as has my hon.”
“I will carry on. As the hon. Member for Sleaford and North Hykeham knows well, provisions are already in place to appropriately control access to puberty-suppressing hormones for children and young people presenting with gender incongruence or dysphoria. Children and young people with gender incongruence deserve evidence-based care.”
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“I hope that addresses the comments the hon. Lady made. On new clause 13, we know that the vast majority of births are safe, but the devastating trauma experienced by many through failures in care must be brought to an end. The CQC has an important role in assessing whether patients are receiving safe, effective and high-quality care, and it is essential that it can do that objectively and independent of Government. It is therefore not appropriate to impose a duty on the Secretary of State to ensure particular ratings.”
“I am sorry, but I did not get the end of that sentence. However, I think the hon. Lady was saying that the Bill essentially abolishes NHS England. Again, as I have said repeatedly, nobody is opposing that. As is well known, the recommendations on the maternity commissioner have come through a separate process. Given the need for public assurance and to earn back the trust of women and families, as well as—I think the hon. Lady said this herself—the shocking revelations that have come through some of this work, Baroness Amos recommended a maternity and neonatal commissioner to drive through these changes and give confidence to the system. That is why we are going to accept her recommendation. Accountability for maternity services obviously remains with the Secretary of State, who will be co-chairing the taskforce.”
“I do not think it was about the supplier. I think it was about the money. It was about inertia in rolling out some good technology that provides good efficiency. It was also about capacity, capability and an attitude to productivity, which we absolutely need to drive more of.”
“It does not matter whether it is held by the authority or by one of its commercial partners; what matters is whether it is held for the public authority’s purpose. The Government agree with the principle of transparency, but new clause 5 would not improve the existing framework. It would risk duplicating duties that already exist, cutting across standard contract terms and creating uncertainty about patient information, which is rightly protected. For all those reasons, I ask hon. Members not to press the new clauses. Finally, I say to the hon. Member for Winchester that we have already debated the single patient record. Public trust is key, and there will be multiple suppliers. We are bringing patients and the public with us and will continue to do so. The hon. Member asked about the FDP roll-out.”
“I understand the concern behind new clause 43, which the hon. Member for Sleaford and North Hykeham spoke to. However, where public money is used to provide NHS services, there should be proper transparency about the contract, the service being delivered and the use of public funds. Patients and the public are entitled to expect that information is not placed beyond reach simply because a service is delivered through a contract. I do not think the new clause necessary, and I am concerned that it could create confusion about the operation of the Freedom of Information Act 2000. The Act already deals with information held by another person on behalf of the public authority. The key issue is not where the information physically sits.”
“However, ensuring the security of our data and the resilience of our systems is already embedded in everything we do. The new clause is therefore simply not necessary. Hon. Members will accept that we want to see continued growth of digital and tech industries in this country; it is one of our real success stories. However, it will not be achieved by cutting across procurement law and not seeking the solutions that provide the best value for our money and the right service for the NHS. Our approach to securing the best IT and tech solutions should always be to seek the best on offer in a diverse, global market, not to prioritise based on location. Prioritising domestic providers means making a decision on grounds other than the quality, integrity or value for money of a solution.”
“Our international obligations matter and are an important driver of the UK economy, including the World Trade Organisation agreement on Government procurement, which gives British businesses guaranteed access to £1.3 trillion in public procurement opportunities overseas annually. As the hon. Member will understand, new clause 5 would require the Government to commit to a new programme of work to develop domestic capability, to reduce reliance on overseas suppliers of IT services and technology. The strategy would also require us to set out an approach to managing the risk associated with our current use of technology provided by overseas suppliers. I welcome the notion of encouraging domestic innovation to ensure the security and resilience of our IT infrastructure.”
“That is not an argument for complacency; we should continue to identify risks before procurement begins. A broad duty of the kind in new clause 3 would risk becoming a reporting exercise and would not necessarily make the highest-risk contracts safer. It could, however, draw time and resource away from the assurance activities that matter most. The right approach is to strengthen the targeted controls, not to create a single statutory risk assessment covering every non-UK supplier. Similarly, on new clause 4, a blanket “buy British” rule would not be the right test for NHS data contracts, although I hope that I have assured the hon. Member for Winchester that home-grown domestic products are absolutely what we are trying to focus on. The UK must treat suppliers from countries with reciprocal procurement access fairly.”
“That is why the Government’s approach is based on targeted assessment and proportionate control. We already have the tools we need in the Procurement Act 2023, which gives contracting authorities the powers to exclude suppliers and terminate contracts where the legal tests are met, including on national security grounds. They may also refer suppliers for a debarment investigation. The National Security Unit for Procurement supports Ministers in assessing suppliers on national security grounds, working closely with Departments and the intelligence community. In health and digital contracts, those procurement powers sit alongside data protection legislation and data protection impact assessments, in line with the digital, data and technology playbook.”
“More than 90% of UK public contracts are currently awarded to UK suppliers, and the Government have set out reforms to make procurement do more to support British industry and supply chain resilience. I do not think that new clause 3 is the right way to achieve proper scrutiny. It would require the Secretary of State, within six months, to conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside the United Kingdom. That would include contracts regardless of the value—we heard a little about that from the Opposition—and of the services being provided, the type of data and whether there is evidence of any sort of concern. Risk is driven by the nature of the data involved, not just where the supplier is located.”
“I am grateful to hon. Members for tabling these new clauses. I recognise the concerns behind them. Contracts involving NHS data, digital services and technology must be subject to proper scrutiny. Patients expect their medical information to be protected, and NHS staff expect the systems that they use to be safe and reliable. The Government agree that Parliament should be entitled to test how those protections work. I also want to be clear that the Government want British businesses to win more public contracts and build stronger UK capability in digital and technology. The Government are already using procurement to support British businesses, jobs, skills and national security.”
“That represents a 10.3% uplift on the back of an uplift of more than 19% across 2024-25 and 2025-26, which again was the largest uplift in funding of any part of the NHS at the time. In 2024-25, we invested around £3.7 billion in primary care dentistry, and we reduced the underspend from £392 million in 2023-24 to just £36 million in 2024-25, maximising the treatment provided across all our constituencies from taxpayers’ money. We are investing £20 million to support digital integration between primary care optometry and secondary care, supporting more eye care in the community.”
“It is a pleasure to serve under your chairship, Ms Lewell. I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. As has been said, we all know how important investment in primary care is, particularly as this Government shift to neighbourhood health, and that is why we have invested so heavily. Although we are absolutely interested in the outcomes, the inputs merit some attention too. We have provided an additional £601 million for general practice to reinforce the front door of the NHS, bringing the total spend on the GP contract to £14 billion in this year. That builds on last year’s £1.1 billion of investment, which was the biggest increase to GP contract funding in over a decade. In community pharmacy, we have increased funding by £340 million, bringing the total spend to £3.636 billion.”
“I want to be really clear with the Committee: mental health remains a priority for this Government, and the Government are already making record investments in mental health services. Spending on mental health continues to increase in real terms and is forecast to reach a record £16.1 billion in 2026-27. That represents a real-terms increase of around £140 million, compared with 2025-26 and around £900 million of real-terms growth since 2023-24.”
“I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. I will turn to amendments 9 and 10 along with new clause 27, which address similar points. These amendments would require integrated care boards to increase their spending on mental health services at least in line with their growth in their total programme funding. Amendment 10 would enable the Secretary of State to implement financial penalties for non-compliance, and new clause 27 would also place the mental health investment standard, or MHIS, on a statutory footing by requiring the Secretary of State to specify an annual increase in the proportion of mental health expenditure for each integrated care board and require integrated care boards to meet that level of expenditure.”
“However, workforce increases and funding alone will not deliver the improvements the public and patients rightly expect in mental health care and support. Demand for mental health support has risen rapidly, as we all know from our constituencies, with long waits and too many people unable to access the right support when they need it. We need a new approach that reduces waiting times, improves care quality and promotes early intervention and prevention in mental health. That is why we are developing a new cross-Government mental health strategy for England that will transform mental health care into a system that responds and intervenes earlier, reduces waiting times for support and ultimately supports people to participate fully in education, work and community life.”
“For this period—2026-27 to 2028-29—the standard has been set on real funding growth, meaning that funding is expected at least to keep pace with inflation. Meeting the mental health investment standard remains essential to delivering the Government’s ambitions on mental health, including achieving full national coverage of mental health support teams in schools and colleges by 2029, and expanding access to NHS talking therapies. The Government’s approach is to maintain strong protections for mental health investment, while giving local systems the flexibility to focus on outcomes and deliver services that meet the needs of their communities, which, as we have heard this morning, are very different.”
“I thank my hon. Friend for that and for her work on this issue. She is absolutely right: parity of esteem is critical, and we are committed to a spending increase to deliver it. I will come on to some of the points that she quite rightly made. Although I do not think he was speaking on behalf of the Select Committee, the hon. Member for Farnham and Bordon took us through some of the concerns of his Select Committee. The Government have put a formal standard and a financial safeguard in place through the mental health investment standard, and as set out in NHS England’s medium-term planning framework, we expect all integrated care boards to meet the standard over the next three years, and all are currently forecast to do so.”
“A more effective and overarching approach will be delivered through our cross-Government strategy. For those reasons, a further statutory duty is unnecessary and I ask the hon. Member for Winchester to withdraw the amendment.”
“Again, my hon. Friend makes an important point. Of course, the rising demand and the ways that waiting lists are managed and supported locally will have to be a critical part of any strategy. Also, as we have said in our elective reform plan, giving people information so that they can understand what is happening in their local systems is part of the wider patient experience work that we are going to do. The Government are committed to prioritising the delivery of mental health services. That is why we have a standard already ensuring that mental health spending keeps pace in real terms, while allowing systems discretion to make additional investment in the way that best meets local needs. The amendments would place an inflexible financial requirement in statute.”
“For those reasons, I ask the hon. Member for Winchester not to press it. I hope he feels assured that the Government will take forward many of the Committee’s concerns in the mental health strategy.”
“Friend just said, we know that good mental health and wellbeing requires more than improving NHS services. It requires concerted action to promote positive mental health and tackle the causes of mental ill health. That is why we are developing a new cross-Government mental health strategy for England, to be published later this year. It will take a whole-system approach, recognising the role of schools, employers, the voluntary sector and local government, and representing all parts of the country in promoting positive mental health and preventing mental health ill. The strategy will also go further on reducing the stigma and discrimination associated with mental health conditions, with a focus on improving mental health literacy across the population. Finally, the new clause risks imposing unnecessary burdens on local systems.”
“My hon. Friend touches on what I will come to as I conclude my remarks on the next new clause. He is absolutely right. The wider determinants of mental health need to be part of developing these services, as with physical health. On new clause 34, I reassure the Committee that the Government are taking significant steps to improve mental health services in this area. We have recruited over 8,500 extra mental health workers since July 2024, we are accelerating the roll-out of mental health support in schools and colleges, and we are investing a record £16 billion in NHS mental health services this year. Furthermore, there will remain a requirement, as introduced in the Health and Care Act 2022, for mental health expertise on local integrated care boards. However, as my hon.”
“These clauses make a clearer, more disciplined framework, where individual accountability is strengthened, ambiguity is reduced and national oversight is more coherent, while retaining targeted tools to support collaboration where it adds value. I therefore commend clauses 43 and 44 to the Committee.”
“Clause 44 amends section 223L of the National Health Service Act 2006 to enable the Secretary of State to set joint financial objectives for integrated care boards and their partner NHS trusts and foundation trusts, where local system-wide alignment is genuinely required. This approach supports the wider policy direction for ICBs to operate as strategic commissioners. With clearer organisation and financial accountability, ICBs can focus on population health outcomes, prioritising prevention, reducing health inequalities, shaping services around need, and driving better value for money through more effective commissioning.”
“By removing sections 223M and 223N, we will ensure that one organisation’s deficit can no longer be obscured by another’s surplus, while preserving the Secretary of State’s ability to set joint financial objectives for integrated care boards and their partner trusts where system-wide alignment is needed. If we are to achieve the ambitious aim set out in the 10-year health plan, of getting most providers to achieve a surplus by 2029-30, we must place the onus back on individual organisations. Each NHS organisation should be unambiguously accountable for managing its own finances, rather than relying on collective system balances to absorb overspends. Importantly, that does not mean abandoning collaboration.”
“That will include replacing “NHS England” with “The Secretary of State” in section 223GC, which concerns the power to give directions about integrated care board expenditure limits, and repealing section 223K on quality payments, as the Secretary of State can use other powers to deliver payments for quality improvement purposes. Having set out a clearer and more streamlined framework for allocating and directing NHS resources, we now turn to how integrated care boards and providers will be held accountable for managing those resources. Clause 44 will omit sections 223M and 223N from the National Health Service Act 2006, which require each integrated care board and its partner NHS trust and foundation trust to balance their finances collectively.”
“That will not remove pooled budgets; they will remain the default where they deliver better outcomes, and local areas will still be able to enter section 75 agreements voluntarily. This clause will introduce proportionate flexibility and enable the Secretary of State to decide, transparently and through published directions, whether funding should be pooled in particular circumstances. That will ensure that we can act quickly when needed, for example in responding to urgent pressures, so that the Secretary of State is not constrained by a blanket legal requirement that does not always add value. Clause 43 will also make necessary consequential changes following the transfer of functions from NHS England to the Secretary of State.”
“That will ensure that safeguards can be applied consistently, such as the ability to recover funding where there is a failure to comply with a direction. Transparency will be maintained through the requirement to publish directions. The clause will also introduce new section 223GB, setting how the direction powers in new section 223GA can be used in relation to expenditure on service integration across health and social care. At present, service integration funding must be placed in a pooled budget with local authorities, even if that is not the most effective approach. The current legislation allows for only one model, even where that may introduce unnecessary bureaucracy or delay. The clause will remove that mandatory requirement, giving the Secretary of State discretion each year on whether integration funding should be pooled.”
“These clauses will make a series of vital changes to the NHS financial framework following the abolition of NHS England, strengthening funding arrangements and financial accountability. First, clause 43 will enable funding to flow to integrated care boards following the abolition of NHS England while simplifying the powers to direct how resources are used. The first change in new section 223G will transfer the responsibility to fund integrated care boards from NHS England to the Secretary of State, maintaining continuity of allocations and allowing in-year adjustments where needed. We will also simplify the existing power in new section 223GA to direct integrated care boards in how resources are used, making it clearer and easier to use.”
“Decisions will be guided by consistent criteria, including joint spending plans and performance objectives. Pooled budgets will continue to be required where they support better outcomes. In exercising these functions, the Secretary of State must also have regard to the need to reduce inequalities in access to health services and the outcomes achieved. Together, that ensures that decisions are—quite rightly—transparent, justified and applied fairly across the entire system. Question put and agreed to . Clause 43 accordingly ordered to stand part of the Bill . Clause 44 ordered to stand part of the Bill . Clause 45 Licence conditions Question proposed, That the clause stand part of the Bill.”
“The clauses introduce flexibility, allowing the Secretary of State to determine when pooling is the best way to achieve better outcomes, while local areas are of course still able to pool budgets voluntarily through section 75 of the NHS Act 2006. The allegation that there is weakening of joint working is not true. The clauses do not remove the ability to pool budgets; they just allow flexibility. As I said, the focus remains on delivering outcomes for patients and communities, not on financial structures. A final question asked for reassurance that decisions made by the Secretary of State will not be arbitrary. Parliament will be reassured through clear safeguards and transparency. Any directions issued under the new powers must be published, ensuring visibility and accountability.”
“We are abolishing NHS England—which, as I have oft repeated in these deliberations, has not been opposed by the Opposition parties—and of course there are some consequences of that, including giving the Secretary of State powers. I will address a couple of other points directly. To be very clear, the better care fund remains a core mechanism to support the NHS and local government to join up health and social care services to a greater degree. The changes made by the clauses address the inflexibility of the current arrangements. The Committee had a good debate earlier this week about the Government’s commitment to enhancing that collaboration and joint working at a very local level.”
“In my comments on the amendments, I think that I addressed many of the points raised. On the final point made by the hon. Member for Farnham and Bordon, he will be aware that the Government have already improved financial oversight of the NHS system this year without any changes. We are getting a grip on the finances that were allowed to go so badly out of control across the entire piece under the Conservative party’s stewardship. The hon. Member for Sleaford and North Hykeham, the Opposition spokesperson, started her comments by saying that the changes made by the two clauses are entirely consistent with the wider Bill, and I agree.”
“That process is out of step with the modern, digital-first approach set out in the 10-year health plan. Technology has evolved since those requirements were set, and we no longer communicate predominately through the postal system. The changes in the clause allow for rapid communication to ensure that the notice reaches the appropriate person promptly. The clause brings the method by which the Secretary of State can deliver notices up to date with modern methods of communication to ensure that everyone affected has the chance to participate in the consultation in a timely way. I am sure all hon. Members agree that that is necessary, so I commend clauses 45 and 46 to the Committee.”
“Clause 46 clarifies the methods by which the Secretary of State can serve certain notices relating to changes in the regulation of healthcare services. It brings existing requirements up to date with modern methods of communication, reducing administrative burden. As the Committee already discussed when considering the abolition of NHS England, the Bill will transfer functions relating to the provider licence and the payment scheme from NHS England to the Secretary of State. When changes are proposed to these documents, NHS England must consult those affected and must notify all relevant organisations of the consultation. Currently, that notice cannot be delivered by email without the agreement of the organisation receiving it—without that agreement, it must be posted.”
“Licence conditions can be set only for specific purposes set out in legislation; the additional purpose does not change the existing licence conditions. The Secretary of State will be able to add or modify licence conditions only following a statutory consultation. This additional purpose will allow the Secretary of State to hold providers to account when they are not meeting their legal obligations; for example, when they are not following procurement rules. As with other conditions in the licence, it means that we can use guidance to influence provider behaviour in these areas. The change is necessary and forms an important part of the Secretary of State’s powers to intervene where providers are not meeting expectations.”
“Clause 45 adds an additional purpose to those already listed in the Health and Social Care Act 2012 under which the Secretary of State can set or modify conditions in the provider licence. It will allow the Secretary of State, who will be responsible for licensing following the abolition of NHS England, to set licence conditions that promote or secure compliance with statutory obligations. The NHS provider licence was first introduced in 2013 for NHS foundation trusts and in 2014 for eligible independent providers of NHS-funded care. It set clear rules and expectations around a range of matters, such as pricing and governance, for providers of NHS services. It also provided a mechanism for regulatory action when failures occurred at those organisations.”
“I do not have any more details on how the clauses will operate in practice and follow through into guidance; that will obviously be in the usual guidance on the operation of the system. It is usual practice for people doing the work to make contact with the receiver of the email to check that they have received it and are acting on it appropriately. Question put and agreed to. Clause 45 accordingly ordered to stand part of the Bill. Clause 46 ordered to stand part of the Bill. Clause 47 Single patient record”
“For those reasons, I ask the hon. Member for Winchester to withdraw his amendment. We have had some helpful comments about some other concerns.”
“We want to ensure that carers who act on behalf of the people they care for get the full benefit from the single patient record. NHS proxy access already allows for people other than patients—which includes carers, parents or care home staff—to manage the health and care of someone they care for. Setting up proxy access requires the consent and involvement of the individual and the person they care for. We will set out in regulations how proxy access will work for the single patient record, as in the existing NHS position. The single patient record will be developed on two priority care pathways in maternity and frailty, which will initially be delivered through local arrangements. Some clinicians and patients will be able to view and manage additional elements of care, such as proxy access for carers, earlier than others.”
“I agree with the hon. Member for Farnham and Bordon that, through this amendment, the hon. Member for Winchester has given us an opportunity to think. I am grateful to him for this chance to talk about carers and this important issue. I am a carer of an older person, and for those of us who are carers, it is helpful to have some discussion about this area. Carers play a vital role and we are committed to ensuring that they have the support they need. We are of course very grateful for all the work that they do. The Bill already includes a power that permits regulations to make patient information available to people other than patients on the patient’s behalf. As the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham, said, that can include carers, and it is our intention to do so.”
“The hon. Lady knows that we are talking about an enabling power in the Bill. All the details will be brought forward in regulations, through discussions and consultation. We will discuss that more broadly as we talk about the wider clause. One of the key issues I have been asked about is protecting vulnerable people. Patients will access a single patient record through the NHS app, and NHS England has published guidance on clinical safety, safeguarding and the NHS app, which provides advice on minimising the risk to those where there may be challenges or potential risks. We will adopt a similar approach to the single patient record. Clinicians will be able to redact information that is too sensitive to share, and we will agree a protocol with professional bodies on how that will be applied.”
“GPs already have professional duties to consider patient and public safety, and existing firearms licensing arrangements support GPs to share relevant concerns with the police where appropriate, while the responsibility for licensing decisions rests with the police. Data shows that, since its introduction in 2023, the marker is being used and that GPs are notifying police of medical issues that have arisen. There is nothing to suggest that the system is not effective.”
“When any individual applies for a firearms licence, the applicant’s doctor must provide details of any relevant medical conditions, such as depression, dementia, mental health conditions or drug or alcohol abuse. A digital maker is placed on the GP patient record when a certificate is granted, and a GP can alert the police if a licence holder has a relevant medical condition. The digital marker automatically flags to the GP if a patient is suffering from a relevant medical condition and is a firearms certificate holder. It is true that the marker is not legally mandated, but it is supported by the British Medical Association and the Royal College of General Practitioners, and the former issues guidance to GPs about the firearms marker.”
“Wherever possible, the single patient record will build on source records such as GP records. As such, it will include relevant patient information and, where appropriate, digital markers such as those suggested in the amendments. We have had some useful discussion as a result of the amendments, but such considerations are generally operational, and legislation is neither necessary nor practical. On amendment 71, Members will know that the Government have been doing significant work in support of a digital medical marker for firearms. Medical information for firearms licensing provided by the applicant has been a mandatory requirement for every firearm and shotgun licence application since November 2021, as we have heard, when the new statutory guidance for chief officers of police on firearms licensing was introduced.”
“In addition, the clause contains powers to make regulations to allow people involved in the provision of an individual’s direct care, including that of any veteran after they have left the military, to access their single patient record. We want the single patient record to improve the accessibility and effectiveness of care for everyone. That includes making sure that military veterans can access necessary support and that staff can provide them with appropriate care. Furthermore, duties in the Armed Forces Act 2006 require the NHS and local authorities to have due regard to the armed forces covenant, which, of course, I fully support. For those reasons, I ask the hon. Member for Winchester not to press amendment 72.”
“On amendment 72, as I have already outlined, the single patient record will build on and connect with existing source records, such as GP or hospital records, wherever possible. Where a person’s status as a military veteran is recorded, it will be possible to make that information available in the single patient record. Therefore, the provisions already ensure that the information is made available, where veterans opt to have that status recorded—that addresses some of the other issues raised by the hon. Member for Farnham and Bordon. There is no need to make any statutory requirement to ensure that staff have that information and consider any necessary adjustments or potential treatment options that may be relevant to ensure safe and effective care.”
“If it is agreed that it would be beneficial for health and care professionals to have wider access to the firearms marker, the single patient record could facilitate that, but we do not intend to fill the Bill with detailed operational requirements such as that. We do not believe that the SPR is the appropriate vehicle for having a debate about regulations requiring a report on the merits of a mandatory marker. As the hon. Member for Farnham and Bordon said, we should not expand the clearly defined scope of the single patient record—the scope is limited to direct care—to include a debate about what is stored more generally in NHS records. For those reasons, I ask the hon. Member for Winchester to withdraw amendment 71.”
“I am afraid I do not know the answer to the hon. Lady’s question, but if it is relevant, I will try to get back to her on it. People applying for a licence must now indicate whether they have seen a medical practitioner other than their GP. The Government also intend to make a statutory instrument to require licence holders to inform the police if they consult a third-party medical practitioner who is not their GP. The single patient record will build on and connect with information from GP source records where appropriate; no new provision is needed for that to happen. That process should be agreed as part of operational arrangements with the profession, in line with the current approach to markers in the GP record.”