Organisation objective

• governance
• statutory item

Executive summary

This paper is for the Board’s information only to provide an overview of the National Proxy Service Directions 2025 (Directions) issued to NHS England (NHSE) in January 2025 by the Secretary of State for Health and Social Care (SoS). These Directions have been issued under section 254 of the Health and Social Care Act 2012 (2012 Act) and section 13ZC and 272(7) and (8) of the National Health Service Act 2006 (the 2006 Act).

The purpose of the Directions (Purpose) is to require NHS England to provide the National Proxy Service (Service). This is a digital service for individuals registered with a General Practitioner (GP) in England (Patients) that enables other authorised individuals, called Proxies, to access digital NHS services on behalf of a Patient to support the delivery and management of the Patient’s care.

Action required

The Board is asked to note the new Directions and the information provided in this Paper regarding their purpose, effect, and requirements.

Background

1. Under section 254 of the 2012 Act, the SoS may direct NHSE to establish and operate a system for the collection or analysis of information. These are functions exercisable in relation to the development or operation of information systems in connection with the provision of health services or of adult social care in England. Under section 13ZC of the 2006 Act, the SoS may give NHSE directions as to the exercise of any of its functions.
2. The Directions are issued by the SoS to NHSE under these provisions and are functions which have been transferred to NHSE under the Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023.

Purpose of the Direction

3. The purpose of the Directions is to require NHS England to provide the National Proxy Service.

4. Proxy access is where a trusted individual, the Proxy, accesses health and care services, such as ordering a repeat prescription or viewing a medical record, for Patients they care for or support.  Accessing such services for Patients and Proxies has sometimes been a time-consuming, inconsistent, and stressful experience that has to date largely been serviced through non-digital channels.    Even where formal digital channels are available (known as “linked profiles”), digital uptake has been low due to the relatively high effort involved in applying for access, which often requires in-person identification with GPs and document verification.    The intention of the National Proxy Service is to provide a single national digital channel that will replace manual and time consuming processes, provide consistency, and reduce burden on GP’s authorising Proxy access and on their Patients and Proxies

5. The National Proxy Service deliverd by NHSE will:

• enable Proxies and Patients to easily request proxy access from their GP through digital channels
• support GPs in making informed decisions on granting proxy access through the provision of standards, guidance, and information from authoritative sources, such as the Personal Demographics Service (PDS)
• enable Proxies to use proxy relationships to access health and care services provided through local and national clinical systems for Patients they care for, such as the NHS App
• enable Proxies, Patients and GPs to manage access to ensure it remains safe and appropriate
• enable anonymous statistical data about the National Proxy Service to be used to support service delivery improvement and strategies which may improve health outcomes for the population and reduce inequalities in health

Effect and Requirements of the Direction

6. From the date of signature of the Directions, NHSE will have a legal duty to comply with the Directions, which will require it:

• to establish and operate such systems for the collection and analysis of information as are necessary to meet the above Purpose of the Directions 
• to analyse the information collected, including linkage to other data lawfully held by NHSE, as NHSE determines is necessary, to achieve the above Purpose

7. These functions are to be exercised in accordance with the Requirements Specification attached to the Directions (as they may be updated from time to time). Also in accordance with the service levels, support and monitoring requirements, and the reporting and governance requirements notified by the SoS in writing to NHSE. The exercise by NHSE of the functions set out in the Directions is also subject to the statutory guidance issued by the SoS to NHSE under section 274A of the 2012 Act: NHS England’s protection of patient data, 23 May 2023* which is guidance that NHSE has a duty to have regard to when discharing its functions under these Directions.

*https://www.gov.uk/government/publications/nhs-englands-protection-of-patient-data/nhs-englands-protection-of-patient-data

Publication

8. NHSE is not permitted to publish any data it obtains under these Directions

Approval of acceptance of Directions and publication

9. The National Director of Transformation and National Medical Director approved acceptance of the Directions on behalf of the Accounting Officer as set out in the NHSE Scheme of Delegation.  The Directions have been published on the NHSE website*.

* https://digital.nhs.uk/about-nhs-digital/corporate-information-and-documents/directions-and-data-provision-notices/secretary-of-state-directions/national-proxy-service-directions-2025

Annex 1

National Proxy Service Directions 2025

National Proxy Service Directions Requirements Specification