This week, the government launched its long-awaited 10-year plan for the NHS. At 165 pages, it’s a dense, managerial, and thoroughly technocratic document—very on brand for a government that wants to appear serious and reformist, while hoping most people won’t read past the executive summary.
There are three main themes:
- Preventative health – A focus on screening, early diagnosis, vaccinations, and lifestyle interventions like pharmacy-led weight-loss services and supermarket food reformulation.
- Community over hospitals – A shift away from a “hospital-dominated service” to one centred on neighbourhood health hubs, the “darzi centres” of previous plans
- Digitisation and AI – A “truly digital health service,” with expanded NHS app functionality, AI-driven diagnostics, and digital-first patient pathways.
It’s a top-down, big-state programme of the kind that’s fallen out of political favour in recent years—ambitious, centralised, and managerial to its core.
But beneath the jargon and aspirations lie profound changes to how the NHS will function—changes that will affect patients, staff, and the very idea of the NHS itself.
General Practice as We Know It Is Over
Let’s be blunt: the traditional model of general practice is finished.
Most GP practices will be absorbed into new Neighbourhood Health Services, large-scale primary care providers bringing together GPs, community health teams, and local authority services. At the upper end (serving populations of 250,000+), even some hospital services will be delivered in community settings.
The independent contractor model—where GPs run their own practices as small businesses—is on the way out. In future, most GPs will become salaried employees of NHS organisations. Your local GP surgery might still exist, but the ethos behind it will be radically different.
This raises big questions for primary care in deprived areas. Independent, often single-handed GPs form the backbone of NHS services in the poorest parts of the UK. Removing them without a clear replacement risks a collapse in care where it’s needed most.
Self-Referral and the Rise of the App
Patients will be able to self-refer via the NHS app to a limited range of hospital specialists, bypassing the GP as gatekeeper. This is part of a broader shift towards a digital-first health service, with algorithms and AI triaging care.
There was a lot of pre-election noise—particularly from the online middle-class left—about Wes Streeting plotting “privatisation by stealth.”
Let’s be clear: this isn’t privatisation, and it certainly isn’t stealthy. If anything, it’s the opposite—a vast programme of nationalisation. The biggest since Nye Bevan.
The Internal Market Is Dead
The internal market, the cornerstone of Thatcher-era NHS reform, is gone. Kaput. Done.
Some limited commissioning through ICBs (Integrated Care Boards) survives, but mostly for primary care and neighbourhood centres. The purchaser/provider split is being dismantled, and central control is tightening. The remaining vestiges of the market model are being phased out, with a clear drive to cut management costs and end duplication.
This is not a managed transition. It’s a hard stop. Commissioning, as we’ve known it, is over.
A Reboot of Public Health
David Cameron’s disastrous decision to move public health out of the NHS and into local government—while slashing budgets—left the country exposed when COVID hit. That, and the lazy, vacuous leadership of Boris Johnson, meant the UK had one of the worst pandemic responses in the developed world.
The new plan re-centres public health, with national campaigns targeting obesity, promoting vaccines, and banning junk food advertising.
This will provoke predictable outrage from supermarket chains, right-wing media, and the online conspiracy-industrial complex, who’ll denounce it as “nanny state overreach.”
But it’s worth remembering: the last Labour government’s smoking ban, statins, and blood pressure drugs saved millions of lives. These weren’t abstract reforms. They gave people longer, healthier lives.
Yet these gains weren’t evenly shared. In some parts of the UK, life expectancy has been falling for more than a decade—driven largely by preventable lifestyle factors, particularly obesity.
The obesity measures in this plan could be as transformative as the smoking ban—but only if the people who need them most take them up. That’s a big “if,” given how much online disinformation now targets precisely those communities.
New Financial Flows
A new system of financial flows will reward outcomes and activity, run directly from the centre—by, one assumes, some all-powerful finance overlord. (Let’s call him Jim.)
There’s no role here for local commissioning. Just top-down control.
NHS IT and AI: A Leap of Faith?
If you’re old enough to remember the National Programme for IT—also known, not so affectionately, as NPfIT or “NPShit”—you’ll be understandably wary of any NHS tech plan.
The public sector’s track record with large-scale IT is, to put it generously, poor.
Yet the new plan hinges on massive digital transformation: national patient records, ambient AI that listens in on consultations to update medical notes, and AI-led diagnostics.
This is a huge gamble. The same people who believe vaccines are mind control won’t trust an AI listening to their doctor’s appointment.
The consequences could be severe: not just worse health outcomes for the conspiracy-prone minority, but reduced access to services altogether.
And let’s not forget—we currently have a vaccine conspiracy theorist running the US Department of Health, with catastrophic consequences.
The Efficiency Mirage
To make all this work, the plan relies on a big assumption: that the NHS can become more efficient—seeing more patients with fewer staff.
The projected workforce even shows a small decline in the number of clinicians over the next 10 years, mostly by cutting overseas recruitment.
The easiest way to achieve this would be to centralise care in big hospitals, where economies of scale work in your favour.
But the plan does the opposite: moving care into smaller, local settings where clinicians travel more and see fewer patients.
To square that circle, the answer is once again: AI and digital tools.
That might sound plausible in a boardroom, but will it work in practice? NHS users aren’t a tech-savvy, app-happy crowd. They’re mostly older people, young mums, and the chronically ill.
They want face-to-face care. Fewer trips to the GP isn’t a win if it means less time with a human being who knows you.
The Biggest NHS Management Cull in History
Margaret Thatcher’s reforms doubled NHS management costs during her time in office—through the internal market, general management, and standalone NHS Trusts.
Now that’s being undone.
Ending commissioning will slash management jobs. Merging functions between NHS England and the Department of Health will cut more. Trusts will lose their back-office teams as HR and IT functions are pooled into regional shared services.
This is the largest programme of NHS management cuts ever.
For decades, politicians—especially on the right—promised to slash “NHS bureaucracy” and funnel savings into patient care. This time, it’s actually happening. Whether it’s wise to do so during a complex transformation is another matter.
Will It Work?
People won’t judge this plan in 10 years. They’ll judge it in four.
If waiting times fall, GP access improves, and patient satisfaction rises, Labour may secure re-election—with a modest majority.
If not, someone else will walk into No. 10. Someone who lacks Labour’s ideological attachment to the NHS and sees it as a costly relic of the past.
“There have always been those who whispered that the NHS is a burden, too expensive, inferior to the market,” said Wes Streeting at the plan’s launch. “And today those voices grow louder, exploiting the crisis in our NHS in order to dismantle it.”
He was clearly referring to Nigel Farage, slouching toward Downing Street, his hour come round at last.
And that’s what makes this all so risky.
Because if you’re about to undertake the biggest NHS management overhaul in a generation, is it really wise to start by firing all the managers?