One of my old PCT colleagues died a couple of weeks back. A North East GP who was a staunch advocate of clinical leadership.
If you have half an eye on the news, you’ll know something big is happening inside the NHS. But the scale of the NHS reforms 2025 is still flying under the radar. This Government is halfway through some of the most sweeping changes the health service has seen in decades.
Some ideas aren’t new: shifting care out of hospitals, focusing on prevention, and using technology to boost productivity. Every administration has said something similar. But the intensity of the digital push — especially the sudden enthusiasm for AI and the decision to work with American firms like Palantir — marks a serious shift.
Performance is improving. Hospital metrics are heading in the right direction. Staff turnover is dropping. It’s far too early to declare victory, but something is clearly happening. Whether these improvements are because of the NHS reforms 2025, or because Sir James “The Jim Reaper” Mackey and a handful of very capable leaders are working miracles behind the scenes, remains to be seen.
1. The Management Shake-Up: The Most Radical Part of the NHS Reforms 2025
Every new Government promises to “cut bureaucracy”. Very few actually do it. This one is genuinely ripping out a whole layer of NHS management — and not the soft targets.
The NHS currently has two broad types of managers:
- Managers inside NHS Trusts, who run hospitals and patient services.
- Managers who run the internal market, moving money, contracts and activity around the system (the legacy of the Thatcher-era purchaser/provider split).
Under the NHS reforms 2025, category two is being wiped out entirely.
- 12,000 management posts are going immediately.
- Further consolidation of back-office functions could push total cuts over 20,000.
This is astonishingly bold from Wes Streeting:
- Cutting managers while simultaneously introducing sweeping reforms is a huge operational risk.
- Those managers usually act as a buffer between political decision-makers and operational failure. Remove them, and the Secretary of State stands alone when things go wrong.
The internal market, in place in some form since the late 1980s, is now being dismantled completely. The NHS reforms 2025 mark the final end of the Thatcher-era system.
2. The Silent Earthquake: The Future of General Practice
The biggest change — and the one almost no one is talking about — is the transformation of general practice.
When the NHS was founded, hospitals were nationalised, but GPs remained private contractors under NHS contract. This hybrid model has defined British primary care for nearly 80 years. Independent contractor status gave GPs autonomy, protected clinical decision-making, and allowed many overseas-trained doctors to build successful, independent careers.
From the 1960s onward, non-UK doctors faced racism in hospital medicine. General practice gave them a level of freedom and dignity they struggled to find elsewhere. Many single-handed practices in deprived areas were kept alive by this workforce when no one else would take them on.
But Covid changed everything. GPs were widely criticised — fairly or not — for doing little face-to-face work during lockdown, then earning significant income from vaccination clinics while the rest of the NHS strained under pressure. That perception has stuck at the top of the system.
Under the NHS reforms 2025, the Government is doing what no previous administration dared:
They are dismantling GP independent contractor status.
The model is being rapidly shifted towards:
- salaried GPs,
- large community clinics,
- fewer GP partners,
- and far greater central control over primary care.
This is the most significant nationalisation of NHS services since 1948 — ironic, given the constant online claims that Labour is “privatising the NHS”. The opposite is happening.
3. Up the ARRS: What the Workforce Numbers Reveal
The Institute for Government’s report on the NHS reforms 2025 is pessimistic, but some progress is clear if you look closely.
The salaried GP workforce is growing at record speed.
Between June 2024 and September 2025:
- Salaried GPs increased by 2,219 FTEs
- That’s a rise of 20.5%
- The monthly growth rate is 147.9 FTEs
- Historically it was 25 per month (2015–2019)
This is a massive shift, driven largely by international recruitment. In 2019, 28% of GP trainees were internationally trained. By 2025, it’s over 50%.
Turnover is also falling — fewer GPs are leaving the profession entirely.
But GP partners are collapsing as a group.
Over the last decade, partner numbers have fallen nearly 30%, and the decline is accelerating under the NHS reforms 2025.
- Partners under 40 have dropped by 61.3%
- Since June 2024, GP partners overall have fallen 4.1%
- Partners under 40: down 17%
The partnership model isn’t “under pressure”.
It’s dying.
4. The Big Risk: A More Centralised NHS Than Ever
All of this points to one huge issue:
The NHS is becoming more centralised than at any point in its history.
- Fewer managers
- Fewer independent GP practices
- More central command and control
- More regional alignment through Mayoral authorities — but not everywhere
The promise of integrated care depends on strong relationships between the NHS and local authorities. But not every area will have a Mayor before the next election, which leaves gaps in accountability.
The biggest worry is the risk to clinical leadership.
The NHS works when clinical priorities and management processes align. It fails when top-down systems collide with clinical reality.
The NHS reforms 2025 risk creating exactly the kind of monolithic nationalised structure Bevan never actually built — and which the NHS has spent decades trying to avoid.
British coal and British steel collapsed under the weight of centralised control.
The NHS survived because it wasn’t built that way.
If Wes Streeting and Sir James aren’t careful, the very reforms intended to modernise the NHS could re-create the weaknesses that destroyed Britain’s other great post-war industries.
https://www.instituteforgovernment.org.uk/publication/performance-tracker-2025/nhs/overview
https://www.instituteforgovernment.org.uk/publication/performance-tracker-2025/nhs/general-practice
https://www.rcgp.org.uk/News/Number-of-GP-practices