As we head into 2026 and the New Year. The Big-Ticket Headlines for General Practice and Primary Care for the next decade

As we head into 2026 and the new year lets take a moment to reflect on possibly the most important document of 2025, the NHS 10-Year Plan. Yes, it was more aspirational than true planning. No, it had no real detail or a roadmap of how the change would come about. Yes, the financial detail was completely missing; and no, it did not address any of the very real concerns around the future of the GP contract.

The Big-Ticket Headlines for General Practice and Primary Care for the next decade

The shift of care away from hospital settings

Technology

Sickness to prevention

Neighbourhoods as the ‘Unit of Health’ Planning and delivery

Financial sustainability

Why do national plans for the NHS often fail?

Often this is due to the recurring cycle of structural, financial, and political issues. Most recently, in March 2025, the UK government announced the abolition of NHS England to bring the service back under "democratic control," citing the failure of past independent management structures to drive reform or improve public satisfaction. The primary reasons for past failure include:

  • Chronic Underinvestment and Raiding Budgets: While funding has increased in absolute terms, it has historically grown at below-average rates (approx. 2% verses 3.8% long-term average). Critically, money intended for long-term "capital" investment (buildings, technology) is frequently diverted to cover day-to-day operational deficits, stalling modernisation efforts.

  • Constant Structural Reorganisation: The NHS has been in a state of nearly constant top-down reorganisation for 50 years. These shifts often duplicate work or create "paralysis by analysis," where crucial national projects are delayed by repeated rethinking of governance structures.

  • Workforce and Retention Gaps: Plans often set ambitious recruitment targets but fail on retention. High levels of staff burnout (e.g., 73% of GP registrars in 2024 reported stress) and a lack of focus on improving working conditions lead to high attrition, undermining service delivery.

  • Failure to Reform Social Care: The collapse of the social care system creates a "bed crisis" in the NHS, where patients who are medically fit to leave cannot be discharged. This prevents the flow of patients through hospitals and is a primary cause of missed targets for A&E and elective care.

  • "Top-Down" Implementation Errors: Large-scale projects, such as the National Programme for IT, often fail because they are imposed from the centre without sufficient engagement from front-line clinicians or understanding of local technical complexities (a problem also often seen when hospital redesign IT systems with no proper engagement with GPs).

  • Mismatch Between Ambition and Evidence: National plans frequently promise significant shifts—such as moving care from hospital to community—without the necessary funding or evidence-based "theory of change" to achieve those goals. For example, 2025 reports noted that productivity improvements promised in the 10-Year Plan were unprecedented and lacked a detailed roadmap for realization

The NHS 10-Year Plan may set out worthy aspirations, difficult to argue with, but for those of us working in primary care, the context feels very different. People facing real-world problems, and healthcare systems that can sometimes feel like barriers to care. This is before you consider the increasingly choppy waters ahead of GP contract negotiations, the growing spectre of a plurality of contracting routes, and the real risk that GMS could be both imposed upon us and diminished.

In this uncertainty, we need a stable foundation, an even keel that helps us reach a future that works for patients and the professions alike. Here are some thoughts on how we might renew general practice for the decade ahead.

Continuity

Continuity isn’t about the old days, or what we used to do when GPs had a personal list. It should be the organising of the long-term understanding and context of people’s lives that allows everything else to make sense. When someone sees the same clinician or small team over time, they build a depth of insight that no dashboard or algorithm can replicate. It brings context, trust and clarity and clinicians feel more grounded, more effective, and less stretched by fragmented encounters.

Continuity creates the conditions for good, shared judgement and stability in the system, which can lead to fewer avoidable admissions, fewer unplanned attendances, and more effective long-term care. Surely, that is true patient-centred care?

Neighbourhoods as the Unit for Health

Health isn't created in national strategies or organisational diagrams. It generated in local areas or neighbourhoods. Neighbourhoods are small enough for personalised care, large enough for meaningful population planning, and grounded enough for long-term trust. But neighbourhood change must grow from the ground up and be accountable to the people who live there. If the NHS wants truly integrated, proactive, and preventive care, this is the scale at which it becomes real.

A Renewed General Practice

An oft asked question is can the partnership model and small GP practices survive? I think the answer is yes. But perhaps not as isolated practices, unable or unwilling to share some of that sovereignty with models of general practice at scale in its different guises. Perhaps the time has come for a greater debate on single and multi-neighbourhood providers, accountable for populations, guardians of local resources, and leaders of out-of-hospital care. In a world where GMS risks being both constrained and diminished, organising at scale is not just protection, it is an opportunity, a chance to demonstrate general practice strengths. A renewed general practice can rise above contracting volatility and deliver its true potential and capability.

Leadership That Bridges Cultures

Primary care sits at the crossroads of many worlds. Clinical, managerial, digital, the community and more. We need leaders who can move fluently between these cultures, turning complexity into coherence, bridging expectations, and helping teams adapt as the system evolves. This is one of the core strengths of general practicebut primary care cannot deliver without a strengthened and well-funded general practice. Asking GPs to take on this role takes them away from clinical work and is too often unfunded from a system point of view. This work needs proper recognition if it is to work.

A Shared Agenda for What Comes Next Nationally and Locally

We urgently need, a shared professional voice, a way for the profession to speak with one voice, even as the ground shifts beneath us and the creates the conditions for division and fragmentation. As ICBs change and diminish in numbers and resources it is too easy for them to say they can’t speak with every practice. They often take short-cuts that lead to problems later. We also need to find the local clinical and managerial leaders who can not only help create the vision but have the ability to take people with them. This is not taught in medical schools and too often is missing in management education too. Leadership needs trust, understanding, plurality, negotiation, and time. The latter is something that too often the political leadership of the NHS dismiss.

Real-World Evidence

The health technology revolution is already with us. Whether it be A.I., wearable sensors, genomics, or diagnostics, we must be directed by what works in everyday real lives and not bespoke pilots that catch the politicians’ eyes. It can provide the real data which can be used to develop and drive neighbourhood strategies and prevention services. Many general practice or primary care teams already have the expertise this requires, based on clinical judgement, training, understanding, and continuity of delivery over time. Real-world evidence is how general practice leads innovation safely.

Despite the short comings of the 10-year plan (and I have been as critical as the next person) and the fact that the moment is uncertain and challenging, it is also full of possibility, if we choose to step toward it together in 2026. There are still challenging conversations and negotiations to be had. Politicians need to deliver the resources. Commissioners need to articulate clear local strategies and back them with the structural support needed. General practice needs to be bold and take control of the local debate.

William Greenwood

Chief Executive and Company Secretary