The Government’s 10-Year Health Plan is bold in ambition and expansive in scope, offering a vision of a reimagined and revitalised NHS by 2035. From digitising the health system and reorganising primary care to investing in community-based services, the plan sets out to address some of the system’s most deeply embedded problems: access, fragmentation, prevention, and workforce sustainability. Yet while the aspirations are well-intended, questions remain about implementation, realism, and equity. 

From NHS to Neighbourhoods 

A central feature of the plan is the creation of a Neighbourhood Health Service (NHCs), where care is delivered as close to home as possible. At its core, this approach is about integration: primary care, pharmacy, mental health, and community services working in partnership under one roof. NHCs, particularly in communities with low healthy life expectancy, are intended to become the focal point of this transformation. 

But serious questions remain. How will these centres be staffed when primary care is already struggling to recruit and retain? What does this mean for existing GP practices, are they being rebranded, replaced or integrated? The plan glosses over these tensions, and as the Doctors’ Association points out, it risks overlooking the fact that “there are already 6,000 neighbourhood health centres, they’re called GP practices.” 

Therefore, are these NHCs a rebranding exercise, or a genuine attempt to reform? The plan leaves this unclear. Without sustained investment in workforce, estate renewal, and local leadership capacity, NHCs may remain a structural ideal with limited real-world impact.  

Primary Care: A Familiar Diagnosis, Unclear Prescription 

Primary care is at the core of the reforms. Commitments to train more GPs, incentivise same-day appointments, and launch new contracts for neighbourhood-level GP collaboration are welcome steps. 

Improving general practice access is a central promise, including ending the 8am phone scramble, introducing new contracts for larger collaborative GP groups, and boosting the number of GPs. These are all important aims. But the real bottlenecks remain: GP workload, morale, funding, and retention. Many practices are under immense pressure, particularly in deprived areas. The plan’s lack of clarity on how GP funding will be redistributed or how outdated contracts and practice-level variation will be tackled leaving major gaps. 

A successful neighbourhood model will require not just more GPs but a wholesale shift in how care is commissioned, managed, and funded.  Without addressing the underlying issues plaguing primary care - GP shortages, outdated estates, toxic cultures, and uncompetitive pay, this plan risks overpromising. The proposed neighbourhood teams may help, but scaling them nationwide will require systemic investment, cultural change, and buy-in from an already overstretched workforce. 

Dentistry: The Forgotten Frontline 

The plan also features an overdue recognition that NHS dentistry is in crisis. For too long, it has been the neglected branch of the health service, underfunded, underprioritised, and increasingly abandoned by professionals due to uncompetitive NHS rates. 

While the government proposes requiring newly trained dentists to commit to three years of NHS service, this is, at best, a temporary fix. Unless the core dental contract is reformed, making NHS dentistry financially viable and professionally rewarding, the profession will continue to drift towards private care. Forcing new dentists into the NHS system with this three-year mandatory service without structural change is unlikely to resolve the issue. 

Expanding the role of dental therapists and other professionals is an important part of the solution and could potentially work. But as recent experience with physician associates has shown, new roles must be introduced with clarity, consent, and care. Scope of practice must be well understood by the public and clinicians alike, and changes must be accompanied by proper regulation and evaluation. 

The NHS App: A Front Door or a Closed Gate? 

The proposed transformation of the NHS App into the primary gateway for all services and the new primary care “front door” reflects the plan’s strong digital ambitions. In theory, this could empower patients, helping them navigate care, access their records, leave feedback, and book services independently. It also promises to simplify clinician workflows and integrate service delivery. 

Yet, there are major caveats. A digital-first NHS may improve care for some but exclude many others. This vision potentially risks deepening inequalities. Digital-first care often works best for the most engaged, health-literate and well-resourced patients. Older people, those with low digital literacy, or individuals without reliable access to smartphones or data could find themselves excluded. A “front door” accessible to some is a barrier to others. There is little in the plan about how to support digital inclusion at scale, nor how to preserve face-to-face access for those who need it most. While the app may become the "front door," it cannot be the only door, especially as reducing health inequalities is one of the main aspirations of this new plan. 

Moreover, digital self-referral and continuous monitoring tools may reduce clinician workload, however we must proceed with caution as some conditions are missed without face-to-face contact. Clinical nuance can be lost through algorithms or chatbots. And while streamlining IT is necessary, history shows that technology in the NHS tends to add cost before it saves money.  

Tackling Inequality – Or Risking Postcode Care? 

A welcome element is the prioritisation of NHC rollout in areas with the lowest healthy life expectancy a nod to addressing health inequalities. But local care is not automatically equitable care. Without strong national coordination, there is a risk of postcode lotteries where affluent areas adapt faster and better than more deprived ones 

The plan rightly acknowledges the UK’s deep health inequalities and commits to a fairer distribution of investment. Establishing NHCs in areas with lowest healthy life expectancy is a step in the right direction. However, hyper-local care carries risks. Without national coordination, it could entrench postcode lotteries in service quality and availability. Fragmentation may worsen if Integrated Care Boards (ICBs) lack the resources or capability to deliver consistent standards. 

There’s also a contradiction at play: the government says it wants more patient voice, yet plans to abolish Healthwatch, the statutory patient representative body. This sends contradictory signals about genuine co-production. Real community empowerment means amplifying voices, not dissolving them. 

There are welcome public health measures in the plan, including action on obesity, mental health in schools, and genomic prevention. Yet the ambition still falls short of a true “health in all policies” approach. The omission of a coherent plan for social care is particularly glaring. Without resolving the crisis in care, hospitals will continue to be clogged, and community care will struggle to function. 

A Final Word: Delivery Is the Missing Link 

The government’s plan is bold and wide-ranging, from payment reforms and genomic screening to structural NHS redesign. It places faith in neighbourhood care, technology, and system integration. But ambition is not delivery. Too many reforms in the past have stumbled on workforce shortages, financial strain, and cultural resistance. There is no doubt this is a plan for the NHS. But is it a plan for health? The systemic drivers of poor health, housing - employment, education, social care are largely absent. And amidst this sweeping reform, NHS England itself is set to be abolished. The symbolic and practical implications of this are still not fully clear. 

Unless backed by real investment, inclusive implementation, and sustained leadership, this plan risks becoming yet another document of good intentions that fails to move the dial on the public’s day-to-day experience of care. Similarly, the financial models proposed, linking provider payments to patient satisfaction are untested and could unfairly penalise providers struggling with external challenges like staff shortages or poor infrastructure. 

Ultimately, this is a plan with potential, but vision alone won’t transform healthcare. The challenge is delivery. If the government is serious about reimagining the NHS, it must follow this plan with a detailed roadmap, honest engagement with clinicians and communities, and long-term investment. Without that, we risk another missed opportunity in the long history of NHS transformation.