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15th July 2025
A single national formulary (SNF) for prescribing in England will be in place within the next two years under proposals, the Government has announced.
Outlined in the new NHS 10-year plan and backed by the National Institute for Health and Care Excellence (NICE), the SNF will reduce duplication and the ‘postcode lottery’ that has arisen out of locally derived formularies, the Government said.
A new formulary oversight board will be set up and given responsibility for sequencing products included in the formulary on the basis of clinical and cost effectiveness.
Prescribers such as clinicians and pharmacists will be ‘encouraged’ to use products ranked highly in the SNF. But they will ‘retain clinical autonomy’ as long as they prescribe in line with NICE guidance, the plan states.
‘The system for getting new medications to patients is needlessly complicated,’ the plan continues.
‘The process by which each local area decides which drugs are available is bureaucratic and creates a postcode lottery.
‘These local formularies do not make sense in a universal service that should provide a core standard of high-quality care to everyone.’
It is hoped that implementing a SNF will drive ‘rapid and equitable adoption of the most clinically and cost-effective innovations’.
‘We will work with industry throughout the implementation of these policies to make sure we realise these objectives together.’
Under the new Government plan for the NHS, NICE will also be tasked with deciding what treatments are no longer providing value for money.
One analysis had suggested 30% of the costs of treatment were no longer good value for money and in some areas such as heart failure lives could be saved by treating people earlier in the pathway, the plan said.
‘To create more space for the myriad of innovations of the future, we will need to improve the outcomes and value we are delivering from innovations already in use.’
NICE will be asked to re-evaluate priority clinical pathways ‘on a rolling basis’, identifying where existing innovation should be retired, as well as instances when one technology should be sequenced after another to improve value.
‘We will link NHS compliance with these decisions to core clinical standards, best practice tariffs and incentives,’ the plan noted.
NICE’s technology appraisal process will be expanded to cover some devices, diagnostics and digital products. It will focus on those that meet the most urgent needs in the NHS and support financial sustainability, such as digital behavioural therapy for adolescents on mental health waiting lists, the Government said.
Dr Sam Roberts, chief executive of NICE, said: ‘The plan gives NICE the power to get medicines to patients faster, reduces the postcode lottery for high impact health technology, and maximises the value for money of existing innovations used in the NHS.’
And Dr Roberts outlined the ways in which NICE will work to achieve this, including new recommendations to extend access to effective treatments beyond their initial indications, providing advice and clearer decision pathways for clinicians on which treatments to try first when there are many choices for the same condition, and helping the NHS to identify and phase out innovations that no longer represent good value or best care.
A version of this article was originally published by our sister publication Pulse.
14th July 2025
Postoperative radioiodine is unnecessary for patients with low-risk differentiated thyroid cancer who have undergone thyroidectomy, a large UK randomised trial shows, potentially saving thousands of patients from undergoing the treatment.
Thyroid cancer is the seventh most common type of cancer globally, with 821,000 new cases diagnosed each year and approximately 48,000 annual deaths, as of 2022.
It has been standard practice internationally to perform a total thyroidectomy on patients with well differentiated thyroid cancer followed by postoperative radioiodine, also known as radioiodine ablation.
However, radioiodine ablation involves hospital admission and isolation, together with the possibility of treatment-related side effects, as well as the need to avoid close contact with children for several days once discharged.
Writing in The Lancet, the researchers noted controversy over this practice, pointing to previous observational studies and one randomised trial called ESTIMABL2 indicating that selected patients with low-risk differentiated thyroid cancer could avoid ablation.
As such, their recent Iodine or Not (IoN) study was a multicentre, Cancer Research UK-funded, phase three trial designed to assess whether recurrence-free survival was non-inferior after no ablation in selected low-risk thyroid cancer patients.
The researchers recruited 504 patients (77% female) aged 17-80 years who had complete (R0) resection following total thyroidectomy; stage pT1, pT2, pT3 or pT3a disease; and N0, Nx or N1a disease.
All patients who had a thyroidectomy were randomly assigned 1:1 to have either no ablation or 1.1 GBq ablation, with a median 6.6 years follow-up in the ablation group and a median 6.8 years follow-up in the no ablation group.
The researchers observed patients with annual neck ultrasound and six-monthly serum thyroglobulin measurements.
They found five-year recurrence-free rates were 97.9% in the no ablation group compared with 96.3% in the ablation group in an intention-to-treat analysis.
The five-year absolute risk difference was 0.5 percentage points, they reported, showing non-inferiority was reached.
There were no treatment-related deaths and adverse events were similar between groups, with the most common being fatigue, lethargy and dry mouth.
‘The IoN trial shows that ablation (or postoperative radioiodine) can be avoided for patients with pT1, pT2, and N0 or Nx tumours with no adverse features,’ the researchers concluded.
There were only a small number of patients with pT3, pT3a, or N1a tumours in the IoN trial, meaning subgroup analyses were underpowered for these patients and care was need when applying the results of the trial to all pT3 or N1a tumours, they cautioned.
‘A clinical decision was made to not provide a definitive statement on the basis of numerically higher recurrence rates in these patients, even though the rates were not higher among patients who did not have postoperative radioiodine than those who did have ablation,’ the researchers wrote.
The results from IoN, taken with the findings from ESTIMABL2, suggested that at least 400,000 patients with low-risk differentiated thyroid cancer worldwide could avoid radioiodine ablation after a total thyroidectomy.
‘A change in UK policy to not offer ablation to all patients with suitably low-risk disease could mean that approximately 2,500 patients could safely avoid ablation each year (if 70% of patients newly diagnosed with differentiated thyroid cancer would typically be given ablation),’ the researchers said.
Professor Allan Hackshaw, a trial investigator from UCL Cancer Institute in London, said the results showed radioactive iodine represented over-treatment in these low-risk patients.
‘The only impact of not receiving this radiotherapy was a positive one on people’s quality of life,’ he said.
This was particularly important because around a third of patients in the study were aged 40 years or younger, and many would have children to care for, Professor Hackshaw noted.
‘Being spared radioactive iodine therapy means they will be able to get back to a near normal life much more quickly, as well as receiving the emotional and physical support of their families in the weeks after their operation,’ he added.
In 2020,
Healthcare professionals have been urged to be alert for a small increased risk of Guillain-Barré syndrome following respiratory syncytial virus (RSV) vaccination in adults aged 60 years and older.
In updated advice, the Medicines and Healthcare products Regulatory Agency (MHRA) said this applies to all recipients of Abrysvo (Pfizer) and Arexvy (GSK). They advised being attentive to signs and symptoms of Guillain-Barré syndrome to ‘ensure early and correct diagnosis’ as well as initiating appropriate care and treatment.
Symptoms include tingling, numbness or pins and needles in the feet and hands, which is usually followed by muscle weakness and difficulty moving joints. Other symptoms can include nerve pain in the legs or back, breathing difficulties, drooping face muscles or trouble swallowing or speaking, and double vision. Paralysis can occur in some severe cases.
Early hospital treatment for Guillain-Barré syndrome can reduce severity and improve outcomes, the medicines regulator said, adding that the benefits of vaccination against RSV for older adults still outweigh the small risk of developing the condition.
The MHRA update stressed that currently there is no evidence of an increased risk of Guillain-Barré syndrome in pregnant women following RSV vaccination.
The NHS currently offers Abrysvo to adults aged 75-79 years old and to pregnant women, with the latter being effective against severe RSV infection in infants.
Arexvy is not currently available on the NHS but may be available privately for use in individuals aged 60 years and older, or those aged 50-59 years who are at increased risk of RSV.
Up to 2 June 2025, the MHRA said it had received 21 Yellow Card reports of suspected Guillain-Barré syndrome in older adults following a vaccination with Abrysvo.
The regulator is reminding healthcare professionals and patients to continue to report side effects associated with the RSV vaccine to the Yellow Card scheme.
So far, around 1.9 million doses of Abrysvo have been given as part of the older adult RSV vaccination programme.
A post-marketing observational study in the United States in older adults estimated that Abrysvo and Arexvy were associated with nine and seven excess Guillain-Barré syndrome cases per million vaccine doses administered, respectively.
Preliminary unpublished post-marketing study data from the UK Health Security Agency (UKHSA) and Public Health Scotland studies in adults aged 75-79 years estimate a combined excess of 15 to 25 Guillain-Barré syndrome cases per million vaccine doses of Abrysvo administered.
A review of the latest UK data by the Commission on Human Medicines has advised that the ‘benefits of the vaccine outweigh the risk of developing Guillain-Barré syndrome in older adults’.
An analysis by the UKHSA published in The Lancet in March found a 30% drop in hospital admissions in 75- to 79-year-olds – who are eligible for the RSV vaccine – after the vaccination programme was introduced.
A version of this article was originally published by our sister publication Pulse.
A generative artificial intelligence (AI) diagnostic tool has been launched by Microsoft, which it claims is four times more accurate than experienced physicians and has the potential to ‘reshape healthcare’.
The Microsoft AI Diagnostic Orchestrator (MAI-DxO) was tested on 304 complex diagnostic cases published in the New England Journal of Medicine and achieved an 85% diagnostic accuracy rate, according to a recent study.
The accuracy of diagnoses by 21 physicians working in the US or UK was also tested in comparison, with a median of 12 years’ of experience. Of these, 17 were primary care physicians and four were in-hospital generalists. Their average diagnostic accuracy was 19.9%.
The research also looked at the cost of the tool, claiming it saved 20% in diagnostic costs compared to physicians.
The study, called Sequential Diagnosis with Language Models, which was not peer reviewed, was published on arXiv – a research sharing platform maintained by Cornell University.
‘When doctors begin their careers, they face a key decision: should they become generalists, with broad knowledge across many medical areas, or specialists, with deep expertise in a narrow field? This division is necessary because medicine is too vast for any one person to master in full,’ the study said.
‘To manage this complexity, healthcare systems rely on collaboration: generalists and specialists work together in clinics and hospitals, combining their diverse and complementary knowledge and decision-making skills to provide patients with the comprehensive and effective care that they need.
‘Today, frontier AI language models are challenging this traditional structure. These advanced systems show remarkable versatility, demonstrating both broad and deep medical understanding, and the polymathic ability to reason across specialties. In effect, they combine the generalist’s range with specialists’ depth.
‘As a result, they significantly outperform individual physicians on complex diagnostic problems, such as those featured in the NEJM clinicopathological conference cases. Our findings highlight this impressive capability. Expecting any single doctor to master the full range of such cases is unrealistic.’
This study comes after Microsoft co-founder Bill Gates, suggested earlier this year on The Tonight Show that AI could mean doctors would not be needed ‘for most things’ within a decade.
However, Microsoft added that its MAI-DxO system is meant to ‘complement’ doctors and other healthcare professionals.
It said: ‘While AI is becoming a powerful tool in healthcare, our team of practising clinicians believes AI represents a complement to doctors and other health professionals.
‘While this technology is advancing rapidly, their clinical roles are much broader than simply making a diagnosis. They need to navigate ambiguity and build trust with patients and their families in a way that AI isn’t set up to do.
‘Clinical roles will, we believe, evolve with AI giving clinicians the ability to automate routine tasks, identify diseases earlier, personalise treatment plans, and potentially prevent some diseases altogether. For consumers, they will provide better tools for self-management and shared decision making.’
AI has a large role in the new NHS 10-year plan, which was published this week. This includes an AI scanning tool for NHS systems in order to flag safety issues in real time.
Last year, a white paper from the Microsoft company Nuance found that over a third of patients are in favour of clinicians using AI in consultations to improve documentation processes such as clinical letters.
Research by the Health Foundation also found that three quarters (75%) of the public support sharing some of their personal health data to aid the development of AI systems in the NHS.
A version of this article was originally published by our sister publication Healthcare Leader.
11th July 2025
Dermatologists working in the NHS are calling for an artificial intelligence (AI) roadmap to help them navigate the use of assistive technology as its use becomes increasingly mainstream.
A new report from the British Association of Dermatologists (BAD) highlights the need for urgent action and urges the Government and regulators to implement changes that ensure patient safety while promoting the adoption of suitable AI technology.
Without stronger regulation and targeted workforce training, there is a concern that the promise of diagnostic AI in dermatology outlined in the new NHS 10-year plan will not be effectively harnessed. Underpinned by both the need to innovate while improving patient outcomes, the report identifies five urgent priorities for policymakers: a clear regulatory framework, investment in digital infrastructure, better data quality and diversity, clearer market signals for developers, and enhanced training for healthcare professionals.
AI technology is already being used in many NHS settings. As demand for dermatology services increases, dermatologists are urging national policymakers to take decisive action to help alleviate this burden. One in four people in England and Wales visit their GP for a dermatologically related condition every year. Since January 2025, the waiting list for dermatology services has been 118% above its July 2020 level – one of the highest increases among all clinical specialities.
One major driver of this pressure is the sharp rise in urgent skin cancer referrals. Over the last decade, referrals have jumped by 170%, but according to NHS data, only 6% of referrals result in a confirmed skin cancer diagnosis. The remaining cases are either benign or non-urgent but place a significant burden on already stretched services, as well as contributing to patient anxiety.
Dr Rubeta Matin, consultant dermatologist at Oxford University Hospitals NHS Foundation Trust and chair of the BAD’s AI Working Party Group, said: ‘Diagnostic AI has huge promise across many disease areas in dermatology, but we are keen to see if it can safely triage and reduce the huge number of patients referred with a suspected skin cancer who don’t need to be seen. If it can, this would significantly ease capacity pressures and help ensure that those who do need care are seen more quickly.’
The report authors said that ‘it is not inevitable that diagnostic AI in dermatology will improve current services’ and warned that innovation and the implementation of AI in dermatology must be done without exacerbating existing pressures or inequalities.
Dr Tamara Griffiths, president of the BAD, commented: ‘We are fortunate to have an innovative and dynamic AI industry in the UK, but it needs support and unambiguous signals from the NHS about the type of tools which are required.’
She continued: ‘In return, the NHS needs a clear regulatory framework and appropriate clinical input to ensure it is adopting tools which are relevant and safe. Most importantly, we need to ensure that when AI is adopted, it improves the overall patient experience and outcomes in terms of safety, convenience, and waiting times.’
Commenting after the launch of the NHS 10-year plan, she noted that while ‘dermatology is seen as especially well-positioned to capitalise on technologies like teledermatology and AI diagnostics’, its potential ‘will only be realised with the right regulation, digital infrastructure and clinical safeguards in place’.
‘Without these, such tools risk falling short of expectations,’ she concluded.
A version of this article was originally published by our sister publication Nursing in Practice.
10th July 2025
E. coli is capable of turning plastic waste into paracetamol and could offer a new and sustainable production method, according to a new study by the University of Edinburgh.
Published in the journal Nature Chemistry, the researchers looked to combine traditional chemistry with engineering biology to create sustainable chemicals using the plastic polyethylene terephthalate (PET).
They used a biocompatible Lossen rearrangement to transform PET-derived terephthalic acid from industrial waste into paracetamol using a harmless and genetically reprogrammed E. coli catalysed by phosphate.
Carried out at room temperature and in less than 24 hours, 92% of the final yield was paracetamol.
The researchers said this paves the way ‘for a general strategy to bioremediate and upcycle plastic waste in native and engineered biological systems’.
The process created virtually no carbon emissions, unlike traditional paracetamol production methods reliant on fossil fuels such as crude oil.
What’s more, over 350 million tons of PET waste is produced annually, often ending up in landfill or polluting oceans. While PET recycling is possible, the resulting products continue to contribute to plastic pollution throughout their lifetime.
This innovative paracetamol production process generates a circular economy by producing sustainable chemicals, reducing waste and greenhouse gas emissions and disrupting the reliance on fossil fuels.
Professor Stephen Wallace, UK Research and Innovation Future Leaders Fellow and chair of Chemical Biotechnology at the University of Edinburgh, said: ‘This work demonstrates that PET plastic isn’t just waste, or a material destined to become more plastic – it can be transformed by microorganisms into valuable new products, including those with potential for treating disease.’
Further development is needed before paracetamol can be produced using this method at commercial levels, the researchers said.
‘Future work will also focus on applying the biocompatible Lossen rearrangement to other chemo-enzymatic cascades and fully integrating this new-to-nature reaction within metabolically evolved microorganisms,’ they added.
Earlier this year, a study examined public and prescriber perceptions of pharmaceutical pollution in Scotland’s water environment, with a focus on eco-directed sustainable prescribing as a strategy to mitigate this pollution.
9th July 2025
A new inherited DNA repair deficiency syndrome, which increases a patient’s risk of developing blood cancer but also leaves them susceptible to DNA damage from chemotherapy, has been identified by a UK research team, highlighting the need to tailor cancer treatment regimens to minimise toxicity in affected patients.
Writing in the journal Nature Communications, the research team, led by the University of Birmingham, reported the discovery of DIAPH1 Loss-of-function (DIAL) syndrome, which is characterised by biallelic loss-of-function mutations in the actin nucleating factor diaphanous-related formin 1 (DIAPH1 or mDia1) and causes clinical symptoms early in life.
The DIAPH1 gene mutations were identified in a single index patient, who had symptoms including microcephaly, behavioural abnormalities, intellectual disabilities, cortical blindness and seizures.
Working with neurogeneticists at University College London, researchers later identified more than 30 patients with these mutations, all of whom exhibited similar symptoms such as microcephaly, intellectual disability, impaired vision and seizures.
Among the cohort, one patient developed Hodgkin lymphoma, and another developed a large B cell lymphoma.
In addition, the clinical symptoms in this cohort were strikingly similar to the DNA repair disorders Nijmegen breakage syndrome (NBS) and Warsaw breakage syndrome, both of which are risk factors of blood cancer.
This finding prompted the team to investigate whether DIAPH1 functioned to regulate the actin-dependent DNA double strand break repair (DSBR) process, which was fundamental to maintain genome stability and prevent the onset of disease.
Through a series of cell analyses, they showed DIAPH1 was essential for facilitating homologous recombination (HR)-dependent repair of DNA double strand breaks induced by ionising radiation and the chemotherapeutic agents, camptothecin and etoposide.
‘Taken together, we identify DIAL syndrome as a previously undiscovered DSBR deficiency syndrome associated with neurodevelopmental abnormalities and tumour predisposition akin to those observed in patients with NBS,’ the study authors concluded.
‘Furthermore, we demonstrate that loss of DIAPH1 results in defective HR-dependent DNA repair, which is consistent with many of the clinical deficits exhibited by affected patients as well as the suggestion that in some cases DIAPH1 may act as a tumour suppressor.’
Study corresponding author Professor Grant Stewart, professor of cancer genetics in the Department of Cancer and Genomic Sciences at the University of Birmingham, said patients with inherited DNA repair deficiency syndromes were ‘usually children who are very sick’.
‘In addition to developmental abnormalities that affect many different organs, these patients are often prone to developing cancer. Unfortunately, the DNA repair defect that is present in every cell in their body makes them extremely sensitive to the therapy that would normally be used to treat their cancer,’ he said.
‘While inherited DNA repair deficiency syndromes like DIAL syndrome are rare, it is critical to identify children with these conditions early in life – especially before starting anti-cancer treatment to avoid life-threatening consequences.’
Professor Stewart said the research was crucial for affected patients and their families, as it not only provided a diagnosis for a previously unrecognised genetic condition but also informed parents and medical professionals about disease progression, potential complications, and cancer risks.
He added: ‘Additionally, this research will help guide oncologists in adjusting cancer treatment protocols to minimise toxicity in affected patients, potentially improving both their quality of life and treatment outcomes.’
The researchers want to ensure DIAL syndrome is included in sequencing panels to allow newborn diagnosis and give the opportunity for more personalised therapeutic regimes to be used if individuals with DIAL syndrome develop cancer.
Dr Laura Danielson, children’s and young people’s research lead at Cancer Research UK – the charity that funded the research – welcomed the study’s findings and the potential for more personalised care.
‘It’s a powerful example of how research can make a real difference, even in the rarest of cases,’ she said.
8th July 2025
The Care Quality Commission (CQC) will carry out ‘rapid response inspections’ of healthcare providers based on prompts from a new artificial intelligence (AI)-led early warning system, the Government has announced.
Forming part of its NHS 10-year plan, this system will see the CQC moving to a ‘more data-led regulatory model’.
The new national AI-powered early warning system will build on the capabilities in the Federated Data Platform (FDP) to monitor real-time data to flag safety issues. Where problems are detected, inspection teams will be deployed quickly to assess service quality.
The changes will mean that in future the CQC will use two different models of inspection:
The Government also pledged to take firmer action where standards are not met by healthcare providers.
The CQC will ‘make sure persistent poor-quality care results in the decommissioning or contract termination of services or providers, no matter the setting, no matter whether the provider is in the NHS or independent sector, and no matter whether they are a GP practice or an individual NHS Trust’, the plan said.
In its first stage, a maternity outcomes signal system will launch across NHS trusts from November, to flag higher than expected rates of stillbirth, neonatal death and brain injury. But when fully implemented it could be used to identify patterns of abuse, serious injuries, deaths, or other incidents.
Health secretary Wes Streeting said: ‘While most treatments in the NHS are safe, even a single lapse that puts a patient at risk is one too many. Behind every safety breach is a person – a life altered, a family devastated, sometimes by heart-breaking loss.
‘Patient safety and power are at the heart of our 10 Year Health Plan. By embracing AI and introducing world-first early warning systems, we’ll spot dangerous signs sooner and launch rapid inspections before harm occurs.
‘This technology will save lives – catching unsafe care before it becomes a tragedy. It’s a vital part of our commitment to move the NHS from analogue to digital, delivering better, safer care for everyone.’
Other planned changes include extending the regulator’s legal powers and expanding its inspection remit. The current three-year time limit for the CQC to bring legal action against healthcare providers will be extended.
The CQC will also assume the function of checking ‘whether every provider (and in time, ICB) has effective freedom to speak up functions’, according to the plan.
As part of plans to reduce the number of NHS quangos, the CQC will also absorb organisations such as the Health Services Safety Investigations Body to counter and simplify the ‘regulatory tsunami that is overwhelming the system but has not led to sustained improvements in safety’, the plan said.
It follows last year’s Dash review into the CQC’s effectiveness which found it had ‘lost credibility’, including a marked increase in the time it took to re-inspect healthcare services.
Average re-inspection times increased from 87 days in 2015 to 136 days in 2024 for ‘inadequate’ ratings, and from 142 days to 360 days during the same period for ‘requires improvement’ ratings.
In addition, the CQC was plagued by IT system failures which led to the temporary ‘loss’ of hundreds of inspection reports.
CQC chief executive Sir Julian Hartley said: ‘We welcome this ambitious, future-focused plan for a world-class NHS that truly delivers for patients and the public.
‘We will develop a stronger focus on all dimensions of quality and on tackling inequalities in access, experience, and outcomes. Our ambition to become intelligence-led will be further boosted by the development of tools that help us capture the voice and experiences of people using health and social care, which we will use alongside our own data and that held by partners to spot and act on risk earlier.
‘We are already developing our new clearer, simpler, assessment approach, and in the future our experienced teams of inspectors, led by our newly appointed Chief Inspectors, will be able to conduct more inspections and share feedback on the findings more quickly – so that providers can make faster improvements, and the public have timely information about care.’
Sir Julian added that a focus on tackling longstanding inequalities and the CQC’s unique perspective across local systems will enable the regulator ‘to understand where gaps between services impact people – and how to close those gaps’.
A version of this article was originally published by our sister publication Pulse.
7th July 2025
With the launch of the NHS 10-year plan, a new operating model will rollout single and multi neighbourhood providers, establish the much-discussed neighbourhood health centres, and ensure all NHS providers become Foundation Trusts with the freedom to decide how to organise their services to best meet local needs.
Work had previously begun on the new operating model with the plans to abolish NHS England and cut integrated care boards (ICBs) announced in March and the axing of more than 200 NHS organisations in June, but the new NHS 10-year plan takes this further.
Commissioning support units are also to be abolished, along with Integrated Care Partnerships. Instead, neighbourhood health plans will be drawn up by local government, the NHS and its partners led by Health and Wellbeing Boards. ICBs must be coterminous with strategic authorities wherever possible by 2035.
A new contract for ‘single neighbourhood providers’ will be rolled out early next year, according to the plan.
It will deliver enhanced services for groups with similar needs over a single neighbourhood of around 50,000 people and GPs will be encouraged to lead these neighbourhood providers as an alternative to working in general practice, it states.
A second contract will create ‘multi-neighbourhood providers’, covering 250,000 or more people, for care that requires a scaled-up approach across several different neighbourhoods in areas such as end-of-life care.
Multi-neighbourhood providers are to work with GP practices and smaller neighbourhood providers in their footprint to create new commercial opportunities including clinical trials and they can also support or take over struggling GP practices.
They will cover functions already being provided in some areas by GP Federations, such as shared back-office functions, overseeing digital transformation and estate strategy, and will provide data analytics and quality improvement.
Smaller neighbourhood teams will bring staff together from primary, community and acute sectors and include other staff such as those working in hospice outreach services.
The plan states that Neighbourhood Health Centres will be in every community starting with places with the lowest healthy life expectancy and where possible by repurposing poorly used, existing NHS and public sector estate.
Staffed by NHS, local authority and the voluntary sector, these centres will be open 12 hours a day, six days a week, and aim to remove ‘the need to go to hospital for urgent care’.
The will provide diagnostics, post-operative care, rehabilitation into the community, as well as debt advice, employment support, smoking cessation and weight management services.
With the focus on best meeting local needs, by 2035 the Government aims for all NHS providers to be Foundation Trusts (FTs) by reinvigorating and modernising this model, with each having the ability to retain surpluses and reinvest them as well as borrow for capital investment.
‘FTs will use these freedoms and flexibilities to improve population health, not just increase activity’. The best of these will hold the whole health budget for a defined local population as a new integrated health organisations (IHOs). A small number will be designated next year with a view to becoming operational in 2027.
IHOs will align investments and savings so the cost benefits of innovation are realised and ‘never blocked’ the plan explains.
The Government aims to ‘reinvent the NHS’ financial model’ as it has ‘developed an addiction to deficits’ the plan states.
‘To restore financial discipline, we will end the practice of providing additional funding to cover commissioner and provider deficits. This year, the £2.2bn in deficit support funding will not go to systems that fail to meet their agreed financial plans. Deficit support funding will be phased out from financial year 2026 to 2027,’ it states.
Instead, this year there will be a ‘transparent financial regime which holds leaders to account’ and by 2029/30 most providers will be expected to deliver a surplus.
All organisations are asked to provide five-year plans to help a shift to long term financial planning. And ICBs will withhold funding for poor quality care and pay bonuses for high-quality care. This will put an end to block contracts that are paid irrespective of how many patients are seen or how good care is.
To support the shift of care out of hospital, ‘year of care’ payments (YCP) will be developed and tested to allocate a capitated budget for a patients’ care over a year rather than a fee for a service.
It will be calculated based on the health need of the population being served. It could cover primary care, community health services, mental health, specialist outpatient care, emergency department attendances and admissions in one consolidated single payment.
These will be an ‘important feature’ of the neighbourhood provider contracts for specified populations or services.
The plan states: ‘The YCP will provide a sharp incentive to keep patients healthy and out of hospital because local NHS organisations will benefit from reducing emergency visits and reinvesting in community services.’
From April next year, ‘intensive’ work will begin with ‘pioneer’ systems which are already more advanced in designing their new care model to implement notional YCPs.
A version of this article was originally published by our sister publication Healthcare Leader.
Almost all patients with complex needs will have a personalised care plan in place within two years under targets set out in the NHS 10-year plan.
By 2027, a new standard will ensure 95% of people with complex care needs will have a personalised and agreed plan in place covering both their treatment and holistic wishes, the Government said.
It will give patients significant ‘choice and freedom’ around their care rather than them being passive recipients of the new Neighbourhood Health Service, also outlined in the plan, it said.
Evidence shows high-quality care plans can improve patient experience but also achieve ‘a return on investment of £3 to the £1 spent on those who use healthcare most often’, the plan states.
But data suggests only about 20% of patients with a long-term condition currently have a care plan in place.
Unpaid carers will be actively involved in care planning, the Government added, with patients also having greater control over their care through the expanded NHS App.
‘By 2028, patients will be able to see who is involved in their care, communicate with professionals directly, draft and view their care plans, book and hold appointments and leave feedback’.
It will be accompanied by a dramatic expansion of the use of personal health budgets through which patients can decide with their care team how resources are used.
Currently around 180,000 patients use personal health budgets which the Government said they wanted to see double by 2028 and increasing to a million by 2030.
By 2035, personal health budgets will be a universal offer for all those who would benefit, the plan states, which will also provide more easy access to end-of-life care provided by hospices or the voluntary sector.
An evaluation from 2014 found the personal health budgets in England delivered quality of life improvements worth between £1,520 and £2,690 per patient, per episode of care, it said.
It is part of broader plans to shift from hospital to community through a newly formed Neighbourhood Health Service with patient-centred teams made up of nurses, doctors, social care workers, pharmacists, health visitors, palliative care staff and paramedics.
Partnerships with charities will also provide new formal support to help people manage their health conditions.
The focus will be on prevention and keeping patients out of hospital wherever possible.
Groups currently ‘most failed’ will be first to access the Neighbourhood Health Service over the next three years to ease pressure on hospitals and adult social care. This includes:
‘Instead of fragmentation and one-size-fits-all, patients will have real choice over the care they receive, real power to steer their care team (including through the NHS App and a care plan), and care will be more personalised,’ the plan states.
Personal health budgets were intended to empower patients with complex, long-term care needs to make decisions about the care and support they wish to receive, but pilots of the scheme to give patients either a ‘notional’ budget or NHS cash to spend were controversial over a decade ago – with some patients found using their budget to buy theatre tickets, ready meals and complementary therapies.
A version of this article was originally published by our sister publication Pulse.
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