The English NHS is in a period of upheaval, with major reforms set to significantly change the structure of the health service and how it delivers care to patients – all of which is highly likely to impact the working lives of doctors.
The central pillar of these reforms is the UK Government’s 10 Year Health Plan, which will set the direction of the NHS and the wider health and care system for the next decade. This plan is rooted in a desire to shift care from hospitals to the community, to create a more digital healthcare system, and to develop a model that emphasises prevention over treatment.
In practice, the plan is set to include a wide range of policy interventions to support the transfer of outpatient care from hospitals to the community, build-up neighbourhood care provision, redirect funding to deprived areas, roll-out greater use of technology and AI, and reemphasise recruitment to expand the numbers of GPs and community-based staff.
An updated workforce plan, rooted in the same principles, is due to follow the 10 Year Health Plan later this year. Analysis of that plan will be published here following its publication.
An updated workforce plan, rooted in the same principles, is due to follow the 10 Year Health Plan later this year. Analysis of that plan will be published here following its publication.
The 10 Year Health Plan arrives at the same time as national leaders are seeking to reduce the cost of the NHS, with significant changes being made to its national and regional structures.
This includes the dissolution of NHS England and DHSC taking back control over the health service, alongside a major reduction in the number of ICBs (Integrated Care Boards) across
England and a restriction of their responsibilities. Further information on these changes and what they might mean is provided on this page.
The 10 year health plan
The 10 Year Health Plan was published on Thursday 3 July, with speeches from the Prime Minister, Chancellor, and the Health Secretary – all of whom emphasised that the plan is intended to deliver fundamental changes to the way in which health services are structured, funded, and delivered.
The plan is also framed as the prescription to Lord Darzi’s diagnosis of the problems facing the NHS in his 2024 review, with an overarching message from Government that they believe their reforms are needed to preserve the NHS.
Totalling at over 140 pages of content, the plan is lengthy, and the BMA will be taking care to analyse it in full, but we have summarised its key points for our members here.
BMA priorities for the 10 Year Health Plan
The BMA engaged actively with the development of the plan and, in our submissions to its consultations, called for greater recognition of the value of doctors – financially, culturally, and professionally – as a means of delivering a stronger NHS.
This was part of a range of broader reforms we called for, including:
- Delivering pay restoration, reforming the DDRB, and addressing pensions and childcare disincentives
- Increasing training places, specialty training, and the use of the specialist role
- Enhancing clinical leadership and giving doctors a greater voice
- Bringing back the family doctor
- Reviewing the role of PAs and AAs and pausing recruitment to those roles
- Addressing sexism, racism, and ableism in medicine
- Ensuring the shift in care into the community is managed and funded safely, emphasising the need to increase investment in general practice and community care while maintaining the capacity needed in hospitals
- Greater revenue and capital investment in the NHS – including to improve GP premises, NHS estates, and IT infrastructure.
- Genuine social care reform
- Improving collaboration and the interface between services
- Investment in public health services.
Related:
- The comprehensive BMA submission to the initial Change NHS consultation exercise
- The BMA submission to the second Change NHS survey
Overview of the Plan
The reforms set out in the plan are centred on – but not limited to – the Government’s three ‘shifts’:
- moving care from hospitals to communities:
focusing on providing more care outside of hospitals, with an emphasis on the development of ‘neighbourhood health centres’ - moving from analogue to digital:
focused on major expansion of the NHS App and greater use of AI and other technology - moving from treatment to prevention:
focusing more on preventing ill health than on treatment, including likely the wider determinants of health and factors that influence a person's need for care.
The plan goes beyond the shifts, though, covering other major areas of reform including:
- developing a new operating model
- introducing additional transparency on hospital performance
- creating a new workforce model
- a new innovation strategy
- reforming NHS finances.
Across these reforms - and the many different goals and policies they encompass – there are steps being taken to address major concerns for the BMA. These include UK medical graduate prioritisation and a move towards increasing specialty training numbers, though crucially by too few to make sufficient difference. Likewise, there are references to introducing new standards for NHS staff wellbeing, supporting doctors to move into the specialist grade, enacting some aspects of social care reform, and taking small steps to tackle obesity and reducing alcohol harms.
However, in contrast, there are critical questions about the absence of detail from the plan as well as over some of its key proposals. The drive to establish a neighbourhood health service is likely to have major implications for GPs and General Practice, that must be addressed. Meanwhile, the suggestion of creating of a new workforce model is a huge move and will raise concerns across NHS unions, the specifics of the financial backing of the plan is uncertain despite commitments made by the Chancellor, and the details of its underlying workforce assumptions are still unclear. These are just some of the many issues that the BMA will be working to clarify and address as we digest the plan.
Long-term workforce strategy
A refreshed workforce plan has been promised after the publication of the 10 Year Health Plan, at some point over Summer 2025. When announcing this plan, Government committed that this plan would be revised every 2 years going forward.
NHSE/ICB Reforms
In March 2025, the Government announced that NHSE will be abolished, with its functions transferred to DHSC. The transition is planned to complete within two years and will require primary legislation to enact.
DHSC also announced changes to ICBs (Integrated Care Boards) – including budget cuts and refocusing their role to ‘strategic commissioning’. This could see significant changes to the way ICBs work, their structure, and the transfer of some of their duties and functions both upwards and downwards.
This is a live issue, with ICBs currently reviewing their plans for how they will implement these changes. The BMA is actively considering how these changes could impact the working lives of our members and what they might mean for the way the NHS works.
The Health and Social Care Act 2012 Act created NHSE (originally called the NHS Commissioning Board), its regional structure and CCGs (Clinical Commissioning Groups). The Act was a top-down reorganisation of the healthcare service, leading to substantial change, diverting scarce funding away from patient care.
Public health services also changed significantly as a result of the Act, with the establishment of Public Health England and granting the 152 upper tier local authorities in England responsibilities for the delivery of the majority of local public health services, moving these out of the NHS. This increased fragmentation, not least because CCGs and upper-tier local authorities were not coterminous. There were further disruptive changes to Public Health in England in 2020 which reduced the independence of Public Health with the UK Government's decision to abolish PHE mid-pandemic and move its functions to the newly created UKHSA and OHID (Office for Health Improvement and Disparities). UKHSA was established as an arm's length body (as PHE was), responsible for health protection, while OHID became responsible for health improvement and sat as a government unit within DHSC - less independent from the government than before.
10 years later, the Health and Care Act 2022 significantly altered the NHS again, undoing or amending many of the 2012 Act’s reforms. ICBs were formalised under statue replacing CCGs (Clinical Commissioning Groups) which were abolished, ICSs (Integrated Care Systems) were created, NHS England and NHS Improvement were formally merged (albeit had been working together as a single organisation since April 2019). NHS commissioners were no longer compelled to put services out to competitive tender, and the Secretary of State for Health had expanded powers, allowing them to create new NHS trusts, direct NHSE, and amend/abolish arms-length bodies (for example, Health Education England, NHSX and NHS Digital were formally merged with NHS England). Local Education Training Boards were abolished, with their powers transferred back to Health Education England (now NHSE). The Act imposed a duty on all NHS bodies to simultaneously pursue three aims: better care for all patients, better health and wellbeing for everyone, and sustainable use of NHS resources.
The BMA opposed the Health and Care Act and campaigned for it to be heavily amended, seeing it as failing to address the NHS’ challenges of poor resources, the state of social care, and health and care staffing. The BMA also had concerns that the Act could increase the level of private sector involvement in the NHS without adequate scrutiny. There was, and remains, concern over a lack of statutory ICB/ICS board-level positions reserved for clinical and public health leadership.
ICSs (Integrated Care Systems) were designed to deliver better, more integrated care for patients, by bringing together the NHS, local authorities and third sector bodies to take on the responsibility for the health and resources of a region (or ‘system’). These had effectively been operating for many years (under the label of STPs – Sustainability and Transformation Plans and then later Partnerships) but were formalised by the Health and Care Act 2022.
The 2022 Act dissolved CCGs (Clinical Commissioning Groups – formed by the Health and Social Care Act 2012) and transferred their powers, including power over NHS commissioning and spending at a local level, to ICBs (Integrated Care Boards) as one of two statutory bodies making up an ICS.
The 2022 Act formalised 42 ICSs across England, working on three key levels: System, Place, and Neighbourhood.
1) System – with two core statutory elements, where major decisions are taken, and overarching strategies agreed:
a) ICB (Integrated Care Board) - focused on core NHS services, with responsibilities including NHS funding, commissioning, and workforce planning.
b) ICP (Integrated Care Partnership) – a wider group of organisations, typically led by local authorities, with a broader scope to examine and plan for the health and wellbeing of the local population.
2) Place (or Place-based Partnerships) - can vary significantly in their form and function, but are normally based around towns, cities, or major NHS trusts within a system. While they are not statutory bodies, ICBs have been expected to devolve some funding streams down to ‘places’ to allow them to plan localised services.
3) Neighbourhood – (or localities in some ICSs) based around populations of 30,000 to 50,000 people, designed to build upon Primary Care Networks where multi-disciplinary teams of NHS and local authority services work together.
How ICBs are changing
Budget cuts
The recently announced 50% cut to ICB budgets is on top of the previously imposed 30% cut to running costs. As part of these cuts, ICB running budgets will be expected to be reduced to a set cost per head of weighted population. How this will be applied will vary system-to-system, with the focus being on achieving financial balance across NHS regions, but not necessarily in each ICB.
The BMA have been clear that ICBs needed time and money if they were going to succeed – these reforms will not give them either.
NHS England has, however, clarified that cost-saving measures should not extend to research roles, writing to providers to confirm that cuts being made at provider level should not lead to reductions in research staffing. Public Health and population health have been discussed as crucial to the future of the NHS, alongside data analytics roles, suggesting these may also be protected.
Staffing cuts
The impact of budget cuts on BMA members employed by ICBs and NHS England directly are a particular concern, as are the potential impacts of staffing cuts on ICB functions. Whilst system leaders have stressed that the NHS and ICSs will maintain business as usual, it appears likely that the scale of upheaval will risk affecting ICB’s core activity, with staff inevitably distracted by the risk to their jobs.
Mergers, ‘clusters’ and organisational changes
NHS England has suggested plans for the potential consolidation of some ICBs. Merging a number of the 42 ICBs is not a new idea, though, as the variability in size and demographic of ICBs has previously led to calls for mergers for more equal comparisons.
The BMA is concerned that mergers between ICBs could be linked to cuts to board membership as, if boards are streamlined, we could see more shared leadership roles between ICBs, and subsequent consolidations. It will be important to critique any mergers to ensure they are based on patient communities and their needs, rather than being rooted in the needs of larger provider organisations or cost cutting. Merger proposals should, therefore, be discussed with local GP practices, their LMC representatives, LNCs and with other ICS partners to review their potential impact on local services.
Changes to ICB functions and responsibilities
The reforms being made to ICBs include potential changes to the functions and responsibilities they hold, with the emphasis on refining the work they do to ensure they are operating in the ‘strategic commissioner’ role. In practice, this means ICBs concentrating more intently on areas like strategy, pathway and service commissioning, population health, and inequalities. Other functions are set to move upwards to NHS regions or national bodies, and others down to primary and secondary care providers.
While a significant number of questions remain, the information provided to date suggests that ICBs will be more removed from the day-to-day activities of frontline NHS staff, particularly in general practice. This could mean GP practices and LMCs (Local Medical Committees) will need to engage with providers and other sub-ICB structures more than with ICBs themselves. In contrast, it appears likely that ICBs will be more involved in work around public health and strategic planning, which re-emphasises the need for independent public health experts to sit on ICB boards.