The government has released its "Fit for the Future: 10-Year Health Plan for England," a document that signals a fundamental paradigm shift for general practice. For busy practice managers, this isn't just another policy update; it’s a roadmap to a completely redesigned operational and financial environment.
This plan is built on a bold vision: to move primary care away from a system of small, independent practices reacting to illness, towards a new model of large-scale, digitally integrated providers focused on proactive population health.
Understanding the implications is the first step to navigating them. This article provides a clear summary of the core changes and what you need to start planning for right now.
A fundamental shift: The three pillars of change
The entire 10-year plan is built on three interconnected, foundational shifts that will reshape how healthcare is delivered.
From hospital to community: The plan aims to move the majority of outpatient care out of hospitals and into the community by 2035. This "left shift" will happen through a newly created Neighbourhood Health Service, designed to provide more integrated services closer to patients' homes.
From analogue to digital: Digital transformation is set to become the core of service delivery, not an optional extra. The NHS App will be transformed into a "full front door" to all services by 2028, and a legislated Single Patient Record (SPR) will give patients control over their health data.
From sickness to prevention: The long-term goal is to create a "predictive, pre-emptive health service" that uses genomic science and data to manage a person's health risks long before symptoms appear. This focus on prevention is what underpins the financial logic of the entire plan, making new risk-based funding models viable.
What will change on the ground? New models and new money
These strategic shifts will translate into concrete changes in the structure, operation, and funding of general practice.
A new home for services: Neighbourhood Health Centres
At the heart of the community shift are Neighbourhood Health Centres (NHCs). Envisioned as "one-stop shops," these hubs will co-locate a wide range of services historically based in hospitals, such as diagnostics and post-operative care, alongside non-clinical support like debt and employment advice.
These centres will be the base for integrated, multidisciplinary teams, and the plan commits to them being open at least 12 hours a day, six days a week.
A new structure: At-scale provider contracts
The plan is unambiguous about its intention to move primary care towards working at a much larger scale. This will be driven by new provider contracts, scheduled to begin rollout in 2026. Practices will need to decide whether to lead, join, or compete with these new entities.
‘Single Neighbourhood Providers’: Covering around 50,000 people, these are seen as the natural evolution of Primary Care Networks (PCNs).
‘Multi-Neighbourhood Providers’ (MNPs): Operating at a scale of 250,000+ people, these are the plan's key agents for transformation. Their remit is extensive: providing shared back-office functions (HR, finance, IT), leading digital strategy, and, crucially, possessing the authority to intervene and take over struggling practices. This model represents a direct and fundamental challenge to the traditional autonomy of the GP partnership.
A new financial architecture: Rewarding value over activity
The financial system is being re-engineered to reward improved health outcomes and productivity, marking a definitive move away from the fee-for-service model.
Key changes include:
‘Year of Care’ Payments: This is a move toward capitated budgets, where providers receive a set budget for a patient's total care over a year. This incentivises keeping patients healthy, as the provider retains any savings.
Performance-Linked Payments: In the new model, payment will be directly linked to the delivery of high-quality, effective care. High performance will attract bonuses, while payments for poor quality can be withheld.
‘Patient Power Payments’: A radical new trial will give patients a direct say in funding. Following care, their feedback will help determine whether the provider receives the full payment.
The evolving role of the practice team
This new world demands a new kind of workforce. The roles of practice managers, GPs, and nurses are set to evolve dramatically.
The strategic practice manager
The role of the Practice Manager will see one of the most significant transformations, shifting from the operational administrator of a single business to a strategic leader within a larger, more complex organisation.
Future responsibilities will include:
Overseeing system-wide digital transformation, including the adoption of the Single Patient Record and AI tools.
Managing and interpreting data analytics for quality improvement and population health.
Navigating complex new financial models like capitated payments.
Data literacy, sophisticated financial acumen, and change management will become essential skills.
The digitally-confident clinician
The plan calls for a clinical workforce that is "AI trained, digitally confident and have skills in modern leadership". For GPs and nurses, daily work will become more proactive, using data to identify and manage high-risk patients. Administration will be reduced by AI tools, freeing up time for complex decision-making. Practice nurses, in particular, will see their roles expand into advanced practice with greater autonomy.
Your strategic imperatives: Four key actions for practice leaders
The path ahead will be challenging, but proactive leadership can ensure your practice survives and thrives. The era of the isolated, independent practice is over. Leaders must focus on four key imperatives:
Collaborate now: Actively engage with your PCN and neighbouring practices to explore formal collaboration, federation, or mergers. Forming larger, resilient entities is essential to bid for the new provider contracts.
Invest in digital capability: Digital transformation is the core of the new service model. Prioritise upgrading IT and investing in continuous training to ensure all staff are digitally literate.
Become data-driven: Data is the new currency of the reformed NHS. Systematically track and analyse a wider range of metrics on outcomes, patient experience, and financial performance to demonstrate value and secure funding.
Rethink your workforce: Start planning now for the integration of new roles and the significant upskilling of your existing staff in areas like data analytics and virtual care.
The direction of travel is irreversible. The practices that succeed in the next decade will be those that move early to work at scale, fully integrate digital innovation, and redefine their role as part of a wider community health service. The strategic choices you make now will determine whether you lead the transformation, adapt to it, or are left behind by it.
Disclaimer: This article is for informational purposes only and reflects understanding as of 3 July 2025. It does not constitute legal, financial, or medical advice. Practices should consult with relevant professional bodies or legal counsel for specific circumstances and always refer to the latest official NHS England (and other relevant bodies) guidance and contractual documents.