Foreword

Primary care is often referred to as the backbone of the NHS – the place where patients show up and rely on those professionals to help them; the place where relationships and continuity make all the difference, the place that connects problems to solutions; the place that works within its means – and we know that high-performing primary care is key to improving health outcomes. 

As we look ahead to a new ten-year plan for the NHS, this is a moment of both challenge and opportunity. The world around us is changing: patients’ needs are evolving, and their expectations are rising, while the wider economic position – much of which is beyond our control – is looming large on what we do and how we do it. 

The burning platform for change is now. Lord Darzi, in his recent review, recognised that we currently spend significantly more on hospital care than on primary and community care, leading to an increasingly fragile system that fails to prioritise prevention and primary care, instead repeatedly opting to pay for the consequences of this shortfall, both financially and in terms of poorer patient outcomes. The current, highly hospital-focused, ‘sickness service’ model has become both outdated and unsustainable. 

As Georg C Lichtenburg said: "I cannot say whether things will get better if we change; what I can say is they must change if they are to get better." A resilient, sustainable healthcare system needs thriving primary care sitting within communities at the heart of delivering population-based, comprehensive, patient-centred continuity of care. So, this is a time to reimagine, to redesign and to lead.

This collection of essays is not a roadmap; it is a view of what the future could look like, written by those leading and working in primary care. It is intended to support both national thinking on the content of the ten-year health plan and inspire primary care leaders to recognise the opportunities that exist if they are willing to embrace them. 

In 2035, primary care stands at the forefront of a fundamentally reimagined healthcare landscape – one that is personalised, proactive and deeply embedded within communities. No longer constrained by rigid structures, primary care has evolved into a system that allocates resources dynamically based on need, ensuring the right care reaches the right people at the right time. This transformation is underpinned by technology-driven personalisation, collective accountability for population health outcomes, and a health system that identifies itself around neighbourhoods rather than organisations. 

We must protect what makes primary care valued – the relationships, the trust and the local knowledge. But we must also be ready to innovate, to collaborate across boundaries – health and beyond – and to embrace new ways of working that support both patients and professionals. 

Ruth Rankine
Director 
Primary Care Network