Frontline

Having spent 25 years on the frontline of the NHS – first as a nurse walking the streets of my community, and later in public health leadership –I have always understood that primary and community care are the beating heart of our National Health Service. They are the foundation upon which everything else is built, and their strength ultimately determines the health of our nation. That is why the government’s new 10-year health plan, with its ambition to shift care into the community, is so important. For decades, we have discussed this “left shift”, the vital move towards more preventive and proactive care. Now, we must finally make it a reality for every patient in every corner of the country.

This shift is more thana matter of policy; it is a clinical and moral imperative that I have witnessed firsthand. Without it, we are simply managing a decline, allowing waiting lists to grow and conditions to worsen until they require costly, complex interventions. I think of the many women I have encountered living with fibroids, a condition that affects 80 per cent of women by the age of 50. When we fail to provide timely check-ups and screenings in the community, what begins as a manageable issue can spiral into a life-altering crisis. All too often, the result is devastating fertility issues and poor treatment outcomes, often culminating in a hysterectomy that an earlier diagnosis could have prevented. This is the human cost of delay. Poorer patient outcomes, severe symptoms, a reduced quality of life, and immense personal suffering, all alongside a far greater financial burden on the system.

This failure creates a ripple effect that strains every part of the NHS. In the Birmingham constituency I represent, I see how delayed diagnosis and treatment lead directly to increased complications, a reduced quality of life, and a higher long-term cost of care. When patients cannot access their local GP or community nurse, they understandably turn to our emergency departments for non-urgent issues. This leads to the overcrowding and long waits we so often read about, which reduce our capacity for genuine emergencies and create a vicious cycle of crisis management. It is a model that exhausts our dedicated staff and fails the very people it is designed to serve. A strong primary care system, focused on that “left shift,” is what breaks this cycle. It ensures patients receive preventive care, early interventions, and timely treatment, leading to far better health outcomes and greater satisfaction.

The 10-year plan provides a strong framework, but we must be honest about the challenges we face. The gravitational pull of acute hospital spending is powerful, and without specific, protected investment for community services, we risk repeating the mistakes of the past. Our focus must be on anchoring care within neighbourhoods, creating integrated teams where GPs, pharmacists, social workers, and mental health specialists work together under one roof. This is not just a theoretical ideal; it is a vision already being realised in cities like mine, as I saw during a recent visit to the Washwood Heath Health and Wellbeing Centre in East Birmingham. There, person-centred holistic care is delivered by neighbourhood multidisciplinary teams, proving that this is the future we can, and must, build. We have also seen this model succeed in places like north-east London, where women’s health hubs have dramatically reduced waiting times for gynaecological care.

The alternative is simply unsustainable. If we fail to move towards prevention and early intervention, costs will continue to spiral, waiting lists will grow, and patient outcomes will worsen. Should primary care services remain underfunded and disconnected, the left-shift will fail, and the broader system reform will inevitably stall. This is our moment to move from rhetoric to reality. We must empower clinical leadership and ensure sustainable funding follows the patient directly into the community. It is about embracing a population health perspective, recognising that true health is shaped by factors far beyond the clinic walls. The 10-year plan is our opportunity to finally build an NHS that is not solely about treating sickness, but about actively promoting health and wellbeing in every community. We must have the courage to make that left shift, to strengthen the heart of the NHS, and to create a service that is sustainable, effective, and truly there for everyone when they need it most.

Image credit: gorden murah surabaya