Starmer's NHS plan promises more GPs and local health hubs
Two hundred new 'neighbourhood health centres' will offer scans, outpatient appointments, mental health therapy and a host of services without the need to go to hospital, under proposals to be outlined in the government's ten-year plan for the NHS.
Sir Keir Starmer said the plan would 'fundamentally rewire' the health service, making hospitals a last resort instead of the 'default' for care. He has previously said the NHS must 'reform or die'.
He pledged to give 'everyone access to GPs, nurses, and wider support all under one roof in their neighbourhood — rebalancing our health system so that it fits around patients' lives, not the other way round'.
Such goals have been shared by successive governments, however, and health leaders said a lack of detail on how the changes would happen prompted 'doubt on whether the plan will stick' in the long term.
Wes Streeting, the health secretary, insisted that the proposals would slash waiting lists for patients and 'turn the NHS on its head'. He aims to create a 'neighbourhood health service' that would provide more care locally and help frail patients stay out of hospital.
The plan is a vital moment for Starmer, who has tethered his political fortunes to the NHS with a £30 billion budget boost. He is off track on a promise to treat 92 per cent of routine patients within 18 weeks but promised to deliver on voters' top political priority with a plan for radically better and more efficient care.
Among policies included in the plan:
• An improved NHS app is to become the 'front door' to the NHS, offering more appointments, test results and advice.• Getting patients back to work will become a core aim of care, with back-to-work targets for NHS groups.• An AI-based 'digital warning system' will issue safety alerts in hospitals.• An expansion of patient choice and more hospital league tables are intended to drive up standards.• British doctors will be given priority for NHS jobs.
However, tougher public health restrictions were largely dropped.
Under the current NHS workforce plan, hospital consultant numbers are due to increase much faster than family doctors.
Streeting will promise to train 'thousands' more GPs by skewing training places more towards family doctors. An updated plan later this year will set out more 'realistic' numbers for hospital doctors to allow for more GPs.
• NHS patients face more delays as 'minimum waits' imposed
The proposed new health centres would be open six days a week for 12 hours a day, and house teams able to diagnose patients and deliver post-operative care and rehabilitative services. Also on offer would be debt advice, employment support, smoking cessation and weight management.
With a health centre for every 250,000 people, the plan aims to end the 'hospital by default' status of the health service, and instead transition to a system where going to hospital is the last resort.
This would mean that, initially, care should be digital-first, through the NHS app. Failing that, it should be within a patient's home, then within a neighbourhood care hub and only in a hospital when deemed necessary.
Speaking before the launch of the plan, Starmer said Labour had 'inherited a health system in crisis, addicted to a sticking-plaster approach, and unable to face up to the challenges we face now, let alone in the future.
'That ends now. Because it's reform or die. Our ten-year health plan will fundamentally rewire and future-proof our NHS so that it puts care on people's doorsteps, harnesses game-changing tech and prevents illness in the first place.'
Neighbourhood health centres would be run by GPs in some areas, while in others local trusts or mutuals would be in charge. Ministers are promising an overhaul of internal NHS payments so that services are paid for better outcomes and incentivised to offer cheaper care that keeps people out of hospital.
• Starmer promised to fix the NHS. A year on, has he succeeded?
Areas that are more deprived and have lower life expectancies will be prioritised for the changes, and the cost of the centres will vary according to their needs.
However, the government is facing questions about how the centres will be paid for as ministers explore private financing deals, as well as whether local bosses will embrace fundamental reform when they are under pressure to balance the books and cut waiting lists.
Streeting promised 'one of the most fundamental changes in the way we receive our healthcare in history. By shifting from hospital to community, we will finally bring down devastating hospital waiting lists and stop patients going from pillar to post to get treated.'
Thea Stein, chief executive of the Nuffield Trust think tank, said many NHS services were already working within communities, adding: 'Simply saying that the approach will be rolled out, without full details on how to bring it about, casts doubt on whether it will stick.'
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Not a single constructive suggestion is made. We live in an age where the sheer volume and speed of events both nationally and internationally comes dangerously close to making conventional governance impossible. This is the perfect Petri dish for the incubation of demagoguery and dictatorships. We should be more prepared to support our elected leaders. Nicholas Oppenheim London SW6 Sir, I am one of those consultants who has left the NHS to work exclusively in the private sector (letters, Jul 3 & 4). At the age of 62 I fear what this government may do to my pension and have, therefore, taken it early. It also means I can continue to strive to practise medicine to the highest standards and not have to engage in what I perceive as the NHS drive to reduce everything to the lowest common denominator. My wife, a GP of 35 years, and I fear there will be no one left to look after us in our old age. 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Ketamine helped me escape my negative thoughts - then nearly killed me
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Small amounts of the Class B drug can give a sense of euphoria and excitement, while large amounts can lead to a state known as the "K-hole," where users feel detached from reality - an out-of-body-type number of under 16s reporting a problem with the drug has nearly doubled over the past two years, overtaking cocaine in popularity with children and young half those (49%) who started treatment for drug misuse in 2023-24 said they had a mental health problem, with more than a quarter not receiving any treatment for the latter. Details of help and support with addiction are available in the UK at BBC Action Line Experts are warning that some young people are taking dangerous amounts of ketamine not only due to it's low price and ease of availability, but also because of the dissociative feelings it brings."What we are seeing is a perfect storm," David Gill, the founder of Risk and Reliance, a company which trains front-line workers on emerging drug trends. "We have more young people struggling with depression, trauma, anxiety, a lack of services - and we have a very cheap street drug that helps them disconnect."Abbie's first line of ketamine did exactly that. She says it "felt like such a powerful place to be"."My thoughts no longer had a negative effect on me - life was passing me by, but I didn't have to engage with it."Abbie's childhood had been hard. Struggling with mental health problems and undiagnosed ADHD, she had left school at 14 and found herself in a whirlwind of drink, drugs and unhealthy relationships. Although addiction cast a long shadow throughout her 20s, Abbie managed to secure a place at university, staying clean throughout, and obtained a healthcare is smart, articulate and wants to do well, but after two abusive and controlling relationships ketamine became the only means she had to block out the when she went to her GP to seek help she was prescribed sleeping tablets and told to "come off the ket"."The withdrawals were so bad I would be shaking and vomiting," she says, "it wasn't that easy to just come off it."Then a deeper level of addiction took hold. "I always prided myself in the early stages of addiction of keeping my morals and my values and not lying to people," Abbie says, "but I couldn't stop the drugs and I found myself hiding my use to my friends."Things escalated. Eventually Abbie was taking ketamine every day - incessantly. The only time she would take a shower, she says, would be when she went out to meet her dealer on the physical effects of overuse began to kick in - horrific abdominal pains, known as K-cramps, would leave her screaming in agony. She would place boiling hot water bottles on her abdomen - burning her skin. And then she would take even more ketamine to numb the pain. What is ketamine? Often referred to as ket, Special K or just K, ketamine is a powerful horse tranquilliser and anaesthetic. 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The bladder lining becomes so inflamed it can result in permanent damage and it has to be Isba says the first signs of ketamine bladder are severe abdominal pains, urinating blood and jelly from the damaged bladder lining."Patients referred to the clinic will receive a holistic approach," she says, "care from the specialist urology team to treat the physical effects of the drug, and then they will be supported - and referred if necessary - to community services who can help with the often complex reasons behind their drug use." 'Completely helpless' Sarah Norman, from St Helens, says she felt like a "silent watcher" as her daughter began to "fade in front" of her September she discovered that Maisie, 25, was addicted to ketamine, which had caused potentially irreversible damage to her kidneys."We are just an average family," Sarah says. "I never thought Maisie would have ended up addicted to any drugs - she doesn't even drink alcohol."Maisie had kept it quiet - ashamed of the stigma attached to her ketamine use. But what had started as a party drug she'd take at festivals had become a substance she couldn't function the end her partner moved out with their three-year-old son."I had nothing left to live for," Maisie says. "It got to the point I was doing bump after bump [snorting small amounts of it]."For a short time I would be knocked out of reality - then I would take more." Eventually, Maisie's mum and sister carried her into hospital - she weighed just five stone (32kg)."The doctors said her body was failing her," Sarah says. "We thought we might lose her."As a parent, she says, she felt completely helpless."It's hell on earth, there is nothing you can do. 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Abbie was rejected from NHS rehabilitation services twice, and reached a point where she considered taking her own life."There was so much chaos around me and the services weren't going to help me, I just wanted to end it all," she after sending a five-page letter to the panel that decides on eligibility she finally managed to access a detox and rehabilitation service."I had three choices," Abbie says, "rehab, section - or in a coffin."Abbie was treated in the same rehabilitation unit as Maisie. She is now out, clean and proud of herself but says the treatment she received failed to deal with her trauma."I can look after myself on a daily basis and I'm doing OK. The real work starts now I'm out of rehab," she says, " and now I am clean, hopefully I can get the mental health support I so desperately needed when I was using."A spokesperson for the Department of Health and Social Care said that as part of its 10 Year Health Plan to reform the NHS, it was going to be much "bolder in moving from sickness to prevention"."This government is driving down the use of drugs like ketamine, ensuring more people receive timely treatment and support, and making our streets and communities safer."
