Research and analysis

Chapter 4: the 3 shifts - hospital to community

Published 17 December 2025

Applies to England

Summary of findings in this chapter

Staff are excited about the potential of this shift to have a real and positive impact on the future of the NHS. They can see how moving care away from hospitals into the community could improve health outcomes, reduce health inequalities, deliver care more efficiently and improve their working lives (with better work-life balance from an expected move from shifts to office hours and more fulfilling relationships with patients).

The public are supportive of this shift in principle but are less confident in its potential to address the challenges they currently experience with the NHS. All public audiences hope that this shift will reduce pressure on hospitals (especially on A&E) and make accessing care more convenient. However, many public participants, and particularly those without experience of multiple or long-term health conditions, start from the assumption that hospitals are the most safe and effective place to deliver care. As a result, there is little initial understanding of the potential of this shift to improve efficiencies and patient outcomes.

Both staff and public have significant concerns about the NHS’s ability to deliver this shift effectively. Although participants, and especially staff, have examples of where this kind of care is already happening in their area, a complete overhaul of the system to focus on the community feels very far away from the status quo. Staff worry about the hospital-centric mindset and a lack of staff able and willing to work in community roles. Patients worry about fragmented care or care delivered outside of hospital leading to safety problems. Both audiences worry that poor delivery of this shift might exacerbate access issues, particularly in rural areas.

The public largely accept that this shift will mean they have to access care differently. Many say they would be comfortable and confident speaking to a healthcare professional other than a GP if it means getting seen sooner. There is also openness to accessing care in new settings like mobile clinics. However, seldom heard audiences point to worries about the potential of this shift to worsen health inequalities if not implemented properly. Some audiences raised concerns that people would be reluctant to access services which have stigma associated with them (like sexual health clinics) if they are located in the community. Those without a fixed address also raised concerns about a system that prioritises delivering care at home.

4.1 Benefits of moving care from hospital to the community

Public and staff participants saw significant potential benefits from this shift, in particular helping to reduce pressure on hospitals.

It was hoped moving care into the community will make accessing care more convenient, something which many seldom heard audiences, especially those living in rural and coastal communities and those with learning disabilities and/or autism, highly valued. Staff participants in deliberative events hoped that by making access to care more convenient and supporting underserved and disadvantaged communities to attend appointments closer to home, the shift will help address health inequalities.

Staff and some public participants, particularly those with multiple long-term conditions and experiences of stroke, hoped that moving treatment and recovery into the community would lead to better health outcomes.

Finally, staff in the deliberative and online events saw the potential for this shift to deliver significant efficiencies if implemented properly.

Reducing pressure on hospitals

Staff participants in deliberative and online events and partner organisations noted that patients often receive care in hospital that could be provided elsewhere. Public participants in deliberative events also noted this, although their focus tended to be on the use of A&E by those who are not facing an emergency.

Staff, public deliberative event participants and partner organisations expected that a shift from care in hospitals to the community would significantly reduce pressure on hospitals and particularly on A&E.

[If this shift happens] you might see less people turning up at A&E. There will be less pressure and it will be an immediate positive. Patients cannot get to see their GP so they turn up at A&E as that’s all that’s there.

(Public deliberative event participant, South East)

On the Change NHS website in response to an open text question, more than a quarter (27%) spontaneously mentioned a reduction in pressure on hospitals and GPs as a key benefit. Delivering more care in the community was also felt to offer real potential for care to become easier and quicker to access, as well as improving the patient experience overall.  

Figure 5: chart showing key perceived benefits with delivering more care in the community for public participants on the Change NHS website

Shows percentage of participants on the Change NHS website selecting the top 5 coded responses to the question: ‘In what ways, if any, do you think that delivering more care in the community could improve health and care?’

	Percentage
Reduce pressure on services, hospitals or GPs	27%
Accessible healthcare services or convenience of access	25%
Quicker delivery of service or reduced waiting times	19%
Bringing services closer to patients, or improved local care or facilities	13%
Ease of transport or parking or associated costs, or travel distance	12%

Base: all those who answered this question in the ‘Start here’ survey (number equals 66,243). The survey was live between 21 October 2024 and 14 April 2025.

This sentiment was also reflected in the nationally representative survey, where over half (53%) selected less pressure on hospitals and reducing waiting times as one of the biggest opportunities of this shift, and 2 in 5 (41%) cited ease and convenience of access as a key benefit.

Figure 6: chart showing key perceived benefits with delivering more care in the community in the nationally representative survey 

Shows percentage of nationally representative survey participants selecting answers to the question: ‘Which of the following do you think represents the biggest opportunity for improving health and care?’

	Percentage
Less pressure on hospitals, reducing waiting times	53%
Better access to scans and diagnostic tests, helping identify health conditions sooner	50%
Making it easier and more convenient for everyone to access care	41%
Increased overall capacity of services	33%
Healthcare that is more focused on prevention	26%
A more comfortable, less stressful patient experience	20%
Care that is more tailored and responsive to the needs of a local population	18%
Improved relationships between patients and healthcare professionals	14%

Base: all those who answered this question in the nationally representative ‘Start here’ survey (number equals 2,025). The survey was live between 12 and 17 December 2024.

Public deliberative participants and staff in the deliberative and online events hoped that a reduction in the pressure on hospitals would improve access for those who need to be treated in this setting.

Community care first - hospital as last resort. More investment needed in community services.

(Staff online event participant)

A selection of ideas for change shared on the theme of reducing pressure on hospitals

Having minor injuries units in more towns or areas of cities and having them open later in the evenings (for example, 10pm) would help relieve pressure on A&E for non-emergencies. Otherwise […] people who have had accidents in the evenings don’t have anywhere to go apart from A&E to get it treated.

(Public Change NHS website participant)

One of the biggest challenges for the NHS is an ageing population. There are frequently times when older people get admitted to hospital because they can no longer be cared for at home temporarily, [for example] for a UTI or dementia patients with short term mobility issues etc. I would propose building separate community nurse-led hubs close to major hospitals that allow elderly patients in these situations to be cared for on a temporary basis in a nurse-led care environment - freeing up hospital beds for emergency cases and operations.

(Public Change NHS website participant)

More convenient access to healthcare

In public deliberative events and the community engagement, participants spoke about current logistical difficulties of hospital visits. Long journeys, difficult routes by public transport and costly parking were often mentioned, especially by those living in rural areas, those with mobility issues and those with limited access to a private vehicle.

There was therefore excitement about the potential for this shift to address these difficulties by providing services in more convenient locations and closer to home. It was expected that this would make the process of accessing care less time consuming, tiring and stressful.

This view was shared by participants on the Change NHS website. In response to an open text question, over half of participants (52%) spontaneously mentioned improvements to the availability and access to care as one of the most important benefits of this shift. In the nationally representative survey, two-fifths (40%) of respondents selected making it easier and more convenient to access care as one of the biggest opportunities of this shift.

Coming from a small town, having better access to a space for tests makes sense and would help many who struggle to access places that are further away.

(Community engagement, those living in coastal areas)

In the community engagement, people with learning disabilities and/or autism were especially likely to identify more convenient access to care as a benefit of this shift. They emphasised how care closer to home had the potential to reduce the anxiety and intense stimulation that can accompany hospital visits.

Partner organisations and staff participants in the deliberative and online events also emphasised the benefits to patient wellbeing of less time and cost spent on travel. They also wondered if more convenient access to services might enable patients to seek help for health concerns sooner, leading to earlier interventions and better health outcomes. 

More convenient for patients to access services locally rather than traveling to acute sites.

(Staff online event participant)

A selection of ideas for change shared on the theme of more convenient access to care

Introduce local hubs (maybe large motor homes that can attend rural areas also), that offer online, bookable appointments for minor issues […] These can be released weekly and offer more out of hours appointments.

(Public Change NHS website participant)

Keep people out of hospitals who are not sick! All diagnostic services should run from a hub. Make sure the hub is central to the community, on bus routes, by taxi, train services. And have loads of car parking. Hospital parking is absolutely shocking, there’s nowhere to park, you end up missing your appointment [because] you can’t find a car parking bay.

(Public Change NHS website participant)

Improved patient experience of treatment and recovery

Staff participants in deliberative and online events, some public deliberative participants and some seldom heard audiences pointed to the impact of extended hospital stays on patient recovery as a problem that could be addressed by this shift. Members of the public with multiple long-term health conditions, and experiences of stroke in particular, understood the benefits of recovering in the community rather than the hospital.

It should be noted, as discussed in detail in section 4.2 of this chapter, that this understanding that recovery in hospital does not always lead to the best outcomes was not universal among the public. Many, particularly younger deliberative participants, expected that hospital would be the safest place to recover from a serious illness.

Among staff and public deliberative participants who were aware of the potential negative health impacts of recovery in hospital, 4 benefits of moving care into the community were mentioned. 

Firstly, reducing isolation. Public participants in the deliberative events and community engagement said that recovering at home, where patients can be supported by family and friends, could reduce loneliness and improve mental health during recovery. In the community engagement strand this was particularly important for children and young people and those with experience of stroke. Those experiencing drug and alcohol dependence were also more likely than other groups to stress this benefit. This audience highlighted the benefit of strong social networks to support recovery and prevent relapse.

Secondly, increased patient comfort. Public participants felt that allowing patients to be treated and/or recover in a comfortable and familiar space would be preferable to being in a busy, often noisy hospital ward. Staff also acknowledged that receiving care in patients’ homes or communities can be less intimidating and more comfortable than in a hospital environment.

I think people only feel safer in hospitals because they don’t have the information. If they had equipment and the education, I think more people would rather stay at home.

(Public deliberative event participant, North West)

Thirdly, supporting patients to remain independent. Participants in the public deliberative events felt that being treated in the community would mean that patients are more able to move about and stay independent for longer.

So, Dad has got COPD. He’s got heart disease […] his breathing was really bad. He didn’t want to go into hospital because he was scared he wouldn’t get better. He wanted to be at home. So they set up a virtual ward. [Virtual wards] saved him being in hospital where people were going down with COVID-19.

(Public deliberative event participant, East of England)

Finally, improved end-of-life care: staff felt that this shift would naturally include a strong focus on improving palliative and end-of-life care services, supporting patients to die at home (if that is their wish). They believed that this could give patients dignity, choice and more support.

More choice and control for patients in their final days.

(Staff online event participant)

Improvements to staff wellbeing and development

Staff in the deliberative and online events, and particularly those who already work in the community, emphasised the potential for this shift to increase staff’s sense of fulfilment and job satisfaction. They said this was because roles based in the community can foster closer relationships with patients (especially if they are conducting in-home visits).

Staff also saw the potential for community-based roles to improve work-life balance by enabling flexibility of working patterns (for example, office hours rather than shift work). They wondered whether these roles might also provide interesting opportunities for career progression, by upskilling staff, empowering them to work more autonomously and creating new and prestigious generalist roles.

More time with people gives better job satisfaction. The autonomy can be energising.

(Staff deliberative event participant, South West)

The public in deliberative events also felt that this shift might increase staff morale by managing demand across the system and therefore reducing pressure on staff. It was hoped that this would contribute to improved recruitment and retention of staff. 

Reducing staff burnout would be a good outcome, they do stupidly long shifts […] this could help retain staff potentially.

(Public deliberative event participant, Midlands)

Potential to improve health inequalities

Staff in deliberative and online events saw potential for this shift to reduce health inequalities by improving access to care for underserved or disadvantaged communities. They hoped that making care more convenient and accessible within communities might encourage patients who find it difficult to access hospital-based care to seek help.

Some staff participants in the deliberative and online events explicitly recognised that care delivered in home would not be appropriate for everyone (for example, those without a fixed address), so emphasised the importance of tailoring the specific care setting to patients’ needs.

More accessible for vulnerable populations.

(Staff online event participant)

Efficiency and better use of resources

Staff participants in deliberative and online events saw the potential for this shift to improve efficiencies and make better use of limited resources. Staff hoped that this shift would:

• reduce duplication of services, if processes were effectively streamlined
• avoid unnecessary hospital admissions, with better information sharing between community services and hospitals - it was also hoped that improved information sharing would lead to swifter discharge from hospitals
• support the early identification of conditions and treating them in the most appropriate settings

A selection of ideas for change shared on the theme of reducing duplication of services

I would like to see clinicians arrange appointments and tests so that they can be undertaken as part of a single appointment where possible. Multiple appointments are stressful and time consuming and the more that can be done in a single visit makes sense.

(Public Change NHS website participant)

Create multidisciplinary specialty clinics (for example, for diabetes or rheumatoid arthritis) where patients can access all relevant services in one visit - consultants, nutritionists, physiotherapists, and diagnostic testing. This would cut down the need for multiple appointments and enhance coordination between departments.

(Public Change NHS website participant)

4.2 Concerns about moving care from hospital to community

Although participants across all strands of this engagement saw the potential for this shift to achieve positive change, they stressed the importance of successful implementation.

Both public and staff participants felt significant investment and staff would be needed for this shift to be a success, something that they worried would not be achievable in the current context. Public participants also had important concerns about the safety of care delivered outside hospitals, while staff noted that current norms around risk management do not support this shift. Although staff felt this shift has the potential to reduce health inequalities, the public, and particularly some seldom heard audiences, had concerns about the impact of some of these changes on a number of underserved groups.

A crucial challenge for the implementation of this shift is a lack of understanding among the public about the ‘need’ for it. In-depth conversations about this shift in public deliberative events highlighted low understanding of the main challenges this shift is trying to address, making this a less intuitive way to improve the NHS than the other shifts.

Public questions about the ‘need’ for this shift

In the public deliberative events, participants often did not initially understand what challenge this shift is trying to address. Although participants recognised the benefits of access and convenience (noted in section 4.1 of this chapter), the benefit of community care delivering better outcomes for patients was not immediately obvious to many. Indeed, many participants - and particularly those who were younger - often came to the events with a strong perception that hospitals are the safest and most appropriate place to treat patients, particularly at the end of life.

This perception tended to soften as participants in the deliberative events heard more evidence about the health benefits of being treated outside hospitals, particularly for patients living with frailty. That said, a minority of participants still questioned whether hospitals would be the safest place for this group of patients.

Participants’ starting point meant that many initially questioned if the shift is necessary, given wider challenges within the NHS. The fact that they did not have an immediate understanding of the problems the shift is trying to address made it hard for them to see how it would help resolve their key challenge of access.

This concern was reflected by partner organisations who said that the shift would require a change in public attitudes and behaviours. Partner organisations felt that a perception of A&E as the ‘default destination’ could undermine efforts to achieve this shift.

Funding and financial viability

Staff, public participants and partner organisations all expected that the shift from hospital to community will require significant investment. Although most could point to examples of care being delivered in the community in their local area at the moment, the model as a whole was felt to be very far away from the status quo. Public and staff identified a need for new infrastructure - and in particular technology, including shared IT systems and a single patient record to deliver this shift. Changes were expected to take time and be expensive.

All audiences questioned whether in the context of current public service funding challenges there would be sufficient investment to deliver this shift. When asked to share their concerns about the shift to community in an open text question, over a third (35%) of participants on the Change NHS website spontaneously raised concerns about funding and resources, of which 1 in 6 (15%) were worried about investment specifically. These concerns were reflected in the nationally representative survey. When asked to identify their biggest concerns related to this shift, 2 in 5 (39%) selected a lack of equipment, suitable buildings and infrastructure in communities and over a third (35%) selected whether care in the community will be properly funded.

Figure 7: chart showing public concerns with delivering more care in the community on the Change NHS website

Shows percentage of participants on the Change NHS website selecting the top 5 coded responses to the question: ‘What, if anything, concerns you about the idea of delivering more care in the community in the future?’

	Percentage
Maintaining a well resourced workforce, or ensuring sufficient staff are available	17%
Maintaining workforce quality, or skilled or qualified professionals	16%
Funding or costs or ensuring sufficient investment	15%
Challenges maintaining a good or consistent standard of care	10%
Lack of community infrastructure or poor community facilities	10%

Base: all those who answered this question in the ‘Start here’ survey (number equals 61,941). The survey was live between 21 October 2024 and 14 April 2025.

Figure 8: chart showing main concerns with delivering more care in the community in the nationally representative survey 

Shows percentage of nationally representative survey participants selecting answers to the question: ‘Which of the following do you think are the biggest concerns?’

	Percentage
Whether there are enough health and care professionals - with the right training - to deliver it	57%
A lack of equipment, suitable buildings and infrastructure in communities	39%
Whether care in the community will be properly funded	35%
Care delivered in the community may be inconsistent or vary between different locations	30%
Errors in care, such as incorrect diagnoses or missed diagnoses	30%
Poor organisation or co-ordination between services	29%
Whether some people or groups will be less able to access certain services	14%
How local services will be held accountable if something goes wrong	14%

Base: all those who answered this question in the nationally representative ‘Start here’ survey (number equals 2,025). The survey was live between 12 and 17 December 2024.

There were also some questions about the financial viability of this model, with many expressing scepticism that delivering care outside hospitals would be more cost-efficient than the existing model of care. Some, particularly staff participants in deliberative events, pointed to the cost of delivering community care in rural areas as an example of where they suspected it would be more expensive to adopt a community-centred model of care.

Staff participants in deliberative and online events emphasised that the shift will require a significant change in the way the NHS currently funds services, and specifically either a dramatic shift in funding flows from acute to community settings or a doubling up in investment to bring parity between the 2 settings. They warned that the first option risked possibly leading to worse care in acute settings in the short term but felt doubtful that there would be the political will for the second.

Staffing

Staff, public audiences and partner organisations felt that for this shift to be a success there will need to be a significant influx of staff into community roles. Wider concerns about staff shortages among those audiences, alongside staff concerns about sustainable workforce planning, meant there was doubt that adequate levels of community staffing could be achieved in practice. Without a significant increase in the community workforce, many staff also worried that the potential benefits of a community role on work-life balance wouldn’t be realised, as they would still feel under pressure to deliver more than they have capacity for.   

I have a friend who works in the community (as a nurse) and she works silly hours into the night because they do not have enough resources. Bring it into the community but really invest in it.

(Public deliberative event participant, East of England)

Of the concerns shared by participants on the Change NHS website through an open text question, staffing was one of the most prominent, with a third (34%) spontaneously mentioning it. Respondents in the nationally representative survey were also very concerned about whether there are enough health and care professionals with the skills needed to deliver this shift, with nearly 6 in 10 (57%) ranking this as one of their biggest concerns.

Staff felt that longstanding views of community roles as less prestigious than other roles in the health sector (discussed in more detail below) might be a significant impediment to large-scale recruitment.

Beyond questions of prestige, staff participants in deliberative and online events also pointed to some additional considerations that would need to be addressed to make roles in community settings feasible and attractive. Some practical concerns related to travel were mentioned time and again: ensuring access to appropriate means of transport, covering the cost of travel and parking, and properly accounting for travel time in rotas.

No incentives for staff to come and work in community. Due to travel costs, parking.

(Staff online event participant)

Some staff in deliberative and online events also mentioned concerns about safety working in community settings, particularly if lone working. There was a perception among these participants that working in the community means working in isolation (although those who already work in the community said this is often not the case). Staff worried that without adequate support, training and resources, community staff might find themselves visiting patients in unknown environments and feeling vulnerable. There were also concerns about a lack of immediate support in emergency situations or if a patient is unpredictable or becomes violent.

In hospitals they [staff] have access to more resources and a safer environment. Whereas in community, resources are limited and most of the time it is lone working, so there is no support.

(Staff deliberative event participant, North West)

Uneven provision of care

Although the public saw the potential for this shift to deliver more convenient access to healthcare, there were concerns that without appropriate funding and investment, the benefit will not be evenly distributed across England. There was an assumption that if there is not enough resource to implement this shift everywhere it will be people living in rural and coastal areas that will miss out, and that in this way the shift will inadvertently exacerbate (rather than resolve) existing geographic inequalities.

There were 2 ways that participants envisaged this happening.

Firstly, there were concerns in the public deliberative events that people living in rural areas may struggle to access community services, particularly if those services have to cover a large geographical area.

Secondly, in both the community engagement and the public deliberative events, those living in rural and coastal areas said that their areas already have poorer infrastructure and receive less funding than other more populous areas of the country. They warned that without a proper focus on how to deliver community services in their areas and the investment to support it, they risked being left behind.

Potential to exacerbate health inequalities

Public participants in deliberative events and the community engagement had serious concerns about the potential for this shift to negatively impact traditionally underserved patient groups.

In the community engagement, a number of seldom heard audiences raised significant concerns about accessing some types of stigmatised care in community settings (for example, mental health services, sexual health services and addiction services). These participants were concerned that if these services are located in the community where a patient lives, that patient might be seen using the service by friends and family, undermining their privacy and anonymity. They emphasised that fear of being discovered accessing certain services in their community might deter some individuals from accessing care.

[There is] concern of people seeing you access some of the ‘stigmatised’ services. So, some diagnostic services should be located in places that are not too public.

(Community engagement, children and young people)

The audiences that raised these concerns most often were those from the LGBTQIA+ community (particularly transgender people), children and young people, and those with drug and alcohol dependency. In particular, children and young people raised privacy concerns about services located in schools, where a patient’s peers would be more likely to see them accessing help.

How will community healthcare work if, for example, someone who is LGBTQ lives in a mostly religious or conservative community?

(Community engagement, LGBTQIA+)

A GP is more private, it’s a safe space. At school it’s a lot more public.

(Children and young people deliberative event participant)

Other seldom heard audiences participating in the community engagement highlighted the potential for problems with access if certain types of community care are primarily delivered in home. For example, sex workers and those from the Gypsy, Roma and Traveller communities expressed discomfort with healthcare staff visiting them in their homes. They also wondered if staff might feel uncomfortable coming into their homes, due to misconceptions or a lack of understanding of their lifestyle.

Those without a fixed address (for example, those experiencing homelessness, the Gypsy, Roma and Traveller community, or those in contact with the justice system) also wondered how they would access community care if they do not have a consistent community, or whether staff would feel safe treating them in locations other than a home or community area (for example, a temporary shelter or hostel).

There was also a prominent concern about the provision of translation services in community settings among some seldom heard audiences. There was a perception among these audiences that interpreters are more readily available in hospital settings than other parts of the health service. They worried that without proper access to translation services, care in the community for those who do not speak English as their first language will be worse. They spoke particularly about the potential for misunderstandings or delays accessing care while waiting for a translator.

Finally, participants with learning disabilities also raised specific concerns about the potential of this shift to impact the quality of their care if not managed properly. These participants had 2 concerns.

Firstly, some mentioned their need to plan extensively when attending an appointment in a new place, meaning appointments in multiple different locations have the potential to be more difficult and time consuming to navigate.

Secondly, they emphasised the importance of healthcare professionals understanding them and their communication needs. They therefore wanted to ensure that, if this shift led to a system where they would have to engage with multiple healthcare professionals, these staff members would have the skills and information to be able to quickly adapt to their patients’ communication needs.

The potential for this shift to exacerbate health inequalities was an area where staff and public perspectives often differed. As detailed above, staff expected this shift to improve access for underserved populations and those from deprived areas.

Perceived risk of lower quality or unsafe care

In the public deliberative events and the community engagement, many participants voiced concerns that this shift could lead to worse quality or less safe care. It should be noted that this concern did not feature strongly in the Change NHS website responses.

Public participants in deliberative events and the community engagement feared that care in the community will result in care being delivered in multiple locations by different healthcare professionals who are not joined up. They worried the onus would then be on the patient to navigate different appointment systems, attend different locations and communicate their history to multiple healthcare professionals. These concerns were particularly strongly expressed by members of the public with experience navigating both health and social care systems simultaneously. Those public participants in the deliberative events and the community engagement with multiple long-term health conditions or who were neurodivergent also saw the potential for this shift to further complicate their care.

How will it work if there is no responsibility or management system? How will the integration work? The interface between hospitals and GPs and social care, and what does access looks like is what worries me.

(Public deliberative event participant, South East)

Public participants also identified safety concerns related to a more fragmented system. They worried that in the absence of a single patient record and clear systems for navigating care pathways, there was a risk that patients with serious health issues who were unable to navigate through the system might slip through the cracks. 

There were also significant concerns about the actual quality of care received in the community in comparison with hospitals. As described above, although there was awareness among some groups of the negative impact of extended hospital stays on health, many public participants in deliberative events had a starting assumption that the hospital is the safest place for those who are very sick. Hospitals were seen as having access to a wide range of staff, resources and expertise, all of which contribute to a sense of safety. In contrast, the public questioned whether community settings - particularly care delivered at home - would have access to the same standard and range of medical equipment and expertise.

This concern about the safety of community settings was expressed most strongly in relation to virtual wards. In the public deliberation and community engagement, most participants without personal experience of virtual wards were initially very concerned about their safety and the risk of patients’ health deteriorating without anyone noticing.

There is a risk of patients deteriorating rapidly and this not being recognised as they are away from immediate advanced medical help.

(Community engagement, those with experience of cancer)

While staff in deliberative and online events did not agree with this assessment of the safety of community settings, they recognised that this perception is widespread among the public. They therefore identified the public not feeling safe and comfortable accessing care in the community as a potential barrier to the success of the shift.

[There needs to be] knowledge and understanding of what community services offer and the benefits, in order to ensure patients are aware, understand and are confident [in those services].

(Staff deliberative event participant, South East)

Although not as widespread as concerns described above, some public participants events raised additional concerns about the safety implications about this shift.

Some were concerned that a system preference for community care might result in patients being sent home from hospital before they are ready or without the proper support to recover at home. This worry was expressed most strongly in the community engagement by those in contact with the justice system. This audience emphasised how early discharge without community support can create a cycle of repeated A&E attendance.

It could be dangerous if it’s not done properly. You’re just abandoning people and saying, ‘Off you go, go home’.

(Public deliberative event participant, North East and Yorkshire)

Some expressed a worry that care in hospitals might deteriorate as a result of this shift, because of a shift in funding into the community.

Some were also worried that appropriate governance processes will not be in place. Some public deliberative event participants asked for more information about what governance processes will look like, who will be involved and how they will hold different community services to account.

In general, staff participants at the deliberative and online events were less likely than public participants to express concerns about patient safety arising from this shift. However, they did voice some concerns about what the execution of this shift might mean for patient safety.

Staff emphasised the importance of training in ensuring that all healthcare professionals operating in the community can do so safely. However, there was significant doubt that investment would be provided to deliver the scale and quality of training necessary.

Some also noted that it might be difficult to maintain a high-quality service during the transition to more care in the community as the workforce adapts to new ways of working and different roles. They felt that poor implementation planning, uncertainty about changes and new roles, and the potential of a rushed transition may impact care.

Moreover, staff participants in deliberative and online events did have some concerns about a culture of risk aversion potentially undermining this shift. They spoke about current risk aversion when transferring patients between hospitals and community which would need to be addressed. They felt this was caused by 3 things.

Firstly, a lack of awareness and understanding between the different settings. Staff in the community felt hospital staff do not always understand their service or capabilities. Conversely, community teams may not fully appreciate hospital constraints. This can lead to distrust and false assumptions. It was also felt that NHS managers need to understand the challenges faced in community settings (as opposed to just a hospital ward).

Secondly, a lack of a joined-up system with clear discharge pathways and responsibilities which means staff can err on the side of caution.

Thirdly, a fear of blame for re-admittance, which means staff can adopt a ‘better safe than sorry’ mindset - a minority of management staff noted that re-admittance targets also drive this mindset.

Some staff participants at deliberative events also expressed concern that healthcare professionals operating alone in a community setting might become too risk averse. They worried that in the absence of colleagues to share information and get a second opinion, healthcare professionals might understandably err on the side of caution.

Too many specialists have become super-specialised, whereas generalists are more comfortable with risk. They [specialists] also have a lack of awareness about what’s available in the community.

(Staff deliberative event participant, Midlands)

The cultural shift from a hospital-centric mindset

Staff participants in the deliberative events pointed to a deeply ingrained ‘hospital centric’ mindset in the NHS as a significant barrier to the success of this shift. They point to the need for a fundamental philosophical shift within the health service as it moves from a reactive, hospital-based model to a proactive, preventative and community-based approach. They said this shift will need to be accompanied by changes in staff culture and attitudes, funding and system structures and incentives.

When discussing the need for a cultural shift away from a hospital-centric mindset, staff in the deliberative and online events expressed a range of different views and priorities based on their role, highlighting the work that will be needed to unify perceptions of community care.

Those who work in acute care did not always understand the complexity of working in the community and the expertise required. They were more likely than other staff to perceive community staff as having less training and fewer skills. However, there was also recognition within the acute sector of the potential of community care to free up hospital resources.

Those working in primary care (for example, GPs) often saw themselves as generalists working in the community and felt that the focus should be on incentivising and supporting them rather than focusing on a bigger shift away from specialist roles. They felt they would have the capacity to manage more cases if they had more support.

Professionals working in the community frequently spoke about feeling undervalued and lacking the same opportunities for training, career progression and pay as their acute-based colleagues. They emphasised that their skills need to be recognised, along with the complex nature of their work.

Managers and executive staff recognised the strategic importance of this shift. However, they also acknowledged the significant financial and resource implications and the need for careful planning and investment.

Administrative and clerical staff highlighted that their roles are crucial for co-ordination and support within clinical settings. They raised concerns about unclear accountability, inadequate safeguards and training and development gaps for non-clinical staff.

Finally, staff in deliberative and online events agree that work would need to be done to increase the prestige associated with community roles. They noted a widespread sense within the NHS that these roles hold less status than hospital-based roles. This was due to a perceived lack of clear pathways to progression and lower pay. Staff participants already based in the community said they often felt undervalued and frustrated as a result of this perception.

Community staff need to feel higher profile and seen equally with hospital settings.

(Staff deliberative event participant, North East and Yorkshire)

4.3 Public recommendations for the delivery of the hospital to community shift

Across the Change NHS engagement, the public were asked to make recommendations to support the successful delivery of the shift from hospital to community. 

In addition, in the public deliberative events, participants were asked to consider 3 specific elements of this shift:

• the role of the GP and how to make best use of a multidisciplinary team in the community
• services which could be delivered in the community
• end-of-life care

From these discussions, the public developed a series of recommendations for ensuring the success of the shift.

The public’s top priority for this shift was that it should relieve pressure on GPs and A&E. They saw potential for some of the interventions discussed to support this, including the introduction of the single patient record and more effective triaging systems. They also felt these changes would need to be accompanied by communications with the public to build trust in receiving care in new settings and with different healthcare professionals.

The public emphasised the absolute importance of ensuring patient safety as more care is delivered in the community. They also hoped that patient choice would be a prominent feature of the shift to community.

Finally the public had specific advice about the services they most want to see in their community (for example, screening services) and how end-of-life care conversations can be best handled.

Relieve pressure on GPs through more effective triaging and a single patient record

The public participants in the deliberative events and on the Change NHS website were willing to accept different models of care in principle.

Public participants at the deliberative events were supportive of seeing a wider range of healthcare professionals beyond GPs. They called for more effective triaging to these healthcare professionals to support this, an idea that was discussed in further detail at the national summit (see chapter 7).

So, we said that we should prioritise triaging to the most appropriate healthcare professionals, apparently this does already happen but it should be done better. You do not necessarily have to go to a GP.

(Public deliberative event participant, South East)

This view was echoed on the Change NHS website where the majority of participants said they would be happy to speak to a range of healthcare professionals other than a GP if it means they are seen sooner.

Figure 9: chart showing which other healthcare professionals the public would be happy to speak to first, instead of a GP, to be seen sooner on the Change NHS website

Shows percentage of participants on the Change NHS website selecting answers to the question: ‘Which other healthcare professionals would you be happy to speak to first instead of a GP, if it meant you were seen sooner?’

	Percentage
A relevant specialist (consultant, dietitian, and so on) instead of waiting for a referral	82%
A nurse to discuss a minor illness	72%
A physiotherapist to discuss an injury	72%
A pharmacist to discuss a prescription to treat common health conditions and/or check and review a prescription	70%
A mental health practitioner to discuss your mental health	59%
Other	6%
None - I would want to speak to a GP first	6%

Base: all those who answered this question in the ‘Your priorities for change’ survey (number equals 21,294). The survey was live between 24 February 2025 and 14 April 2025.

Public participants were also broadly content to see healthcare professionals outside a GP surgery or hospital. The majority of participants on the Change NHS website were happy to see a healthcare professional in a mobile clinic, pop-up clinic in community centre, pharmacy, online or in their home.

Figure 10: chart showing which settings the public would be happy to speak to a healthcare professional in, outside of a GP surgery or hospital, on the Change NHS website

Shows percentage of participants on the Change NHS website selecting answers to the question: ‘Which settings would you be happy to speak to a healthcare professional in, outside of a GP surgery or hospital?’

	Percentage
A mobile screening clinic (for cancer tests, blood tests, and so on) instead of waiting for a referral	85%
A community centre (a pop-up clinic)	74%
Pharmacies	68%
By digital appointment (on your phone, tablet, laptop, and so on)	62%
Your home	57%
Faith buildings (a pop-up clinic)	31%
Schools and colleges	26%
None - I want to be seen in a GP surgery or hospital	5%

Base: all those who answered this question in the ‘Your priorities for change’ survey (number equals 21,199). The survey was live between 24 February and 14 April 2025.

However, to feel most confident in this new approach, the public wanted reassurance that care would feel co-ordinated, facilitated by a single patient record. This view was expressed strongly in the public deliberative events, in the community engagement and on the Change NHS website, where around 7 in 10 (66%) participants said that a single patient record was the step that would make them feel most confident in using services in new settings and engaging with new healthcare professionals.

Figure 11: chart showing public priorities to feel confident using services in new settings and with new healthcare professionals on the Change NHS website

Shows percentage of participants on the Change NHS website selecting answers to the question: ‘To feel confident using services in new settings and with new healthcare professionals, which of the following is most important to you?’

	Percentage
That healthcare professionals will have access to my records, so they know how to treat me and what my history is	69%
That my GP would have a record of every appointment and conversation, so nothing gets missed	60%
That healthcare professionals that are not GPs are trained to spot things that could be signs of more serious illness	47%
That my personal data will be handled safely and securely	39%
That my concerns and issues will be taken seriously	36%
That I will be seen sooner than if I went to a GP	22%
That I will be seen at a more convenient time and/or location	11%
Other	4%
None of these	1%

Base: all those who answered this question in the ‘Your priorities for change’ survey (number equals 21,291). The survey was live between 24 February 2025 and 14 April 2025.

Single healthcare records and a joined-up system were particularly important for many seldom heard audiences and those who interact frequently with the NHS. These participants described struggling to interact with a fragmented care system and felt they would be particularly impacted if care delivered in the community does not feel joined up. Audiences for whom this felt particularly important included those with learning disabilities and people who are neurodivergent.

[I hope] The introduction of digital patient records can significantly reduce the stress of repeatedly sharing medical history. For autistic individuals, this minimises communication fatigue and enhances the continuity of care across different NHS services.

(Community engagement, learning disabilities and/or autism)

A selection of ideas for change shared on the theme of more effective triage

Local urgent care [at a hub] where patients are triaged on arrival. It [could] have a pharmacy for prescriptions and first aid over the counter, advanced nurses and paramedics for minor ailments and for assessments, and GPs for patients who need a GP.

(Public Change NHS website participant)

Everyone wants a hospital close to home and fights closure of the local facilities but most minor to moderate trauma, acute medical problems (chest infections, rashes, asthma exacerbations, faints, UTIs) could be easily treated or triaged at an urgent care centre equipped with basic lab and imaging facilities. These centres would need nursing staff and a medic with GP level experience including basic paediatrics and trauma. Many lab tests can be done without needing the full facilities of a hospital lab. Imaging can be read by AI. Having local facilities would avoid or minimise ambulance use and save patient time and thus lost working time.

(Staff Change NHS website participant)

Build trust in the wider community workforce

Despite willingness to consider consulting a wider range of healthcare professionals in principle, public participants noted that this might be more challenging to achieve in practice, due to concerns about lower quality or unsafe care mentioned in section 4.2 of this chapter.

The public therefore recommended making an effort to build knowledge of different healthcare professionals’ skills and expertise, helping the public to move away from the belief that a GP should be the gatekeeper of their care or, for those who are more unwell, that hospitals are always the best place to be. For example, public participants in deliberative events felt it would be important to raise awareness of pharmacists’ ability to prescribe medication for certain illnesses.

I think making greater awareness of the availability of different services. The GP isn’t the be all and end all.

(Public deliberative event participant, South West)

This idea was more fully explored in the national summit, covered in chapter 7.

Some participants in the community engagement stressed that building this trust will also depend on healthcare professionals doing things differently. For example, those who felt they have been stigmatised while accessing healthcare - in particular sex workers and those from the Gypsy, Roma and Traveller community - said that for the shift to succeed, staff working in the community should have training to address bias and build understanding of cultural differences.

Continue to reduce A&E admissions with ambulance triage

There was appetite to expand the use of models of care which divert patients from A&E. In public deliberative events and many of the community engagement workshops, public participants explored the idea that the ambulance service could triage people at home and refer them to appropriate community services. Ambulance triage was supported in principle, because it was clear to participants how it could relieve pressure on A&E. However, participants often stressed that their support was contingent on sufficient resources being allocated to the new systems to ensure there are enough properly trained staff.

Prioritise ambulance triage. [People can then have] access to treatment more quickly, and there will be more space in A&E.

(Public deliberative event participant, North West)

Ensure patient safety is at the heart of any new system

The public were content to accept moving care from hospital to community only if it does not have an impact on standard of care. Public participants in the deliberative events and community engagement wanted reassurance on a range of factors deemed important to safety. These included ensuring that staff have the right training and expertise, making sure that the quality of equipment in the community is comparable to that in the hospital and ensuring that enough resources are allocated to services - for example, enough healthcare professionals to closely monitor virtual wards.

This was particularly important for some seldom heard audiences, such as those who are digitally disengaged or excluded, those living in rural communities and those with multiple long-term health conditions, as they felt that their complex needs or lack of digital infrastructure meant they risked experiencing less safe care.

I imagine that there’s going to be a lot of people feeling ‘Well, am I getting the same care as what I would get in a hospital and have I been sent the right person?’

(Public deliberative event participant, South East)

Public participants in deliberative events also wanted reassurance that if care can be delivered more cheaply in the community, patients will only be sent home from hospitals when it is safe to do so. Some also wanted the context of a patient’s home life to be taken into account when taking decisions about whether it is safe for them to leave hospital.

Our concern was that in a stressed system, sometimes people might be sent home before they are ready.

(Public deliberative event participant, South West)

Respect patient choice

Although the public were happy to accept different models of care delivered in communities, public deliberative event participants emphasised the importance of choice. This was raised particularly in relation to 2 key areas.

Firstly, in virtual wards. Many participants had safety concerns in relation to virtual wards. They strongly emphasised that patients should always have the choice to stay in hospital if they feel safer there and should not be pushed to use a service they do not want to.

Lots of things have to work in order to make the idea (virtual wards) work […] There has to be an option to go into them [virtual wards], not being told you have to. Or it’s an excuse to push people out of hospitals too early. There are cases where hospitals can feel the safest space.

(Public deliberative event participant, North West)

Secondly, when making decisions about end-of-life care. Giving choice in this area was seen as a way to give patients dignity and control at the end of their lives. Most participants at the public deliberative events recognised that there will be those who want to prioritise quality of life or the comfort of dying at home, but others may want to prioritise living longer and pursuing all treatment options. They felt both these choices should be respected and supported wherever possible.

Protecting choice in the system was also important for several seldom heard audiences. In particular, the ability to opt out of receiving care at home was important for those without a fixed address and those without the infrastructure at home to support remote care (for example, those living in coastal and rural communities and digitally disengaged and excluded audiences). 

When locating services in communities, prioritise screening and diagnostics

When thinking about the types of services that might be delivered more effectively in communities than hospitals, public deliberative participants were most excited about and prioritised the delivery of screening and diagnostics. This excitement reflected their enthusiasm for screening services as a key priority for the prevention shift as detailed in chapter 6.

Prioritise opportunities that prompt you to think about your health, and are proactive, for example the cancer screening trucks.

(Public deliberative event participant, London)

Public participants in deliberative events said delivering these services in the community will benefit individuals, as they will be easier to access. Consequently, it was expected that uptake would increase, ultimately leading to better health outcomes among the population at large. It was also expected that moving these services would help reduce pressure on hospitals, meaning space and staff could be reallocated elsewhere.

However, some public participants at deliberative events did stress that there should not be a one-size-fits-all approach to introducing this kind of service into communities, saying planners should respond to local needs and requirements. For example, these participants questioned if a local town that already has a hospital would also need to introduce a community diagnostic centre.

One size doesn’t fit all here, in a geographical sense. I’m [location] based, we have a hospital so don’t bother putting stuff in [location] - we have it all. But there are some places which are miles from a hospital and really do [need it]. We don’t want to get evangelical about it and say this cannot be in hospital - it’s as convenient as anywhere else.

(Public deliberative event participant, South East)

Public participants in deliberative events also emphasised the importance of promoting those services that are available in communities to ensure proper take up. They suggested communication about these services to patients directly and through relevant healthcare professionals.

It’s a priority that people are aware of services [so that] they are well used. Not just patients [should be made aware, but] also NHS staff. For example, make GPs aware and [they can] tell patients.

(Public deliberative event participant, Midlands)

Sensitive conversations with patients about what they want from end-of-life care can support high-quality care in the community

In public deliberative events, some participants discussed processes for end-of-life care. These discussions resulted in a passionate recommendation for an increased focus on conversations about end-of-life care. These participants wanted patients’ wishes to be understood and recorded, considering questions like what quality of life looks like for them and where would they like to die. While there was some sense that this may happen already within families, it was not felt to be consistent across the system at large.

To ensure these conversations are delivered sensitively and effectively, these public deliberative event participants had 3 requirements.

Firstly, conversations should happen early, while the patient is still able to engage with the topic. Many could foresee a situation where the patient’s health has deteriorated and they are no longer able to discuss or make decisions about their end-of-life care. Four in 5 (79%) of participants on the Change NHS website also said they would support having an early conversation about end-of-life care, including the opportunity to discuss what a good death would mean for them.

Ability to have the conversation earlier on and to review it and change their mind what kind of care they find acceptable and what they want.

(Public deliberative event participant, South West)

Secondly, there should be resources to train and educate healthcare professionals or non-clinical staff on how to facilitate conversations. There was a strong view among these participants that conversations need to be delivered empathetically and sensitively, and that clinicians need to have the tools to start the conversation if they need to.

Doctors need to be comfortable talking about taboo subjects such as end of life. Doctors need a different type of education regarding communication of these taboo subjects.

(Public deliberative event participant, South East)

Thirdly, cost should not be the driving factor in end-of-life care. There was a very strong view from these public deliberative participants that discussions about end-of-life care should not be framed around cost. Any discussion of cost (for example, in relation to treatment or the money spent in the last 12 months of life) was felt to be unacceptable. These participants strongly wanted to focus on what is right for patients and were happy to accept that this might mean significant funding is spent on this stage of life.

I wouldn’t like the finances to be at the centre of decision making […] Death should not be about what is the least expensive option for the NHS.

(Public deliberative event participant, South West)

4.4 Staff recommendations: what needs to change for the shift to be a success

Staff recommendations for the best way to make this shift again differed from those put forward by the public. Time and again, staff emphasised the importance of training and retaining a high-quality community workforce. They also pointed to efforts to promote collaboration across all areas of the workforce as essential to the shift’s success. Where staff recommendations aligned with the public was in relation to the importance of having the technology needed to deliver this shift and the importance of systems to ensure patient safety. However, their feedback on how best to deliver in these areas was more specific.

Develop community careers

Staff in deliberative and online events said that the development of a generalist skillset is an important aspect of strengthening the community workforce. Staff saw a generalist skillset as enabling a healthcare professional to take a whole patient approach - considering their lifestyle, social needs and preferences when making decisions about their care, rather than just specific health conditions. Many said they already see a trend in this direction, with increasing demand for professionals with broad skillsets, capable of managing a diverse range of conditions and providing holistic care in the community.

It’s common sense - the whole patient mindset.

(Staff deliberative event participant, South West)

Developing a generalist skillset was seen as valuable for developing staff who can step into senior staff roles, improving workforce resilience and enhancing patient assessment, management and care. Staff at deliberative events also wondered if the ability of generalists to offer cross-departmental support and manage a wider scope of care could improve the efficiency of systems and patient flow through them.

Staff emphasised the importance of education and training across all levels to support the development of this skillset. Specifically, participants at the staff deliberative and online events suggested including community placements in training, cross-professional learning, shared training across health and social care, early exposure to generalist practice and rotations between hospital and community settings. They suggested that training should focus on holistic care, upskilling in diagnostics, mental health integration and communication skills development. For these staff participants, empowering the workforce to become community decision-makers through professional development and support was seen as essential.

Flip training on its head. So train in the community and then go into hospital if needed.

(Staff deliberative event participant, South West)

Some staff participants in deliberative and online events emphasised that moves to develop a generalist workforce must not come at the cost of maintaining essential specialist knowledge, particularly in areas requiring advanced expertise. The presence of specialists within the system was also felt to be vital to meeting patient expectations, particularly around safety. Staff participants in online and deliberative events therefore emphasised that getting the balance of generalist and specialist input will be critical. They felt that a multidisciplinary team in the community, supported by access to specialists, is the most effective way to deliver patient-centred care.

Generalist skills are great. But I feel as a staff member and patient that seeing a specialist is reassuring. The saying ‘jack of all trades master of none’ springs to mind.

(Staff deliberative event participant, North East and Yorkshire)

It is important to note that the term ‘generalist’ is divisive. For many staff in the deliberative and online events, the term suggests that these healthcare professionals have less skill and are less valuable than a specialist. They felt that this is a widespread perception across the NHS, and that it acts as a significant barrier to staff wanting to take on these roles.

Generalism isn’t valued. Rewards and prestige drive people towards specialism.

(Staff deliberative event participant, South West)

Staff recruitment and retention challenges must be addressed

Staff participants at deliberative and online events saw recruiting and retaining a skilled community workforce as a significant challenge that requires multiple strategies to address. They had 4 recommendations.

Firstly, improving pay and progression. Staff recommended increasing rates of pay and benefits (for example, support with parking and transport, flexible working hours), access to training and professional development opportunities and creating clear paths to progression.

Secondly, building familiarity and experience with working in the community. For example, staff participants at deliberative and online events recommended making a community placement compulsory in training. They felt this would demystify the setting and encourage recruitment, as well as helping to build respect for the setting among secondary care colleagues.

Thirdly, taking steps to create a more supportive environment - for example, using digital tools to facilitate teamworking, establishing an approach to shared risk management and ensuring shared physical spaces to interact with colleagues.

Finally, valuing community roles. Staff participants in deliberative and online events recommended that efforts should be made to elevate the perceived value of community careers. Many suggested that work needs to be done to position community roles as just as prestigious, desirable or skilled as hospital-based positions.  

Support collaboration and build trust

Staff in the deliberative and online events emphasised that greater cross-system collaboration and multidisciplinary team working will be key to the success of this shift. They wanted NHS leaders to focus on breaking down silos and encouraging more collaborative working between departments and services. They called both for greater collaboration and communication between teams within the community and between hospital and community staff.

Improve communication and working between different teams.

(Staff online event participant)

Staff said that a key focus of these efforts should be building trust and shared risk management. Staff at deliberative and online events wanted efforts to be made to remove a culture of blame and build instead an environment of shared learning, where teams can openly discuss risks and learn from mistakes.

Staff participants in deliberative events also had specific advice for improving the transition of patients from hospital back into their community. Overwhelmingly, staff felt more integrated systems and services will improve patient transfers. They called for: 

• shared technology and IT systems, coupled with consistent documentation across care settings, to allow for a comprehensive view of patient history and facilitate safe patient transfer
• collaboration across settings, including encouragement to communicate with each other - this involves establishing clear communication channels, having open dialogues about patient needs and joint decision making between hospital and community staff
• standardising care pathways across settings to create shared expectations

[There needs to be] single systems and shared care records, so we can have better visibility of clinical decisions and needs. It makes it easier to safely share and manage risk.

(Staff deliberative event participant, South West)

Ensure significant investment and a strategic approach to implementation

Staff at the deliberative and online events called for investment in key areas to ensure the success of this shift. In particular, they stressed the importance of investment in IT systems to support integration across the community and with hospitals. At the event with administrative staff, participants particularly emphasised the importance of improved IT systems to facilitate more efficient and collaborative working.

Staff participants in online and deliberative events hoped that investment in IT infrastructure would result in:

• integrating systems between organisations and departments to ensure easy sharing of information
• more reliable technology, saving time spent on systems that are not functioning as they should
• a reduction in the number of staff logins
• better working in the community

Investment in reliable IT infrastructure and systems that actually work together.

(Staff online event participant)

Some staff deliberative and online participants also spoke about investment in equipment and supplies to ensure that healthcare professionals working in the community have access to the tools they need outside of hospital.

In addition, staff deliberative and online participants noted that for this shift to be a success, sufficient investment will need to be made to ensure there is the capacity to support timely transfers from hospital to the community. This included ensuring there are enough staff to support patient care and the proper physical infrastructure to support them safely.

Although a less dominant theme overall, staff felt that for this shift to be successful, there needs to be a systematic and phased implementation. They recommended that changes are carefully planned, piloted and phased, with time allotted to learn from feedback.

Take time to get it right rather than rushing changes.

(Staff online event participant)

Staff also felt that for greatest success, there must be a balance between standardisation and local flexibility. They wanted to see some flexibility in how local areas adapt and implement changes to best suit their needs, while also adhering to clear protocols and implementing standard operating procedures.

Enable local solutions to local problems.

(Staff online event participant)

See a list of all chapters