Research and analysis

Chapter 7: bringing together the 3 shifts - a vision for the future of the NHS

Published 17 December 2025

Applies to England

Summary of findings in this chapter

The culmination of the Change NHS engagement was a national summit where public and staff participants who had taken part in earlier deliberative events came together to discuss proposals for a more ‘personalised’ NHS, where care would be tailored to a patient based on their level of need. In this vision, those who are mostly healthy would primarily access the NHS through the NHS App and where appropriate will be directed to a healthcare professional other than a GP. Those with more complex needs would access the NHS through neighbourhood health hubs, where staff with different skills are co-located to deliver more holistic care. This vision for the future would be enabled by successful implementation of the 3 shifts.

Below is a summary of findings.

Public and staff summit participants agree with the principle that the NHS should be there for everyone but does not need to be the same for everyone. There is widespread acceptance that care could be better tailored to individual needs, with those with the most complex needs experiencing the NHS differently. This is especially true of access to care where, although participants want to see improvements for everyone, many agree that those with more complex or urgent needs should receive more intensive support, including being prioritised for appointments.

Summit participants see potential for elements of this vision to create efficiencies and a better patient experience. For those who are mostly healthy, triaging through the NHS App to the most appropriate healthcare professional is seen as a tangible way to address primary care access issues. It is also hoped that this will make access to care quicker and more convenient for these individuals. Implementing an approach for those with complex needs where care is delivered in the community or in their home is seen to be more convenient for patients and will deliver more holistic and efficient care.

However, there were significant concerns about how realistic this vision is. Both staff and public summit participants question if the NHS will be able to deliver the sustained investment and high-quality technology they perceive as essential to the delivery of key elements, such as triaging through the NHS App and creating neighbourhood health hubs.

There are worries about the impact of these changes on underserved groups, as a result of the system feeling complex and difficult to navigate. For example, summit participants are concerned about how those who are digitally excluded, have low literacy levels or poor English would engage with the NHS App, should they be considered mostly healthy and be expected to engage with the NHS through that route.

While summit participants agree with the principle that the NHS could work differently for different people, for some, seeing how this might look in practice raises questions of fairness. In particular, some question the fairness of those with complex needs having access to holistic care through, for example, a neighbourhood health hub, while those who are mostly healthy with the same symptoms are sent to a healthcare professional other than a GP like a pharmacist. They worry that this puts those who are mostly healthy at risk of having important symptoms missed by a healthcare professional who does not have sufficient expertise to correctly diagnose a serious illness.

Public summit participants’ acceptance of the proposed care pathway for those who are mostly healthy is based on the assumption that choice will be fundamental to the system. They say that access to care through the NHS App (and the resulting triage to the most appropriate healthcare professional) is acceptable, but only if a patient in this segment could instead easily make an appointment to see a GP if they wanted to. This presents a challenge to the ability of this new system to deliver efficiencies if patients choose to engage with their GP instead of using the NHS App. It will therefore be vital that early experiences with the NHS App for mostly healthy patients deliver seamless, quick and high-quality care.

Staff and public summit participants emphasise the importance of clear communication about these proposed changes to ensure their success. They stress how vital it will be for the public to understand and trust the new system so they use the correct access points, contributing to the delivery of quicker and more efficient care.

7.1 Context

At the Change NHS national summit, public and staff participants discussed and deliberated a new vision for care, enabled by the 3 shifts, which will form a key part of the 10 Year Health Plan.

As part of this conversation, we first explored the principle that ‘the NHS should be there for everyone, but not the same for everyone’. We then discussed how this might look in practice by providing illustrative examples of access and care pathways for individuals with different types of need. This included:

• individuals who are mostly healthy
• children and young people
• maternal and early years
• adults living in communal settings
• adults with intensive needs
• adults with complex mental health conditions
• socially excluded groups

While conversations covered the potential access and care pathways of all of these different groups, summit participants discussed the experiences of the first 5 audiences in greater detail. 

Key features of the pathways that were discussed and explored were:

• those who are mostly healthy accessing care through the NHS App in the first instance
• those who are mostly healthy and are experiencing mild symptoms are signposted to healthcare professionals other than a GP in the first instance - a particular example of an individual with mild stomach pain being directed to a pharmacist was used to bring this feature to life
• prevention becoming a feature for the NHS App for those who are mostly healthy, with the ability to track health goals and receive advice and incentives to stay healthier
• individuals with additional needs accessing care through a neighbourhood health hub - where healthcare professionals with a range of specialisms and skills are co-located
• how care would be delivered in these hubs, including ensuring the time and expertise for incorporating prevention support in every interaction
• instances of care being accessed and delivered in other settings - we spoke about care for adults living in communal settings being delivered in that setting through specialist teams, children and young people accessing care in their school and pregnant people accessing care from a midwife at home

An online version of the national summit was also held to accommodate past public deliberative participants who were unable to attend the national summit in person. In this condensed session, online summit participants were introduced to this vision and asked to share their views through an online feedback app. Their views were consistent with in-person summit participants, so the 2 groups have been reported as one below (public summit participants).

Some key features of this vision, like access to the NHS through the NHS App and attitudes towards seeing other healthcare professionals in place of a GP, were tested on the Change NHS website and the parallel online survey with a representative sample of 2,025 English adults. This was part of the ‘Your priorities for change’ survey. Results have been included throughout this chapter where relevant. Notable differences between audience subgroups among participants on the Change NHS website have also been identified where relevant (where an audience response differs from the total by plus or minus 5 percentage points), as have details of staff and public Change NHS website responses, even where views are consistent.

7.2 Benefits to this new model of care

Staff and public summit participants were interested in the concept of delivering care differently based on need. They saw real potential for it to address some of the challenges the NHS is currently facing.

Participants from both audiences had examples of where elements of this vision are already delivered in their areas, including the use of an app to triage primary care appointments and care tailored to specific groups’ needs delivered within the community. As a result, this approach felt familiar, particularly for staff. 

Support for the principle that the NHS should be there for everyone but does not need to be the same for everyone

Both public and staff participants agreed with and accepted this principle. As a result, the majority were comfortable with those with more complex or serious needs interacting with the NHS differently from those who are mostly healthy.

Most said it would be acceptable for those who are mostly healthy to access the NHS primarily through the NHS App, while those with more complex needs access care through neighbourhood health hubs or teams specifically tailored to their segment.

I think we all wanted to be treated as individuals [by the NHS], we don’t want to go through the same conveyor belt, we all have different needs.

(Public summit participant)

Many summit participants also saw it as reasonable and fair that someone with more complex needs would get access to a healthcare professional more quickly and easily than someone who is mostly healthy. This view was reflected in responses on the Change NHS website and by respondents to the nationally representative survey, as shown in the tables below.

Table 7a: proportion of participants on the Change NHS website supporting people with more complex needs being prioritised for appointments

	% answering 4 or 5 on a scale of 1 to 5 (where 1 is ‘strongly against’ and 5 is ‘strongly support’)
All participants on the Change NHS website	62%
Nationally representative sample	60%

Table 7b. breakdown of Change NHS website public and staff participants supporting people with more complex needs being prioritised for appointments

	% answering 4 or 5 on a scale of 1 to 5 (where 1 is ‘strongly against’ and 5 is ‘strongly support’)
All public participants on the Change NHS website	61%
All staff participants on the Change NHS website	62%

Base: all participants on the Change NHS website who answered this question in the ‘Your priorities for change’ survey (number equals 21,182). This survey was live between 24 February and 14 April 2025. All those who answered this question in the nationally representative ‘Your priorities for change’ survey (number equals 2,015). This survey was live between 17 and 20 March 2025.

Relieving pressure on GPs and hospitals

Public and staff summit participants saw the potential for these proposed changes to relieve pressure on primary and urgent care and address the key challenge of access. This was one of the most attractive benefits of the proposals.

Both audiences expected that if this system is working as it should, many patients who are mostly healthy would be directed away from a GP appointment to another appropriate healthcare professional, improving access to primary care for the individuals who really need it. Some also hoped that by cutting out the ‘middleman’ - the GP - those who are mostly healthy will be able to access the specific care they need more quickly. 

[The new system can mean] easier access and hopefully reduced waiting time in A&E, stress on doctors, better environment to work.

(Public summit participant)

Responses on the Change NHS website reflect the public’s openness to seeing healthcare professionals other than a GP, although responses from the nationally representative survey show slightly less enthusiasm.

Table 8: proportion of participants on the Change NHS website who would be happy to speak to the following healthcare professionals, instead of a GP, if it meant being seen sooner, compared with the nationally representative survey

	All participants on the Change NHS website	Nationally representative sample
A relevant specialist (consultant, dietitian, and so on) instead of waiting for a referral	82%	60%
A nurse to discuss a minor illness	72%	64%
A physiotherapist to discuss an injury	72%	52%
A pharmacist to discuss a prescription to treat common health conditions and/or check and review a prescription	70%	60%
A mental health practitioner to discuss your mental health	59%	46%

Base: all participants on the Change NHS website who answered this question in the ‘Your priorities for change’ survey (number equals 21,294). This survey was live between 24 February and 14 April 2025. All those who answered this question in the nationally representative ‘Your priorities for change’ survey (number equals 2,015). This survey was live between 17 and 20 March 2025.

Both staff and public summit participants suspected that clear and quick signposting to the most appropriate healthcare professional through the NHS App would also help the public to know where to go other than A&E or urgent care for help with a health concern, relieving pressure on these services too.

[The NHS App will help with] promoting and signposting to different routes of care. Signposting [will be] better for patients- go to walk in centres, etc.

(Public summit participant)

A better patient experience

Public and staff summit participants saw the potential for elements of these proposals to improve patient experience both for those who are mostly healthy and those with more complex needs.

[These changes] would benefit people who have more complex needs.

(Public summit participant)

I think this is the ideal situation, because it’s very patient focused, rather than a one size fits all […] whatever keeps the patient happy, safe and engaged with services.

(Public summit participant)

Both audiences expected that for people who are mostly healthy and able to use the technology, triaging through the NHS App would result in faster access to care than they currently receive. Quicker access to care was felt to be important in managing anxiety around health symptoms and preventing more serious health concerns by catching issues quickly.

Some also suspected that healthcare professionals other than GPs might have more flexible working patterns that could better suit people who are mostly healthy and in work. Being directed to a pharmacist rather than a GP was a particular example of where public participants expected this might be more convenient than the current system, due to longer opening hours and the ability to drop in without an appointment.

Both audiences also saw the potential for proposed changes to significantly improve patient experiences for those with more complex needs. Accessing care through a neighbourhood health hub was felt to bring real benefits. Summit participants hoped that seeing the same healthcare professional and having co-located teams would take away some of the stress of managing a complex condition and speed up referrals processes. They also suspected that by enabling more holistic care, underlying issues experienced by patients using these hubs would be spotted and dealt with more quickly and efficiently.

Where it was proposed that people in certain segments could see healthcare professionals in the comfort of their home or another familiar place, participants saw benefits in managing the anxiety or confusion possibly associated with receiving care. 

[Receiving care locally means] being able to meet people’s needs better, building that relationship, closer to home so you might get that community sense, even people being recognised within their communities, I think there is a real strength in personalisation within the community.

(Staff summit participant)

Support staff to deliver better patient care

After engaging with plans in detail, many staff summit participants felt that this neighbourhood health hub approach would help them to provide better care for those with more complex conditions. They said it would allow the staff interacting with patients to get to know an individual, their background and current circumstances better, supporting staff to view patients more holistically. 

They also saw real potential for this approach to help with collaboration in neighbourhood health hub locations. Co-locating in the same space was seen to help facilitate both formal and informal knowledge sharing that could enable better patient care.

Potential to empower patients

Some staff summit participants also saw the potential for key features of these proposals to empower patients to self-manage their health. They hoped that signposting and information on the NHS App would help those who are mostly healthy to identify the most appropriate place to get care and take responsibility for using only the correct service.

[The public] need to be supported and empowered to help people make a change in their lives. We’ve set this up as a challenge, with a hierarchy of doctors being God. So, the public now think, I need to see a doctor about this, or a GP. People should be educated: ‘I can go to a pharmacy.’

(Staff summit participant)

Proposed reminders to check in and log symptoms on the NHS App were also felt to be another opportunity to support patients to manage their care and seek help at the most appropriate time.

7.3 Concerns about this new model of care

Investment and staff required to make this new system a success

Notwithstanding the widespread perception that some of these proposals already exist in certain areas, public and staff summit participants felt that successfully implementing these plans across England would represent a very significant overhaul of the NHS. They questioned how realistic this is in the context of current funding and workforce challenges cited across the engagement. This led to significant scepticism about whether the proposal will succeed in delivering real and lasting change.

This sounds really good! I would love for this to be in place. But this isn’t just a matter of reorganising the health system, it’s going to require a great deal of money. We keep getting told that this money doesn’t exist. So how are we going to rearrange the resources we have to make this work?

(Staff summit participant)

Both audiences pointed to specific, significant investments that they expected would need to be made to support these proposals.

Investment in high-quality technology was universally seen as essential, particularly an NHS App that works seamlessly and a single patient record that allows information to be shared between healthcare professionals and across different parts of the health and care system.

There was also an expectation that neighbourhood health hubs need to be located in specialist or new spaces, resulting in the need for a significant investment in physical infrastructure.

It’s about having that funding and space. Things like children’s centres and other centres would be fantastic but it’s about having the infrastructure and facilities to do that.

(Staff summit participant)

Staff participants at the summit also expressed significant concern about whether there is the workforce available to deliver some of these proposals. Many were struggling with staff shortages in their area, so questioned how there would be capacity to deliver care to those with complex needs in this more staff-intensive model. This led to calls for a workforce plan to help ensure the NHS can attract and retain the staff needed for the neighbourhood health hub element of this vision to work. 

If people get this, this would be fantastic. But my concern is, we are talking about so many teams but where do we get all the staff?

(Public summit participant)

The impact on underserved groups

Top-of-mind for most summit participants when reviewing these proposals were concerns about how underserved groups will experience the NHS if these proposals are enacted. In particular, both staff and public summit participants raised concerns about the digital-first approach proposed for those who are mostly healthy in relation to those who are digitally excluded, have literacy problems or who do not speak English as a first language. They worried that these groups would be unable to access timely care or be put off engaging with the system entirely.

I do worry for people who don’t speak English and people who may seem to have capacity but there may be some possible areas for misunderstanding, some people are more articulate than others.

(Public summit participant)

Some summit participants also worried that the complexity of different individuals accessing the NHS in different ways might be difficult to navigate for certain groups, particularly those who have less understanding of, and confidence in, the NHS. A few also questioned if the complexity of the system would result in those who ‘speak the language of the NHS’ receiving better care, while those who are less familiar with the NHS slip through the cracks.

[the person who was mostly healthy] is probably able to work out how to access the services that he needs - but other people might use the App and get really lost in it and not get the services they need.

(Staff summit participant)

A few public and staff summit participants mentioned the potential for the introduction of physical hubs for individuals with complex needs to compound challenges with access to care for rural populations. These participants expected that hubs would not be as close to these populations as a traditional GP surgery. They therefore questioned if this element of the new model of care would make it more time consuming and costly, or simply impossible, for those with complex needs living in rural areas to access the care they need.

Living rurally, if you don’t drive and you’re pregnant and don’t want to drive, you can’t access these things.

(Public summit participant)

Questions about how individuals know how they are expected to access the NHS

Both staff and public summit participants wanted to understand more about how the system will identify and support individuals with more complex needs. There were significant concerns that someone with complex needs might be defined as ‘mostly healthy’ and therefore not receive the care they need and are entitled to through a neighbourhood health hub. Many asked what measures will be in place to identify if someone has more complex needs and make them aware of how they should be accessing the NHS.

There was some debate about the role individuals should be able to play in determining if they have more complex needs that the system should support. Here public and staff perspectives differed. Public summit participants hoped and expected that individuals would be able to have a say, while staff warned against too much patient involvement. Staff feared that this could lead to some people who understand how to game the system getting preferential access to care, above people who need it more.

There were also significant questions about how individuals transition between being considered mostly healthy by the system and having more complex needs.

Most commonly, questions focused on the transition from a person being defined as ‘mostly healthy’ to someone with complex needs. Participants wanted to understand what systems will be in place to identify when a change is needed, especially if a patient is experiencing a gradual worsening of symptoms, and make sure patients are receiving the care most suitable to them.

A smaller number of questions focused on the transition from being defined as having more complex needs to ‘mostly healthy’ when their needs changed. Some wondered how those who have been receiving intensive and holistic care would cope with now receiving what was perceived as more basic and less personalised care. This concern was especially strong in relation to children and young people, where staff said there are already problems with the management of long-term health conditions when individuals transition to adult care. 

And at 18, there needs to be a bit of continued support. Traditionally, after 18 you’re off on your own. They need to be guided after 18.

(Staff summit participant)

The impact on staff

Staff summit participants raised some worries about how these proposed changes might impact them, particularly without sufficient investment or the workforce plan that they believed would be needed to ensure success.

Staff said that current staffing shortages are already a source of significant pressure. They therefore worried that these proposals, which they believed would be more staff intensive, would lead to even greater pressure on their time. Without significant action to attract and retain staff, staff summit participants struggled to see how the new system would not contribute to additional stress and burnout.

[There’s a] complete lack of staff […] If there’s more staff, you’d be able to have [this kind] of flexibility.

(Public summit participant)

The only thing about this resource, a lot of these [example care pathways] are resource-heavy compared to the old way (that doesn’t work very well I fully register).

(Staff summit participant)

Some also questioned whether, without increased investment and resources, encouraging mostly healthy people to visit healthcare professionals other than a GP would just move the problem elsewhere to other already stretched professionals. They emphasised that this would lead to even greater problems for workload and morale for these professionals. 

It [this pathway] does put a lot of pressure on pharmacy staff, especially inner-city pharmacies.

(Public summit participant)

A few staff participants raised concerns about current NHS staff culture standing in the way of change. They pointed to traditional and hierarchical models as a potential risk to the collaborative culture that will be needed to deliver care for those with complex needs through neighbourhood health hubs.

A few staff also raised concerns that if these new systems are misunderstood or not working as they should, patient frustration will be directed at staff. They warned that exposure to significant public discontent would have a negative impact on staff morale and likely retention.

Confidence in the NHS App triaging to healthcare professionals other than GPs

Public and staff summit participants expressed concern that triaging individuals who are mostly healthy through the NHS App might result in serious symptoms being missed. These participants wondered who would be doing the triaging and what the process for capturing symptoms would be. They worried that if this process was not detailed enough or was carried out by a person or tool without the right expertise, a person with a serious health condition might be told they do not need to seek medical help. 

I suppose you put the info into the App - what happens before it [tells you] where to go? Is it a person that looks at it and assesses it? Is it AI? We need to know that whatever is behind it all is making the right decisions.

(Staff summit participant)

Many public and staff summit participants also worried that a lack of skill, confidence or access to the right information on the part of healthcare professionals other than a GP might prevent the anticipated benefits of this new model of care from materialising.

The most commonly mentioned concern of this nature was that individuals who are mostly healthy might receive lower-quality care from healthcare professionals who are not GPs. Some public summit participants were concerned that other healthcare professionals, and particularly a pharmacist, might not have the time, expertise or skill needed to spot markers of a serious condition such as cancer or sepsis. A smaller number of public summit participants had a similar worry about mental health conditions going unnoticed and therefore untreated by healthcare professionals who do not have the skills, time or expertise to identify them.

A few participants worried specifically about this in relation to patients who might be less forthcoming or able to express their symptoms, with men cited as a specific example of a group who might not disclose their experiences in this context.

What if they miss something? What if they put a sticking plaster on and they miss something really important?

(Public summit participant)

This concern about missed symptoms was shared by a few staff participants who worried about the loss of the holistic assessment delivered by a GP. However, others emphasised that a single patient record could support identification of symptoms of more serious issues even if the healthcare professional is not a GP.

It will be down to pharmacists coming out with the right treatment. What if they’re not educated enough in making that diagnoses and to give the right treatment?

(Staff summit participant)

On the other hand, some staff and a few public summit participants raised concerns that healthcare professionals who lack skills and confidence might simply divert individuals sent to them by the NHS App back to GPs or A&E for a diagnosis. In this scenario, staff said triaging through the NHS App to another healthcare professional will create an extra level of unnecessary complexity to patient experience and will not lead to the intended relief on GPs and on urgent and emergency care.

I’ve been directed to see a pharmacist before. A pharmacist doesn’t want to take responsibility and tells you to see the GP. The NHS needs to work with pharmacists to empower them more.

(Public summit participant)

Staff summit participants emphasised the importance of proper safeguards and risk management in place to support this new model of care. They emphasised that this will ensure patient confidence in visiting a healthcare professional other than an GP and give these healthcare professionals confidence to diagnose without relying on GPs, urgent care or A&E.

On the Change NHS website, the most prevalent concern about speaking to a different healthcare professional instead of a GP was that care would not be joined up (68%), although a third (34%) were concerned that they would receive worse care under this system.

Figure 24: chart showing public concerns about speaking to a healthcare professional other than a GP on the Change NHS website

Shows percentage of participants on the Change NHS website selecting answers to the question: ‘What, if any, concerns would you have about speaking to a different healthcare professional instead of a GP?’

	Percentage
Care not feeling joined up between different healthcare staff and services	68%
Receiving worse care	34%
Lack of availability	30%
Unfamiliarity	22%

Base: all those who answered this question in the ‘Your priorities for change’ survey (number equals 21,113). The survey was live between 24 February and 14 April 2025.

Issues of fairness

Once public summit participants had considered the detail of what care delivered differently based on patient need might look like in practice, some raised serious concerns about the fairness of this system. While this view was not widespread it was held strongly by the participants who expressed it.

If they [those who are mostly healthy] see something that makes them think they are being treated differently, there’s concern.

(Public summit participant)

This concern was triggered by comparing the experience of care for an individual who was mostly healthy with the care delivered to someone with similar symptoms who had more complex needs. These public participants were particularly uncomfortable with the contrast between a consultation with a healthcare professional who is not a GP for a mostly healthy individual (for example, a pharmacist) and the holistic care delivered by a known practitioner to someone with more complex needs (for example, a midwife or GP).

A key driver of these worries about fairness was a lack of trust in other healthcare professionals to be able to spot symptoms of significant illnesses in mostly healthy individuals, mentioned in detail above. Public summit participants worried that those with complex needs would receive higher-quality care than those who are mostly healthy, therefore putting these mostly healthy patients at risk. Possibly also contributing to these concerns was low understanding among public participants who would themselves be considered mostly healthy about what living with complex or additional needs entails. As such, there was little understanding of how care in the community might help to more efficiently deliver the extensive support these groups are likely to already be receiving.

There’s an idea with younger people where ‘oh they’re fine, they can fight that off’. I don’t feel the investigation stage is that thorough.

(Public summit participant)

Once these concerns about fairness were expressed, public summit participants (and staff to a certain extent) also voiced concerns about the potential for individuals to ‘game’ the system. They worried that those with more confidence or knowledge of the system would aim to be considered someone with complex needs and thereby receive higher intensity care than they ‘should’ be entitled to, further undermining the fairness of the system.

7.4 Public and staff summit participants’ recommendations for ensuring this new model of care is a success

At the summit, public and staff participants collaborated to develop recommendations for ensuring this vision is a success. Most important of these was ensuring there is sufficient investment and long-term strategic planning to implement these proposals properly.

Summit participants also emphasised the importance of communicating clearly with the public about these changes and ensuring the technology exists for key proposals to work as they should.

Summit participants hoped that choice would remain a key feature of this vision, to support patient preferences and to ensure that those facing health inequalities are not left behind.

Secure the investment and long-term political will needed to properly deliver 

Public and staff summit participants emphasised again and again the need for sufficient investment to ensure the success of this vision. Investments in staff, technology and physical spaces were seen as particularly vital. Without this investment they saw the potential for these proposals to add complexity and frustration to current processes, undermining the vision’s stated goals.

More support from government to fund […] investing into services, for frontline staff, support for the service users and resources.

(Public summit participant)

All agreed that the implementation of this vision will take time and some, particularly staff summit participants, were concerned that it might be abandoned if a new government is elected. Many pointed to past NHS reorganisations as examples of proposed changes being abandoned before they have had the chance to become embedded. Summit participants hoped that this government will secure the political will and commitment across parties to maintain this trajectory even if the political landscape or government does change.

Communicate clearly what changes have been made and why

Both public and staff summit participants acknowledged that delivering care differently based on patient needs is complex and, for some, the way their care is delivered would feel very different. They therefore emphasised the importance of a concerted effort to inform the public of the changes to the NHS and what it means for them. They identified 3 essential elements of communications.

Firstly, practical advice on how individuals should access the NHS. This was believed to be essential to the success of this vision. It would ensure that the public use the correct tools and pathways and therefore assure the delivery of the efficiencies both staff and public expect to come from individuals seeing the right healthcare professional at the right time.

Secondly, building trust in the skills and expertise of healthcare professionals other than GPs. While this was less widely emphasised than practical advice, nonetheless many public summit participants felt it would be important to address anticipated discomfort among the wider public about seeing a healthcare professional other than GP, even if recommended to by the NHS App. They called for an effort to tell the public about who else can help them with specific symptoms to ensure those who are mostly healthy go where they are signposted, relieving pressure on GPs, urgent care and A&E.

Thirdly, accurately describing a system where care is delivered differently based on need. When thinking about the framing of this new way of delivering care across all communications, some public and staff summit participants questioned if the term ‘personalisation’ used in the summit was quite right. They worried that the term might create unrealistic and unachievable expectations among members of the public, particularly those who are mostly healthy. Some particularly noted that for these individuals, the reduced reliance on a known GP might lead to an experience of care that feels less personalised to their needs compared with the current model.

[There needs to be] appropriate support. Promoting and signposting to different routes of care. Promoting different routes to healthcare. Signposting better for patients - go to walk-in centres, etc.

(Public summit participant)

Enable some choice in the system

Public summit participants accepted a system in which mostly healthy individuals access the NHS digitally in the first instance and are routinely signposted to a healthcare professional other than a GP only if the choice remains to access and receive care in much the same way as happens now.

These participants hoped and expected that if a mostly healthy individual wanted or needed to access the NHS offline or to see a GP, they would be able to do that easily. This choice was seen as important protection for those in underserved groups and mitigates against the worries described above that healthcare professionals other than GPs will not have the skills or experience to diagnose more serious health conditions.

[It’s important] to have the choice to see the GP immediately if he wanted to.

(Public summit participant)

Build confidence by ensuring the technology supporting these proposals really works

Public and staff summit participants saw properly working technology as vital to the success of this vision. In particular, they emphasised the importance of the NHS App working smoothly and seamlessly the first couple of times a patient uses it. They hoped this will ensure those who are mostly healthy feel confident using the NHS App in place of direct contact with their GP surgery or a visit to urgent care.

Responses to the Change NHS website point to public willingness to engage with the NHS App, with 8 in 10 (78%) saying they are likely to use the NHS App as the main way to access services and information. This highlights the potential of a high-quality app to streamline access to care for most of the population.

Subgroup analysis of participant responses on the Change NHS website also highlights a broad level of comfort with using the NHS App among key audience groups, with those aged 75 years showing slightly less comfort.

Table 9a: proportion of participants on the Change NHS website and nationally representative survey respondents saying they are very likely or fairly likely to use the NHS App if it became the main way to access NHS services and information

	% likely to use the NHS App
All participants on the Change NHS website	78%
Nationally representative sample	70%

Table 9b: proportion of participants on the Change NHS website from each audience saying they are very likely or fairly likely to use the NHS App if it became the main way to access NHS services and information

	% likely to use the NHS App
Aged 55 to 74 years	77%
Aged 75 years and over	67%
Ethnic minority	80%
People with a disability	79%
Living in rural location	83%
Living in coastal town	79%

Base: all participants on the Change NHS website who answered this question in the ‘Your priorities for change’ survey (number equals 21,206). This survey was live between 24 February and 14 April 2025. All those who answered this question in the nationally representative ‘Your priorities for change’ survey (number equals 2,015). This survey was live between 17 and 20 March 2025.

Staff summit participants also emphasised the importance of the successful implementation of a single patient record. They pointed to multiple instances where facilitating multiple healthcare professionals to access the same patient record would enable this vision. This included supporting healthcare professionals to spot persistent or underlying problems for those in the mostly healthy segment and enabling collaboration between the teams supporting individuals in segments with more complex needs.

This view was also held by participants on the Change NHS website who most frequently selected ensuring healthcare professionals have access to healthcare records as the most important factor in ensuring they felt confident using services in new settings and with new healthcare professionals.

Figure 25: chart showing the factors that influence public confidence in 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	66%
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%

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 and 14 April 2025.

Those facing health inequalities must be at the heart of the model’s design

A key concern for both public and staff summit participants was the impact of a seemingly more complex, and in many cases more digital, system on those groups who are traditionally excluded or find it difficult to engage with the health system.

As mentioned above, public summit participants hoped that by maintaining some choice in how individuals access the NHS, those who are digitally disengaged or who struggle with literacy or English would still be able to access quality care.

Some summit participants also suggested that there might be a role for care navigators, to help ensure that those at risk of exclusion are able to access the right parts of the system, even if their health status might mean they are mostly healthy.

There needs to be a navigator who coordinating things. Someone to speak to.

(Staff summit participant)

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