10 Year Health Plan: One year on – Sickness to prevention

A year on however, I don’t think many of us working on the frontline can say we’ve truly experienced this shift yet. The ambition is clearly there, but the reality is that the system is still rewarding treating illness far more than preventing it.

Every day, general practices are tackling rising demand, workforce pressures and increasingly complex patients, and when capacity is stretched, prevention inevitably comes secondary to acute care. The patient sitting in front of you will always take priority over preventing illness that may occur five or ten years from now.

And that’s not because clinicians don’t place sufficient value on prevention or have received insufficient national guidance to deliver the shift. It’s because the system as it currently stands rarely gives us the time, workforce or resources to prioritise it.

A shift from sickness to prevention needs the people to deliver it

Despite the emphasis on prevention, there has been insufficient focus on growing the workforce expected to deliver it. Many experienced primary care nurses are approaching retirement while recruitment into the profession remains challenging.

Practice nurses lead much of the preventative work within primary care – from immunisations and cervical screening to cardiovascular risk management, diabetes care and health promotion – yet the pipeline of future nurses remains fragile.

One example illustrates the problem. General practices receive significantly higher funding to support medical student placements than they do for nursing student placements. While funding arrangements vary, the disparity is stark: a practice may receive around £250 per day to supervise a medical student but only around £25 per day for a student nurse placement. Mentoring students requires protected clinical time, supervision and administrative support. Faced with such unequal funding, many practices simply cannot absorb the financial impact of offering nursing placements, despite wanting to support the next generation.

If we are serious about shifting from sickness to prevention, we must be equally serious about investing in primary care nursing education. Fairly funding student nurse placements would allow more practices to offer high-quality learning experiences, expose more undergraduate nurses to the rewarding career opportunities within general practice and help build the skilled workforce needed for the future. Prevention begins long before a nurse sees their first patient – it begins with investing in their education.

Joined-up care needs to move beyond aspiration and become reality

The 10 Year Health Plan places significant emphasis on neighbourhood working and shared digital records, and rightly so. If these ambitions are realised, they have the potential to transform care for patients with the most complex needs, including improving predictive and personalised care. However, from where I sit in general practice, this remains more aspiration than everyday reality.

Take an example from my own practice last week: I still found myself coordinating multidisciplinary care for a patient with learning disabilities and complex physical needs by sending emails, making telephone calls and, quite literally, copying and pasting email correspondence into the patient’s medical record to create a timeline of events. It is time-consuming, inefficient and introduces unnecessary risk. Every professional held part of the picture, yet we struggled to easily see the whole – the patient.

Addressing this is essential to delivering the shift to prevention, and where the 10 Year Health Plan has enormous potential. A truly shared care record, accessible across health and social care, would not simply improve efficiency – it would improve safety, reduce duplication and allow clinicians to make better-informed decisions. It would enable multidisciplinary teams to collaborate in real time, rather than relying on fragmented emails and repeated phone calls. For patients with the most complex needs, it could fundamentally change their experience of care.

The challenge now is turning policy into everyday practice. From the perspective of a primary care nurse, shared records remain one of the most important innovations that has yet to become commonplace.

We need to provide the right incentives

If ‘sickness to prevention’ is truly a recognised national priority, then the incentive structures must reflect that. Instead, in some cases the opposite is happening.

Vaccination is a good example of this. Practices are rightly encouraged to achieve high vaccination uptake, but some of the thresholds attached to funding can feel so difficult to reach that they inadvertently discourage additional investment in reaching the most underserved communities.

When practices know they are unlikely to achieve the highest thresholds despite significant effort, there is less incentive to invest additional time and resource into finding those harder-to-reach patients.

Unfortunately, that’s a reflection of a system that still prioritises managing today’s pressures over investing in tomorrow’s health outcomes.

The next few years need to take a different approach

The direction of travel is without a doubt the right one. It is self-evident that an NHS that prevents illness rather than simply responding to it is better for patients and clinicians and ultimately more sustainable for the health service.

But one year into delivering the 10 Year Health Plan, it is difficult to say that frontline primary care feels fundamentally different. Looking ahead, we must invest where action on prevention actually occurs, in primary and community services, and strengthen the workforce delivering it.

This shift hasn’t yet taken place, not because of inertia from clinicians but because of how the system is still designed.