The government’s 10 year Health Plan sets out an ambitious shift towards more preventative, community based care. But the NHS cannot deliver this alone. Success depends on strategic partnerships that bring together the full range of local services—from primary care, community and mental health services to acute providers, local authorities, and the voluntary, community, faith and social enterprise sector.
New guidance from the NHS Confederation reflects insights from leaders across the country on what makes these partnerships effective in practice and the fundamental challenges they are working to overcome. Their reflections are timely. With reduced running costs across the system and rising pressure on services, collaboration is no longer optional—it is the only viable way to sustain care and redesign how local systems respond to growing demand.
One message is clear: partnerships thrive when they begin with relationships rather than organisational charts. Before any formal agreements are drawn up, partners need time and space to build trust, test ideas and resolve problems collectively.
Many leaders described how early, informal collaboration helps teams understand each other’s pressures and strengths. This ‘people‑first’ approach often matters more than the organisational form a partnership eventually adopts.
However, despite enthusiasm for closer working, infrastructure remains a significant obstacle. Leaders consistently highlighted fragmented digital systems that hinder seamless care. For example, patients often report having to repeat their story multiple times — such as in maternity services where records may be split across hospital systems, GP systems and separate paper records.
This fragmentation is reinforced by misaligned digital procurements, legacy paper processes and the personal liability GP partners hold as data controllers. Leaders described this as an ‘innovation trap’ — outdated systems remain in use while new digital tools are layered on top.
Estates issues mirror these challenges. Across providers, primary care and local government, budgets are siloed, capital rules remain rigid and teams lack a shared picture of public buildings that could be used more effectively. Even where suitable space exists, reimbursement mechanisms or local leasing rules can make access difficult. The result is inefficiency and missed opportunities to co-locate services and build integrated neighbourhood models.
Innovation is still possible. In areas such as Hillingdon, new triage tools in general practice are being used to link primary care and community trust electronic patient records, while population health data from these tools is shared with the council to improve vaccine uptake and screening.
For many leaders with strong relationships already in place, finance is the factor holding back progress the most. Organisations currently feel the operational impact of reducing activity or closing a ward, yet the financial benefit is often removed from local baselines, absorbed centrally or lost through substitution. This substitution effect occurs when, for example, a partnership prevents a high needs cohort from being admitted, only for another cohort to fill the same beds—making savings extremely difficult to realise.
Mature partnerships need the autonomy to work with national and local teams to redesign financial flows ahead of new neighbourhood contracts. The principle of what leaders want is clear: systems need mechanisms that protect income, share gains fairly and allow resources to be reinvested locally to support prevention and continuity of care.
Leaders also recognise that the current operating environment is extremely challenging—not only for frontline staff but for those facing uncertainty in local government and within Integrated Care Systems. Increasingly, primary care providers or NHS trusts are stepping into leadership roles, bringing partners together, hosting partnership boards or evolving existing interface groups. These interface groups—locally established to tackle issues such as referral quality or discharge processes—have proved effective in many areas.
Partnership based approaches have already helped organisations tackle operational challenges such as elective and emergency waiting times, proving that performance improvement and neighbourhood health are not separate endeavours.
Overall, leaders told us that no single organisation can deliver the 10 Year Plan —we must encourage leadership that recognises this reality. National, regional and ICB leaders must provide the air cover and support for those driving change: the acute trust leader pivoting their organisation towards preventative work; the primary care leader recognising queues at A&E as a shared system issue; the community trust leader improving patient experience through closer collaboration with local government.
All of this relies on one final ingredient: policy and legislation must enable—not obstruct—local partnership working. If the government wants the 10 Year Health Plan to succeed, areas already progressing well need the freedom and incentives to go further. Greater flexibility around pooled budgets, capital allocations and Section 75 agreements is essential. Allowing primary care and voluntary sector partners to participate fully would signal national support for local innovation.
This shift would help create a more devolved, high trust system where local leaders are as accountable to their system partners on integration as they are to national bodies such as NHSE and the Department of Health and Social Care on operational performance.
Delivering the 10 Year Health Plan is not about creating new organisations. It is about strengthening existing partnerships, removing the barriers they face and building the confidence to act collectively.
With shared leadership, the right incentives and a commitment to work as one system, local partnerships can turn ambition into action—creating a stronger, more preventative, community focused health service that meets people’s needs now and for the decade ahead.
By George Johnston, a senior policy and delivery manager at the NHS Confederation’s Primary Care Network.
