‘The neighbourhood health service… will bring care into local communities; convene professionals into patient-centred teams; end fragmentation and abolish the NHS default of ‘one size fits all' care.'

This is the key message in the 9,000-word dissertation the 10-Year Health Plan outlines for the future of primary care. By moving care closer to patients and becoming a ‘one-stop shop' for patient care, it promises to shift care away from the secondary settings and alleviate pressure from crumbling hospitals. But despite ambitious rhetoric the questions remains - how will it actually work?

The scheme revolves around the neighbourhood health centre (NHC), with chancellor Rachel Reeves announcing the opening of 250 in the Autumn Budget. NHCs aim to pull together various care providers into one place, facilitating holistic care for users.

Essentially they will provide an on-demand MDT in primary care, reducing the need for patients to bounce endlessly between siloed individual providers. Plans are for centres to be open six days a week for a minimum of 12 hours, likely leading to a phase out of the urgent treatment centre. This will allow speedy delivery of diagnosis, imaging and treatment as patients need it, replacing current instinct to present to secondary care as a first port of call.

Alongside NHCs plans are to introduce new primary care contracts - the single and multi-neighbourhood providers. The single-provider model will replace PCNs, with estimated patient-loads of 50,000; multi-providers (essentially GP federations) will cover over 250,000 patients.

With economies of scale, fixed back-office costs can be distributed across more patients, theoretically decreasing cost-per-patient. As with NHCs larger providers will be able to increase their scope closer to that of secondary care, pulling demand away from the hospital. These savings will be compounded by the digital revolution, with the NHS App becoming the holy grail for accessing care.

However, despite potential savings, scaling up at this level can create new issues. As with ICBs and NHS trusts, larger hierarchy creates room for inefficiencies and waste, particularly with less leader oversight. More-so, they run the risk of further removing autonomy from GPs, becoming cogs in another NHS machine. And workforce provision may prove to be the biggest hurdle.

 At a recent Health and Social Care Select Committee inquiry MPs met representatives from general practice, pharmacy and district nursing to discuss how these centres would be staffed. As with any conversation regarding NHS staffing, the picture was bleak. For nurses, incentives to work in the community are simply not good enough. District nurses require an extra two years of training and are currently seeing 150% of their full patient capacity per day and yet cap out at a Band 5 salary, while an equivalent hospital charge nurse receives Band 6 pay with a more defined job role.

For GPs, despite RCGP estimates of 5,000 extra doctors needed per year to meet demand, forecasts anticipate only 3,500 will be produced this year. Simultaneously surveys show that one-third of GPs plan to leave their jobs in the next five years. Health minister Stephen Kinnock touts GPs as the ‘conductors to the orchestra' of neighbourhood health - but it seems this orchestra may be left to disharmonious chaos.

Even RCGP chair Professor Hawthorne admitted: ‘We're all struggling to understand what neighbourhood services means.' Getting GPs on board, in the loop and enjoying their work again will be key to delivering any sort of primary care reform. Failure to do so will only worsen the current recruitment and retention crisis.

As a working hospital doctor, I have mixed feelings on how this will play out. The idea of pulling demand away from the hospital and providing space for innovation and science feels like a genuine weight off every doctor's shoulders, and I am cautiously optimistic.

But this isn't the first time we've been presented a preventative revolution and I suspect it won't be that last. Early pilot schemes are showing promise, however, national roll-out will be a completely different story - every neighbourhood has different needs and will face different hurdles consequently. What is certain is that unless underlying workforce and infrastructural issues are solved, the empty rhetoric we've received so far will inevitably remain just that.

Dr Tej Pradhan is an independent health policy journalist and current NHS resident doctor. Find more of his work on his Instagram @drtejpradhan.