A vision for 2035

By Dr Duncan Gooch, GP and Clinical Director, Erewash Health Partnership

In 2035, primary care and general practice stand at the forefront of a transformed healthcare landscape – one that is personalised, proactive and deeply embedded within communities. No longer constrained by rigid structures, primary care has evolved into a system that allocates resources dynamically based on need, ensuring the right care reaches the right people at the right time. This transformation is underpinned by technology-driven personalisation, collective accountability for population health outcomes, and a workforce that values itself. 

To illustrate this vision, consider Sarah, a 45-year-old woman with asthma, diabetes and work-related stress. A decade ago, Sarah’s care was fragmented, dependent on her own ability to navigate multiple appointments, with little coordination between providers. Today (2035), her care is appropriate to her needs, supported by technology-driven health planning, a proactive and risk-stratified approach to long-term conditions, and seamless integration across general practice, dentistry, optometry and community pharmacy.

Community-based healthcare: bringing care closer to home

By 2035, a fundamental shift has taken place in healthcare – care is delivered within communities rather than requiring patients to travel out of their local areas. The old paradigm of ‘out-of-community’ care being the default has been replaced by a model where people receive high-quality, personalised healthcare in the places where they live and work. The necessity of going out of the community for healthcare is now the exception, rather than the norm.

For Sarah, this means that rather than navigating multiple service providers in different locations, she receives all but the most complex care within her local area. The services required to achieve this – including diagnostics, specialist-led clinics and multidisciplinary community teams – have been developed within local hubs. Only a small number of exceptions, such as complex surgeries, highly specialised treatments, or advanced interventions requiring niche expertise, necessitate travel beyond the community. 

To achieve this shift, investment in appropriate estates, workforce and resources has been a priority. Primary care at scale has been developed to provide the infrastructure and governance needed for expanded services, and healthcare professionals have been recruited and trained to deliver a wider scope of care. This has also created opportunities for better integration of social care, voluntary services and community-led health initiatives, ensuring that healthcare is not only clinically effective but also deeply rooted in the community’s broader wellbeing. 

Working with local assets has been essential. Local organisations, schools, workplaces and local businesses have become active partners in delivering health interventions. From gyms offering structured health programmes to schools integrating wellbeing initiatives into their curriculum, the entire community plays a role in improving population health. This approach has also fostered trust and continuity, as patients like Sarah receive care from professionals who understand their local contexts and the factors influencing their health.

Technology-supported personalisation: from protocols to precision

The greatest shift in primary care has been the move from a generalised, protocol-driven model to a personalised, technology-enhanced approach. General practice is no longer about universal annual reviews but instead uses technology-driven risk stratification to ensure patients receive the level of care they need, when they need it most.

For Sarah, this means her digital health assistant monitors her biometric data and lifestyle habits, adjusting her care plan dynamically. If her asthma deteriorates, her GP is alerted immediately, while her community pharmacist provides targeted interventions. Meanwhile, stable aspects of her diabetes management are overseen through a digital platform, allowing her to avoid unnecessary visits while maintaining access to specialist support when needed. 

The digital transformation of primary care has been made possible through sustained government investment in health technology, with national digital support and private sector partners co-developing AI-driven risk stratification tools

Crucially, relational continuity is embedded in Sarah’s care. While technology optimises efficiency, it does not replace trusted relationships with her local care team. Her general practice remains central to her neighbourhood, ensuring she continues to see familiar healthcare professionals who understand her history and preferences. These trusted relationships extend beyond clinicians to include social care, community pharmacists and voluntary organisations, reinforcing an integrated, community-based model of care. Furthermore, proactive care management teams now identify those most at risk and intervene early, reducing the need for crisis-driven care and ensuring Sarah receives the right interventions at the right time. 

The digital transformation of primary care has been made possible through sustained government investment in health technology, with national digital support and private sector partners co-developing AI-driven risk stratification tools. Regulatory frameworks now mandate interoperability between GP, hospital, pharmacy and social care records, reducing inefficiencies caused by siloed data systems. 

To ensure digital health solutions remain accessible, national digital inclusion policies have provided funding for community-led training programmes, ensuring patients and professionals alike can effectively use emerging technologies. Moreover, reimbursement models have adapted to support digital-first care delivery, compensating providers for proactive, technology-enabled interventions rather than just face-to-face consultations

Rethinking accountability: from individuals to population outcomes

For decades, accountability in primary care rested primarily with individual clinicians, leading to variation in practice, defensive decision-making and individualised working. By 2035, this model has shifted to collective accountability based on population health outcomes and patient experience. 

Rather than being judged on how many asthma reviews they complete, local groups of practices are accountable for reducing asthma exacerbations across their local population. Similarly, dental, optometry and community pharmacy services are fully integrated into population health, ensuring that early warning signs of chronic diseases are detected and addressed collectively. Sarah benefits from this new model, as her entire care team – from her GP to her pharmacist and community optometrist – shares responsibility for improving her overall health, rather than just meeting isolated clinical targets. 

Moreover, accountability structures now incentivise collaboration rather than competition, ensuring that workforce efforts are aligned towards improving outcomes rather than meeting arbitrary quotas. Groups of practices and neighbourhood collaborations work together, fostering an environment where best practices are shared, and variation is reduced, while still allowing for personalised, patient-centred care. 

Additionally, primary care delivery at the neighbourhood level has fostered a distinct identity, strengthening patient trust and engagement. These neighbourhood-based collaborations ensure that healthcare is not just about delivering services but about embedding a sense of community-driven healthcare leadership, where both providers and patients are active participants in shaping health outcomes. This has led to stronger community engagement, where patients like Sarah actively contribute to shaping healthcare services through co-design initiatives and feedback loops that continuously refine and improve care models.

Workforce transformation: a profession that values itself

By 2035, the primary care workforce has undergone a major cultural shift, recognising and respecting itself as a cornerstone of the NHS. Terms and conditions are now aligned with those of secondary care, ensuring pay parity, structured career progression and protected time for professional development. This has made general practice an attractive career choice, reducing burnout and ensuring workforce sustainability. 

Crucially, primary care has taken ownership of developing the workforce of the future, including clinicians and managers. Every local collaboration has embedded training and leadership programmes, ensuring the next generation of GPs, practice managers and allied health professionals are nurtured within primary care itself. 

Groups of practices also function as anchors within natural communities, ensuring that healthcare is locally embedded and responsive to population need

Equally important is the full integration of dentistry, optometry and community pharmacy into the workforce model. These professions no longer operate in isolation but are recognised as fundamental to primary care’s mission. Community pharmacists, for example, are now leading routine medication reviews and chronic disease management, while optometrists provide early screening for conditions such as diabetes and stroke. 

Additionally, primary care is playing a direct role in economic and workforce development. Apprenticeships, health coaching programmes and career pathways are now embedded within local healthcare collaborations, ensuring that the local workforce is trained within primary care itself. Groups of practices also function as anchors within natural communities, ensuring that healthcare is locally embedded and responsive to population needs. Harnessing community assets – including voluntary organisations, schools and local businesses – has strengthened the ecosystem of care, allowing professionals like Sarah’s GP to spend more time on meaningful patient interactions rather than administrative burdens.

Balancing prevention and productivity: a necessary tension

A major challenge in healthcare reform has always been the tension between upstream prevention and industrialised productivity. By 2035, primary care has found a way to balance these priorities by embracing hybrid models that create efficiency while preserving the human aspects of care.

The socioecological model – which emphasises addressing root causes such as housing, education and employment – has been fully integrated into primary care. Local practice collaborations work alongside local authorities and social enterprises to improve food security, air quality and physical activity, tackling the determinants of health before disease develops. 

To balance this, primary care has also embraced productivity-enhancing innovations such as digital triage, remote monitoring and automation of administrative tasks. These efficiencies free up capacity, allowing GPs and other professionals to focus on complex cases and relationship-based care, rather than being overwhelmed by bureaucracy. 

Furthermore, standardising algorithms and processes has been central to improving quality and reducing unnecessary variation. By adopting evidence-based digital protocols, local practice collaborations have ensured that clinical decisions are consistent, efficient and patient-centred. This standardisation has not only increased safety but also enhanced the ability to scale best practices across neighbourhoods, ensuring equitable care.

Importantly, using community assets has played a crucial role in both prevention and efficiency. By embedding dentists, optometrists and pharmacists within local health strategies, primary care has ensured that chronic diseases are identified earlier, reducing the demand on GP and hospital services. Community organisations, in turn, deliver structured health interventions that complement formal healthcare provision, ensuring that Sarah and others in her neighbourhood benefit from a holistic, responsive healthcare system.

Conclusion

By 2035, primary care has redefined itself – not just as a service but as an integrated system that personalises care, ensures accountability, values its workforce and strengthens local communities. 

Sarah’s experience in 2035 is radically different from a decade ago. Her care is tailored, continuous and proactive, with technology ensuring her needs are met efficiently while still preserving the human relationships that matter most. Her health is no longer managed in isolation but as part of a broader community-wide effort, with her general practice acting as a central hub that connects healthcare, social support and economic opportunities. 

The future of primary care is not just about technology or efficiency – it is about trust, collaboration and impact. By embracing this vision, we can create a primary care system that truly delivers better health for all.

Read the full collection