Healthcare providers to play pivotal role in reducing patient backlogs under NHS 10-year plan

The 10-year plan for the NHS has mapped out a crucial role for healthcare providers in delivering reforms that were unveiled in July a year after the government's blunt assessment that the service was "broken".

The flagship policy to fix the NHS will inform healthcare policy for years to come. And the central focus on how the private sector can help deliver the government's NHS plans holds out major opportunities for healthcare providers that embrace the proposed reforms, which include changes to the operation of the Care Quality Commission (CQC), measures for tackling patient backlogs, and the rollout of neighbourhood care models.

CQC changes

In October 2024, the Dash report into the Care Quality Commission and its operational effectiveness found significant failings at the independent regulator of health and social care in England. Following publication of the report, it had looked as if the CQC could be scrapped.

Two years on and, instead, it is being bolstered. The CQC will shift to a new intelligence-led model, supported by expansive new access to data, and given statutory powers to access all NHS and publicly held datasets relating directly or indirectly to care quality.

A national artificial intelligence (AI)-led warning system will also be established. This will allow for the identification of quality issues as they emerge in parts of the NHS, which could trigger a CQC inspection occur on a rapid response basis. For providers and investors, this means increased inspection and enforcement risk, as well as a need to re-write compliance policies. 

CQC enforcement powers

In addition to improved access to data, the CQC will have enhanced enforcement powers. These will include an extended time limit within which to bring legal action against providers and to review how to improve patients’ experience of clinical negligence claims. CQC enforcement action is currently limited to three years from the date of an incident.

The CQC will have two types of inspection available: rapid response inspections, which are undertaken in response to specific concerns; and routine planned inspections which typically take place every three to five years.

In addition, a new set of staff standards will come into effect from April 2026. Those are being developed with the Social Partnership Forum, and poor performance on staff-related outcomes will act as an early warning signal for CQC, and may trigger a rapid response inspection.

These enhanced enforcement powers and access to healthcare data are intended to equip the CQC to identify where additional inspections are required and to assemble rapid response teams of skilled inspectors. These teams will be able to respond to concerns, investigate concerning healthcare patterns and take enforcement action for an extended period compared to the current three-year limit.

Healthcare providers need to be aware of these enhanced enforcement powers and the healthcare data to which the CQC will have access. Ensuring compliance with policies, procedures and guidance including the new staff standards will guard against the risk of clinical incidents and complaints and so reduce the risk of the CQC conducting a rapid respond inspection which may be time consuming and costly.

Targeting backlogs

There is likely to be increased reliance on independent providers to reduce the backlog. Following the deal struck between the NHS and independent sector this January as to how the health service would go about drawing on capacity of the latter, the plan reaffirms the government's intention to rely on private sector capacity to treat NHS patients where it is available. The government will enter discussions with private providers to expand NHS provision in the most disadvantaged areas.

Neighbourhood care models

Neighbourhood services will be designed in a way that reflects the specific needs of local populations. Although the government will set out its service delivery expectations, the way in which healthcare services tailor their operations will be outcomes focused, and based on the needs of the local population.

The plan details one neighbourhood care model: a single GP practice primary care network. This provides a wide range of services, including many traditionally found in hospitals, such as day surgery, pharmacy, physiotherapy, specialist clinics and outreach services. It also offers evening and weekend GP appointments.

The proposed neighbourhood care model has high patient satisfaction scores. It reports that 97% of its patients had confidence and trust in the last GP they saw and 91% would recommend it to someone who had moved to the local area. It is also rated outstanding by the CQC.

The government intends that this new model of healthcare provision will result in improved healthcare operations, better patient outcomes and greater patient satisfaction, in turn reducing the need for the CQC to be burdened with so many reactive rapid response inspections.

Healthcare providers should consider how their services might fit into a neighbourhood care model and how they might engage in discussions with government to lessen the healthcare backlog by providing services as an independent provider. These new models offer opportunities for healthcare providers to get ahead of competitors and lead the way with local independent healthcare provision.

Osborne Clarke comment

The new NHS plan introduces significant changes that healthcare providers will need to be aware of, particularly regarding the CQC and the reliance on independent providers. The CQC will adopt an intelligence-led model with enhanced access to data and new statutory powers, increasing surveillance and enforcement risks. Providers will be looking to update compliance policies to mitigate the risk of rapid response inspections, which could be triggered by poor performance, new staff standards or emerging quality issues identified by AI-led systems.

Additionally, the plan reaffirms the government's intention to leverage private sector capacity to reduce NHS waiting lists, particularly in disadvantaged areas. Healthcare providers should explore opportunities to engage in these discussions and contribute to alleviating the backlog.

The introduction of neighbourhood care models, which tailor services to local populations and report high patient satisfaction, presents another avenue for providers to innovate and improve patient outcomes. Embracing these models could position providers as leaders in local independent healthcare provision, enhancing their competitive edge and reducing the burden on the NHS.

This is the final Insight in our series on the NHS 10-year plan that has looked at the role of the private sector, digital health suppliers, product manufacturers and pharmaceutical suppliers.