‘Last chance to secure NHS future as we know it’, Oldham tells Pulse conference

Long-standing Government adviser on neighbourhood health and former GP Sir John Oldham has warned that this is the ‘last chance’ for GPs and community colleagues to ensure the future of the health service.

Sir John made the remarks yesterday at the inaugural Community Pharmacy and General Practice conference in Birmingham, organised by Pulse’s publisher Cogora and the National Pharmacy Association.

The retired GP most recently served as strategic adviser to the health secretary between March 2025 and March 2026, advising on the Government’s shift towards neighbourhood health models.

Closing day one of the conference – aimed at fostering collaboration between GPs and pharmacists – he stressed the need for funding to follow the shift of healthcare from secondary to primary care, and warned that if structures and culture remains unchanged, the efforts ‘will fail’.

He said: ‘If instead you start by rigorously understanding the needs of the people we serve – and you mobilise those collective assets through fostering relationships, not dismantling them – then you assist that by changing financial flows to reinforce that mobilisation of assets, and all of you get together as a single voice, a powerful voice in the system.

‘There are more of you who want this to happen, but… you’re disadvantaged by the siloed and fragmented approach. My encouragement to you at this conference and others is act together to make sure what is necessary for the people you look after happens, and if we do that, then we have a chance, and I really believe that this is the last chance to secure the future of the NHS care system as we know it.’

Sir John, who also previously served as the Department of Health’s clinical lead for quality and productivity, working on the NHS Quality, Innovation, Productivity and Prevention (QIPP) programme, placed the blame for failings up until this point to shift care into the community on NHS England.

He said: ‘Now you’ll have heard for 12-15 years that we want to move shift care from hospital to community integrated care, and it’s never really happened on a big scale, and it’s worth thinking why.

‘There have been design failures, operational failures, management of change failures, and leadership failures, and the leadership failure has to be fairly put at the door of NHS England.

‘They have what I might describe as an institutional ignorance and almost bias against primary and community care, not through wilful malevolence of any individual, but through the very nature of the beast itself.

‘It may surprise you that until the last 18 months or so, two years, there was no executive or non-executive on the board, who had either primary or community care direct experience, and yet that is 90% of activity.

‘Most of the senior leaders, almost exclusively, have come from hospital management, so when the repressor is on and targets have to be met and phone calls from the ministers ring, they revert to what they know, not what they don’t know, and that’s part of the issue.’

Reflecting on whether it would be ‘any different this time’, Sir John did not have an answer to provide, but stressed that the understanding of healthcare by Andy Burnham, the favourite to succeed Keir Starmer as Labour party leader, as positive factor.

Answering a question from Pulse, on how GP targets for providing online access will square with closer working at a community level with patients, potentially eroding continuity, Sir John said that ‘continuity of care is an undervalued phenomenon’ but not necessarily ‘in conflict’ with online access, as long as there were fewer national directions that GPs have to follow.

He said: ‘I don’t think the two are in conflict, but the more that you just try and do things by national edict, as opposed to sensibly saying “this is what we want to achieve, how are you going to do that locally?” and letting folk get on with it – and if there’s one thing I know about Andy Burnham, he’s a devolver, so who knows? But I do think the two are possible to do.’

Sir John further stressed how AI will inevitably change the NHS, warning that this must be harnessed in the best manner.

He said: ‘I mentioned about the AI-empowered patient completely upending healthcare, and I’m serious about that. The pace of change there is enormous… but we better embrace that and make sure it’s properly curated.’

Also speaking at the Community Pharmacy and General Practice conference, RCGP president Professor Victoria Tzortziou-Brown welcomed the prospect of pharmacists and GPs working together, but warned that ‘unintended consequences’ must be avoided when setting up new pathways by ensuring these are based on evidence.

She told the audience in Birmingham this morning: ‘I think the first thing is to clarity of purpose. We need to be very clear, what is it that we are trying to achieve, what would good look like, and definitely what good would look like is not more appointments and more activity and more interactions. It is about improving care for patients, isn’t it? It is about improving patient experience, ensuring greater equity, better sustainability of our NHS, better outcomes, clinical outcomes too.

‘And this means that we need to develop and design services around people, around our patient population, taking into account, particularly the needs of those with more complex needs and more vulnerability, and that means moving beyond transactional care. We need holistic care, coordinated care around the whole person, and I think that’s where neighbourhoods offer us an opportunity to do things better.’

She added: ‘Our vision, when we think about neighborhood care, is building on the strengths of general practice, building on this expert medical generalism that we bring, the unrestricted first contact care that we provide, the continuity and coordination that we we provide across the whole patient journey, but also utilising these different expertise that our community teams can bring and working together and to achieve this.

‘For me, evidence coming from a research background is really, really important. As we develop these new models of care, we need to continually evaluate these, so that we understand both where they are valued, but also any unintended consequences.’

The two-day Community Pharmacy and General Practice conference, held at the National Conference Centre in Birmingham, is finishing up today having featured a host of senior GP and pharmacy speakers, as well as a video address from primary care minister Stephen Kinnock – in which he said the Government will continue to ‘ease pressure’ on GPs by expanding the use of pharmacists.