Hospital to Community: NHS Care is Moving Closer to Home

Along with the transition from analogue to digital and from treatment to prevention, moving care into the community has become one of the government’s three focus points in alleviating these pressures on acute services, and is part of a greater overall effort to future-proof the NHS. If this shift is implemented effectively and backed by the long-term support it needs to succeed, its impact will be felt far and wide.

But what needs to happen for it to work?

The idea that care should be delivered closer to people’s homes isn’t new. As far back as the NHS Five Year Forward View in 2014, policy direction has consistently pointed toward prevention, community support and integrated local services.

What’s changing now is the urgency behind long-standing pressures on the system. From the 18-week elective backlog to workforce shortages and an ageing population with increasingly complex needs. These pressures are not confined to hospitals, but they’re undoubtedly at the root of them.

The Darzi Report on the NHS, published in 2024, reinforced the importance of shifting focus. It noted that "too many people are ending up in hospital because too little is spent in the community." Despite commitments to change this, hospital spending continues to dominate NHS budgets, rising from 47% in 2006 to 58% in 2022. At the same time, the community care backlog has grown exponentially, with over one million people waiting for support and more than 50,000 waiting over a year; the majority of them children and young people.

Rather than interpreting this as a failure, the message now is one of opportunity. Community care has the potential to ease the strain on hospitals and ambulance services, whilst providing faster, more personalised support in way that’s far more equitable than how it’s delivered now.

Among the most tangible signs of this shift is the rapid expansion of services offered by community pharmacies. These high-street hubs have long been a trusted first point of contact for people managing everyday health concerns, but recent developments are elevating their role within the wider health system.

In January 2024, the NHS formally launched Pharmacy First, a service that allows pharmacists to assess and treat seven common conditions without the need for a GP referral. These include sinusitis, earache, infected insect bites, and urinary tract infections in women. Until now, these conditions have contributed significantly to GP workloads.

The scheme is expected to free up 10 million GP appointments each year. This is more than a short-term win – it’s a new level of confidence in the clinical expertise of community pharmacists and opens the door to a wider expansion of pharmacy-based care.

That expansion is already underway. In March 2025, the government announced a record £617 million investment over two years for community pharmacy services. This includes new support for patients on antidepressants, as well as wider access to emergency contraception through the NHS.  More importantly, the funding also covers workforce training and integration within primary care systems, two areas often overlooked in previous rollouts. Both will be essential to building and maintaining public confidence in the expanded role of pharmacy services and ensuring patient safety.

Collectively, these measures are helping to redefine the role of the pharmacy as not just a dispenser of medicine, but as a frontline provider of care.

The shift to community care goes way beyond the walls of pharmacies. True transformation requires a whole ecosystem that includes GPs, district nurses, mental health teams, social care professionals, voluntary sector partners and above all, the people and communities themselves.

This ecosystem already exists in many areas, but it remains fragmented. This is why Integrated Care Systems (ICSs) were established to address this exact problem. Their remit is to bring together NHS bodies, local authorities and care providers to plan services in a more joined-up way, tailored to local populations. However, the effectiveness of ICSs varies, and many still face barriers related to funding flows, data access and digital maturity.

Despite these challenges, there has been progress. Last year, Nottingham and Nottinghamshire ICB launched NottAlone - a co-produced digital platform designed to improve access to mental health support within the community. Developed to address local service gaps and ensure consistent, age-inclusive advice, the initiative also provides guidance for those supporting others. By working closely with residents to shape the platform around real needs, NottAlone is helping to strengthen early support in the community and build a more connected approach to care.

Another example is Frimley Health and Care ICS, which implemented a proactive remote monitoring service in 2022 targeting over 4,000 high-need patients and 800 care home residents. The initiative was designed to reduce unnecessary hospital admissions, enable earlier interventions, and enhance the quality of life for residents by spotting health deterioration sooner. Since implementation, the service has led to a 40% reduction in hospital admissions for high-need patients and a 34% reduction for care home residents. A&E attendances also decreased by 31% and 40% respectively for these groups, helping to ease pressure on acute services while supporting more proactive care closer to home

Clearly, there’s potential for other ICSs here. Whether through similar campaigns focused on managing long-term conditions, supporting care home residents, or strengthening links with primary care, the right approach will always depend on the needs of each community. After all, no two areas are the same, and what drives demand or creates barriers in one place might look very different in another. That’s why understanding local priorities and tailoring support accordingly will be essential to reducing pressure on services and improving the quality and continuity of care.

None of this can happen without people. As care shifts closer to home, the demand for a different kind of workforce grows. Community nurses, allied health professionals, social care workers, mental health practitioners and pharmacists are central to delivering care in the settings where people live and work.

While the NHS Long Term Workforce Plan, published in 2023, set ambitious growth targets and a renewed focus on training and retention, significant challenges remain. Recent research by the Nuffield Trust highlights that many staff across the NHS - particularly younger workers - are concerned about pay, career development, and recognition. Building a sustainable workforce for the future will depend on addressing these gaps across all settings, including community services.

Making the shift sustainable will mean more than growing numbers. It will require making community-based careers visible, supported and equipped for the future - with fair access to digital systems, training opportunities and career progression, wherever people choose to work.

Digital infrastructure is the thread that connects all of this. For community care to function as a coordinated whole, information needs to move with the person. That might be from a hospital discharge team to a local district nurse, or from a community pharmacist to a GP.

Shared care records are a critical part of the solution. While many regions have made strong progress, integration is still patchy. Too often, professionals must rely on phone calls or workarounds to piece together patient histories.

This is where integrated care software, like Access Intelligent Care Platform, can truly help. When staff can see real-time updates, set alerts, and collaborate across organisations, they are better equipped to prevent crises and respond early. For patients and families, it also means less duplication and greater confidence in the system.

Digital tools also make it easier to monitor outcomes and identify where resources should be focused. A virtual ward is a prime example of how care delivery no longer needs to be confined to physical buildings or people. Using advanced remote monitoring technology, the NHS has helped thousands of people receive hospital-level care at home every day, supported by clinical teams who can intervene if risks escalate.

Alongside this, Technology Enabled Care (TEC) solutions, such as remote sensors, personal alarms, and home monitoring devices, are increasingly playing a role in social care, helping people with long-term conditions to stay safe, independent and supported within their communities.

Although there has been no formal indication of further investment in virtual wards or remote monitoring initiatives, overlooking the opportunity to expand these models in the 10-year NHS plan would risk losing one of the most promising innovations in community-based care.

Strengthening community care is a vital step toward securing the future of the NHS and reshaping how people access and experience support. For the shift to be sustainable, however, there must be a greater focus on prevention, earlier intervention and personalised services that can easily evolve and adapt to meet the changing needs of communities.

In a March statement ahead of the Spring Budget 2025, the Chancellor indicated a 4.7% real-terms funding rise for health and social care in 2024/25, but only a 1.8% increase for 2025/26. While this points to short-term stability, questions remain over longer-term investment in community services.

Once the official announcement is made in a few weeks’ time, turning ambition into action will depend on ensuring that funding, training, and digital infrastructure are aligned, and that health and social care move forward together to support this complex but necessary shift.

Without a resilient social care system, efforts to keep people well at home, manage long-term conditions, and reduce hospital pressures will continue to fall short. While government has set up an independent commission to shape long-term reform, with recommendations due in 2026, practical improvements are needed now to make community-based care a reality.

Hospitals will always have an essential role, but the future of health and social care needs to start being built much closer to home.