NHS 10-Year Plan: The devolved NHS and what the new operating model means for pharma, medtech and device suppliers

Chapter five of the NHS 10-Year Plan sets out one of the most radical structural shifts in the service’s 75-year history. A transformation from a command and control model to one built on devolution, place leadership and local accountability.

It proposes a new operating model where Integrated Care Systems (ICSs) and, within them, Places and Neighbourhoods, take the lead on delivering health outcomes. Central bodies like NHS England will step back, focusing on setting strategy, enabling innovation and intervening only when performance demands it.

In many ways, this is the long awaited next step in NHS evolution, from a centralised bureaucracy to a locally led partnership of health, care and community organisations.

But for many in General Practice, local government and industry, the plan generates as much concern as optimism.

Is the system ready to lead itself? Will local devolution come with genuine flexibility, or simply pass down national pressures without national support? And crucially – who is accountable for what?

From command and control to local autonomy: What the new NHS model looks like

The chapter envisions an NHS where decision making is “as close to communities as possible,” rooted in population need, local relationships and real time data. It outlines three levels of accountability:

• ICSs set strategic direction, lead collaboration and co-ordinate investment.
• Places, which are usually aligned to Local Authority footprints, design and deliver local services.
• Neighbourhoods, which look set to evolve from PCNs, enable integrated, preventative, personalised care.

National bodies like NHS England and DHSC will focus on a smaller set of priorities, provide enabling frameworks and intervene only when systems underperform.

This is the most explicit move yet toward a federated NHS, one where central bodies enable rather than dictate. It’s a model that invites greater responsiveness, agility and creativity. But it also comes with real risk.

The risk is we get devolution without support

For many of my NHS contacts, particularly GP leaders, federation board members and PCN clinical directors, the word “devolution” often raises eyebrows. Not because they oppose local leadership but because they’ve seen too many examples where responsibility is devolved but power and resources are not.

As one PCN lead recently put it: “We get told we’re in charge but we don’t get the money, the staff or the headroom to actually lead.”

This concern is echoed by system leaders. ICS executives are being asked to:

• Reallocate funding upstream without destabilising hospitals.
• Manage system risk in real time.
• Deliver improvement on workforce, access, inequalities and productivity.
• Do all this with limited new funding and declining public satisfaction.

Without adequate infrastructure, data access and workforce support, local autonomy risks becoming a smokescreen for central withdrawal rather than meaningful empowerment.

New rules, new risks: Who’s accountable in a devolved NHS?

A key shift in this chapter is the redefinition of accountability. Instead of hierarchical performance management, the plan proposes shared accountability for outcomes between NHS bodies, local government, VCSE partners and communities.

This is a welcome reframing. But in practice, it creates ambiguity.

• Who is accountable if a neighbourhood fails to reduce health inequalities?
• What happens if a Place decides not to prioritise a national target?
• How do system partners hold each other to account when funding and authority are unevenly distributed?

The plan suggests central targets will reduce but national frameworks like the Core20PLUS5 will remain. This hybrid model may lead to confusion about what’s truly flexible and what’s non-negotiable.

In my new book Embedded, I argue that pharma, medtech and diagnostics companies need to understand not just who decides but also how decisions get made. In a devolved NHS, there’s no single gatekeeper but multiple overlapping spheres of influence. Mapping those is now essential.

Unlocking commercial opportunity – how suppliers can engage the local NHS

For suppliers, especially those accustomed to national deals or high level pathways, the new operating model poses a challenge. There is no “one NHS” anymore. To access budgets, secure adoption and embed solutions, you must engage at multiple levels:

• Nationally. Align your product with NHS priorities, outcomes frameworks and regulatory standards.
• Regionally (ICS). Show system level benefit on pathways, costs and workforce.
• Place based. Demonstrate how you improve local delivery, productivity and population outcomes.
• Neighbourhood/PCN. Prove value at the point of care, supporting practices, reducing workload and enabling prevention.

This shift opens up new routes to market but only for companies prepared to understand local context, build long term partnerships and offer pathway aligned, integrated solutions.

How suppliers must adapt to a devolved NHS

To thrive in a devolved NHS, pharma, medtech and device companies must change not just what they sell, but how they sell it. That means:

• Building ICS engagement teams who understand system pressures and decision making flows.
• Partnering with Neighbourhoods/Primary Care Networks, not just hospital trusts.
• Designing offers that flex to local population needs and delivery models.
• Investing in co-production, bringing clinicians, managers and community leaders into service design.
• Ensuring solutions reduce, not increase, local workload and complexity.

This is the message at the heart of Embedded. If your offer only works top down, it won’t last. But if it empowers local delivery, it is likely to be adopted, protected and scaled.

One NHS, many systems: Why local diversity demands tailored solutions

A devolved NHS won’t look the same everywhere. Different ICSs are already adopting different governance models, digital solutions, workforce strategies and partnership frameworks.

Some Places will fully integrate NHS and Local Authority commissioning while others may retain separate funding flows but agree shared outcomes.

Some ICSs will prioritise elective recovery. others will double down on prevention or mental health. And some neighbourhoods will be led by GPs, others by community providers or integrated teams

This diversity is a strength, but it creates a complex landscape for suppliers. National alignment remains important but local tailoring is now essential.

No longer can a sales team present one pitch and expect traction across the country. The new model requires understanding local plans, local pain points and local decision makers.

Why building relationships with Place leaders is now essential

Another shift outlined in this chapter is the elevation of Place leaders, often jointly appointed between the NHS and local government, to strategic leadership roles.

These leaders are charged with:

• Setting local priorities.
• Convening partnerships.
• Allocating resources across sectors.
• Driving service redesign.

For suppliers, this means building new types of relationships. Not just with NHS procurement or clinical leads but with Place executives, Directors of Public Health, and system integrators.

It also means understanding the culture of local systems. Some ICSs are innovation first and collaborative; others are risk averse or under financial strain. Tailoring your approach requires research, listening and patience.

The left shift in action: Supporting community care and prevention at scale

One of the consistent themes across this blog series is the “left shift”, moving care from hospital to community and from treatment to prevention.

This won’t happen without strong, well supported Place and Neighbourhood delivery teams. But as GPs regularly tell me, there’s a growing mismatch between what they’re being asked to do and what they’re resourced to deliver.

Digital tools, remote monitoring and new care models are welcome but only if they reduce workload, improve coordination and are co-designed with frontline teams.

For industry, the message is clear; please don’t just sell the tool, support the transformation. That’s how you build lasting relevance in a devolved system.

Embedding solutions in the new NHS model

Chapter five marks a pivotal point in NHS evolution. The promise of local leadership, shared accountability and place-based planning is both exciting and overdue. But the risks of fragmentation, under resourcing and blurred responsibility are real.

For General Practice, the concern is being asked to lead transformation without the time or tools to do so. For suppliers, the challenge is navigating a system with no single door and no one size fits all model.

The opportunity lies in embedding yourself at the right level, offering solutions that work with, not on, the local NHS. And in doing so, helping the system turn a powerful ambition into practical delivery.

At www.scottmckenzieconsultancy.com, we work directly inside the NHS, supporting provider organisations, commissioners and system leaders to implement real change. We then help pharma, medtech and device companies interpret what’s happening, so they can engage the right stakeholders, align with NHS priorities and get their innovations embedded into care pathways.

With 10 years in pharma and more than 20 years working within the NHS, Scott brings a unique dual perspective, now captured in his upcoming book, launching September 2025, Embedded: How Pharma, MedTech, and Device Companies Can Get Their Products into NHS Pathways and Stay There, which distils everything he’s learned into a practical playbook. Whether you’re launching a new product or trying to unlock stalled adoption, Embedded shows you how to reframe your offer, align with NHS priorities, and make change stick.