13 March 2025
NHS England will be abolished in order to reduce bureaucracy, Prime Minister Sir Keir Starmer announced today.
Speaking from Hull, Starmer expressed his desire to bring the “overstretched” and “unfocused” health service back under “democratic control.”
He also spoke about a lack of clear lines of accountability within NHS England.
A large number of senior management positions are expected to be affected by the changes, which have been designed to reduce duplication between NHS England and the Department of Health and Social Care.
NHS England will go from 13,000 to 6500 staff, the Guardian reported.
Pritchard will be replaced on interim basis by Sir Jim Mackey, currently chief executive of Newcastle Hospitals NHS Foundation Trust. Mackey will take up the role at the end of March.
Health and social care secretary, Wes Streeting, had previously voiced a desire to return the NHS chief executive role to within his own department, as was the case before the Lansley reforms in 2012.
The news of NHS England’s closure also comes ahead of the publication of the Government’s 10-Year Health Plan, which is expected this spring.
Recovery and reform
Today’s announcement has been met with both caution and relative optimism by organisations working within the NHS.
The NHS Confederation and NHS Providers, the membership organisation for NHS trusts in England, released a joint statement, which called the closure of NHS England “the end of an era for the NHS” and “the biggest reshaping of its national architecture in a decade.”
Matthew Taylor, chief executive of the NHS Confederation, and Daniel Elkeles, incoming chief executive of NHS Providers, said that the announcement “comes at an extremely challenging time, with rising demand for care, constrained funding and the need to transform services.”
“History tells us this will cause disruption while the transition is taking place,” Taylor and Elkeles said.
They emphasised that stability in the short-term will be needed in order to prioritise patient care.
“We also need to ensure we get the right balance between recovery and reform given the opportunity provided by the upcoming 10-year plan,” Taylor and Elkeles added.
Members of both organisations will want to see “strong voices maintained for the health service in future policy making and the major decisions that affect leaders and their staff,” the statement said.
It went on to emphasise that “NHS England was set up to provide arms-length operational independence for the NHS from government and it will be important that the service maintains its ability to inform policy-making and all decisions that affect operational delivery.”
The NHS Confederation and NHS Providers and their members will work with the Government to “help this transition go smoothly and to ensure the 10-year plan helps the Government to meet its ambitions,” Taylor and Elkeles said.
They also noted that local NHS organisation and health bodies will need to be involved in the transformation, “so that an optimum operating model can be created.”
Sarah Woolnough, chief executive of The King’s Fund, said that the most important considerations in light of the news are how the abolition of NHS England will make it easier for people to get a GP appointment, whether it will shorten waiting times for planned care, and whether it will improve people’s health.
“Ministers will need to explain how the prize will be worth the price,” Woolnough said.
She continued: “It is absolutely right that democratically elected politicians must have clear oversight of how the NHS delivers for patients and spends hundreds of billions of taxpayer money. It is also reasonable to want to deliver better value by reducing duplication and waste between two national bodies where they are performing a similar role.
“It is true that over its just over a decade of existence, NHS England has been asked to take on a lot more additional power, functions and therefore staff, than it was originally designed to do.”
However, in light of the expected publication of the 10-Year Health Plan, the Government “must be clear why this significant structural change at this time is necessary, and how it fits into their wider plans,” Woolnough believes.
She added: “As with previous NHS restructures, structural change comes with significant opportunity cost, with staff who would otherwise be spending their time trying to improve productivity, ensure safety and get the best outcomes for patients, now worrying about whether they will have a job.”
The AOP view: a welcome opportunity for reset
The AOP has welcomed news of the NHS restructure as an opportunity for a “serious reset” of the health fundamentals in England.
Adam Sampson, AOP chief executive, said: “It is clear that the NHS has not been getting the basics right. The public rightly want an NHS that works for them, but their trust in the system has been eroded.”
He added: “Fundamental change is needed. With a growing crisis of longer waiting lists, staff shortages and funding constraints – the time for reform is long overdue. This moment presents a serious reset of the health fundamentals in England and the opportunity to deliver on the Government’s commitment to the three big shifts, in particular moving care from hospital to community settings.”
The reform must deliver on the Darzi report’s call for a rebalancing of investment from secondary to primary care, including optometry, in order to ensure a more integrated, accessible, and resilient system that delivers for the public, Sampson said.
He noted that AOP work over the past year, including the organisation’s co-commissioned PA report, “has highlighted that the opportunity to do things differently is very much within our grasp.”
“We believe that ensuring eye care is part of a transformed primary care service is essential to meet the rising demand for health care of a growing, ageing population, and shift to a prevention-led service that will help to keep people well and grow the economy,” Sampson said.
He continued: “It is fair to say our evidence-based calls for extending the role of community optometry have been met with a combination of disinterest and resistance by some key individuals in NHS England; indeed, their preferred direction of travel seems to be to concentrate more rather than less of the limited eye care spend in the hands of hospitals.
“As politicians of all persuasions have agreed today, this change will remove some of the blockers to the transformation of our health services.”
Sampson added: “We look forward to working with the Government to ensure the 10-Year Health Plan is a success, bringing care closer to home and creating a prevention-led, digital health service that is fit for the future.
“It’s time for action to rebuild public trust and deliver on the Government’s vision: a healthcare system that works for all.”
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Anonymous14 March 2025
I believe NHS England still controls the GOS fee level? I understand the administrative spending of it and practice inspections etc, had prior to this announcement already been devolved down to English area Integrated care boards (ICB - "to join up health and care services" ).But my understanding is ICBS do not have control of the finances, these are still held by the remnants of the PCTS now Health (& Social) Care partnerships. Locally my ICB has managed to standardise Enhanced Optometric Optometricservices, across 5 different Health Care Partnerships (so fewer issues with Px crossing pseudo NHS borders), but some optometric fees have been reduced to fund it. With pathway been over complicated by EeRS (not connecting to Optometric PMS software) , Single Point of Access, Third party triaging of our referrals, and then elderly patients been expected to use electronic systems rather than a person to offer Choice of providers. The algorithms of which seem biased to get patients to choose the NHS hospitals rather than other private NHS providers.
If there is a push to move things to primary care, our concern should be there is no evidence that the funding will follow the patients. Secondary care does not intend to relinquish any of its funding to primary care and shrink their empires. Yet, they still want us to do even more work for them and just add it the cost of specs, a model that is broken.
We need a union, like the Doctors have the the BMA, which organises optometry to work to rule , and for our NHS only patients just to perform the basic GOS, no diagnosis / triaging and just refer on signs and symptoms, flood the hospitals until they come up with a workable plan for optometry.
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Don Williams13 March 2025
A Welcome Reset for Healthcare in England
The abolition of NHS England marks a pivotal moment in reshaping how healthcare is managed and delivered across the country. While some may lament the end of an organisation that has held significant influence over the NHS for more than a decade, it is difficult to ignore the reality that, for many on the frontline, NHS England has often seemed more like a bureaucratic obstacle than an enabler of progress.
I fully agree with Adam Sampson’s view that this restructuring presents an opportunity for a much-needed “serious reset” of healthcare fundamentals. The NHS has long struggled with inefficiencies, duplicated efforts, and a disconnect between policy and practical patient care. With waiting lists at crisis levels, primary care stretched beyond capacity, and a growing burden on hospitals, there is an urgent need for reform that prioritises accessibility, efficiency, and prevention-led healthcare.
One of the most pressing issues has been the centralisation of decision-making within NHS England, often at the expense of more localised, patient-focused solutions. This has been particularly evident in eye care, where optometry’s potential to deliver high-quality, accessible community-based care has been continually undervalued. As Sampson rightly points out, NHS England’s approach has favoured concentrating resources in hospitals rather than embracing the role that community optometrists and ACPs (Ophthal) could play in alleviating secondary care pressures. If this restructure truly allows for a shift in investment and responsibility from hospitals to primary care, including optometry, it could be one of the most positive transformations in recent healthcare policy.
Of course, change on this scale comes with disruption, and questions remain over how this transition will be managed to avoid unnecessary upheaval. However, if executed correctly, this could be the moment when long-standing barriers to progress are dismantled. A leaner, more responsive system that genuinely prioritises patient outcomes over administrative entanglements is long overdue.
The 10-Year Health Plan must now deliver on its promises—not just in rhetoric but in real, actionable change. This is an opportunity to build a healthcare system that works for everyone, ensuring services are delivered efficiently, funding is allocated wisely, and patients receive the care they need without unnecessary delays or bureaucratic hurdles.
For too long, NHS England has appeared more concerned with process than with practical solutions. If this restructure means fewer barriers, greater integration, and a genuine shift towards community-based care, then it is undoubtedly a step in the right direction.
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