In recent years, we’ve seen a shift in how the NHS operates, with a growing focus on local neighbourhoods as the heart of healthcare delivery. But what does this really mean for patients and the healthcare professionals delivering care? One of the most exciting innovations driving this change is the use of locally developed care pathways – tools that can transform how we manage patient care across communities.

However, implementing localised healthcare pathways in the NHS faces several barriers: Integrated Care Boards (ICBs) are operating under significant financial pressure. There is a lack of clarity around how funding will flow to neighbourhoods, and limited autonomy at local levels to resource the collaborative work needed to design, agree, and document care pathways. Without dedicated funding and governance support, frontline teams struggle to turn pathway discussions into usable, standardised tools at the point of care. These systemic issues undermine the potential of localised, integrated care.

From Hospital to Community, Treatment to Prevention, and Analogue to Digital: The NHS’s Big Shifts

The NHS has set a bold vision for the future, aiming to shift the way care is delivered by focusing on three key areas:

1. From hospital to community: The goal is to ensure that people can stay in their homes or communities as long as possible – avoiding unnecessary trips to hospital when they don’t need to be there.
2. From treatment to prevention: By promoting earlier interventions and better management of long-term conditions, the aim is to prevent people from getting sicker in the first place, which reduces strain on the system overall.
3. From analogue to digital: We’re moving toward a more digital future, where care pathways, health records, and communication between services happen on digital platforms, making the whole system faster, smarter, and more efficient.

Care pathways play a huge role in contributing to the successful achievement of each of these shifts. They provide clear, localised, and evidence-based guidance for clinicians, helping them make quicker and more confident decisions. In turn, leading to better care for patients – closer to home, earlier in the process, and often without needing to step foot in a hospital.

How Do Care Pathways Help Healthcare Professionals?

For healthcare professionals – whether GPs, nurses, or community care teams – clear guidance is a game-changer. Care pathways act like a roadmap, providing direction in the complex world of patient care. When clinicians can quickly access the information they need – whether that’s guidance on managing a chronic condition or knowing when to refer to a specialist – it cuts down on decision-making time and reduces the chances of errors and harm. By providing guidance to practitioners at the point of care through evidence-based steps, these locally agreed pathways dramatically reduce the cognitive burden on GPs. Instead of second-guessing clinical decisions or navigating an ever-changing landscape of guidelines services and thresholds for referral, clinicians can rely on streamlined processes to act swiftly and decisively. This can be particularly important in areas like urgent care, where time is often of the essence. Instead of having to rely on memory or find information across multiple systems, pathways ensure that everyone is working from the same page.

A New Opportunity for NHS Wales: Pathways Beyond Elective Care

The potential for pathways doesn’t stop at supporting planned care. The national implementation of HealthPathways across NHS Wales, with localised pathways in each of its seven constituent health boards, has already used pathways effectively to streamline elective care, helping to reduce waiting times and improve patient flow. But there’s a big opportunity here to expand this success and apply the same approach to non-elective care – especially urgent care.

Currently, NHS Wales faces pressure on its emergency departments and hospital beds, particularly during winter months. By using locally tailored care pathways to keep more people in their homes – whether that’s through better management of long-term conditions or urgent community response services – patients can be supported where they live, and hospitals can focus on the most critical cases. This not only improves patient outcomes but also eases the burden on healthcare professionals and the NHS as a whole.

What Does This Look Like in Practice? A Real-World Example from South Tyneside

Let’s look at a real example: South Tyneside has been leading the way in implementing locally developed HealthPathways, and the results speak for themselves. By providing GPs and community healthcare teams with locally agreed, easy-to-access clinical guidelines, they’ve improved the way care is coordinated across the area. This has reduced unnecessary hospital visits and allowed patients to receive care in the community where it’s most convenient for them.

Clinicians in South Tyneside report that these pathways save time, increase their confidence in making referrals, and improve the consistency of care. Patients are happier too, as they get quicker access to the right care without having to wait for hospital appointments or make unnecessary trips.

Why Are Care Pathways So Important?

When you look at it, the benefits of locally developed pathways are clear. They:

• Reduce variation in care: By providing everyone with the same clinical guidelines, pathways ensure a consistent approach to care.
• Improve coordination: When pathways are shared across primary, secondary, and community settings, it creates a more integrated, connected system.
• Help manage pressures: In areas like urgent and unscheduled care, pathways can standardise how services are accessed and reduce pressure on emergency departments.
• Support preventative care: By intervening earlier, pathways can help reduce the need for emergency care and hospital admissions.

What’s Next for NHS Neighbourhoods?

So, as the NHS continues to move toward its 2025/26 vision, locally developed care pathways are going to be an essential part of solution. They provide the foundation for a more integrated, patient-centred health system – one where care is delivered where it’s needed, at the right time, and with the right support.

For NHS leaders, this is an exciting opportunity to drive change, reduce inefficiencies, and improve outcomes across the board. Care pathways are more than just clinical tools; they’re a strategic asset that helps us build a health system that truly works for patients and professionals alike.

In conclusion, locally developed care pathways, that are easily accessible at point of care, are not just a nice-to-have – they’re becoming a must-have in the future of NHS neighbourhoods. As we move toward a more proactive, connected, and preventative approach to healthcare, these pathways will play a key role in ensuring that patients receive high-quality care, wherever they are.

Author

Dr Jonathan Tose, GP in Manchester, UK

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Dr. Jonathan Tose is a clinical editor for HealthPathways in South Tyneside and the Clinical Lead for Streamliners, UK.