In reading the NHS 10-Year Plan, I was drawn by the phrase “a value-based approach,” repeated strategically and with intent about nine times. In one of those excerpts, it says: “The era of the NHS’s answer always being more money, never reform, is over. It will be replaced with a new value-based approach focused on getting better outcomes for the money we spend.” As someone with a keen interest in health equity and having recently completed the value-based healthcare (VBHC) programme at Harvard Business School, the recurrence of this phrase caught my attention and signalled the emergence of a pivotal change in how the priority areas in the 10-year plan, hospital to community, analogue to digital, and sickness to prevention, will be delivered. It beacons a transformation that VBHC visionaries in primary care may have long hoped for: a move towards care organised around what truly matters to patients, with better alignment between outcomes and costs. At the same time, it left me even more curious about its practical implementation. This article captures my reflections on this topic and highlights how core components of VBHC can be leveraged in translating this policy into practice.

Value-based healthcare, as originally defined by Michael Porter, is the organising principle of healthcare delivery that maximises outcomes that matter to patients relative to the cost of achieving this. It reorients health systems around six core tenets of organising care into integrated practice units centred on medical conditions, measuring outcomes and costs for every patient, transitioning to bundled payments for care cycles to better align with value, integrating care across facilities, expanding excellent services geographically, and enabling a robust IT platform. These aren’t just abstract words; they are the underlying framework of how VBHC transforms healthcare. Additionally, one of the most powerful, yet under-discussed, strengths of VBHC is its potential to address health inequalities. By shifting focus to outcomes that patients care about and disaggregating data by population groups, VBHC allows us to see where care is failing particular communities. It creates accountability not only for clinical improvement but also for ensuring equitable health gains across socioeconomic, ethnic, and geographic divides. For a health system like the NHS, committed to universal coverage and tackling inequalities, this offers an invaluable approach.

The plan’s commitment to three radical shifts: from hospital to community, from analogue to digital, and from sickness to prevention, reflects core VBHC principles. There is a clear intention to dismantle siloes, address fragmentation, move services closer to where people live, improve through digitalisation, and tackle health inequalities, all of which sound like an opportunity window for value-based healthcare to take a central position.

I’ve been reflecting on how the NHS 10-Year Plan’s ambitions can be realised through the principles of value-based healthcare (VBHC), particularly within the proposed Neighbourhood Health Services. These community-based hubs, led by multi-professional teams, mark a clear evolution from today’s Primary Care setting. While Primary care has witnessed expanded General practice capacity through the Additional Roles Reimbursement Scheme (ARRS), introducing roles like social prescribers, pharmacists, and paramedics, many remain siloed by institutional and contractual boundaries, limiting shared accountability for outcomes that truly matter to patients. In our Harvard discussions, we often returned to the concept of Integrated Practice Units (IPUs): multidisciplinary teams that take responsibility for delivering outcomes across the full cycle of care for a specific condition, with a focus on outcomes and efficiency. Could these new neighbourhood teams, especially in areas with high prevalence of specific health conditions, evolve into IPUs?

For example, in a community with a high prevalence of frailty related admissions, a neighbourhood team could bring together GPs, geriatricians, physiotherapists, pharmacists, social care, and mental health professionals, not merely as co-located staff bound by contracts, but as a team jointly accountable for reducing hospitalisations, and enabling independence at an individualised patient level. This would require more than coordination and demand shared responsibility. Can tools like Patient Reported Outcome Measures (PROMs), which capture patients’ perspectives on their health and quality of life, and Time-Driven Activity-Based Costing (TDABC), which calculates the true cost of care delivery over time, support teams to learn, adapt, and scale across sites? If implemented with these components, neighbourhood teams could represent not just a structural redesign but a cultural shift, organising care around people in a way that primary care is yet to see.

In all the priority areas, there is a potential to embed PROMs to measure value and time-driven activity-based costing (TDABC) to understand what it costs, leveraging that insight to guide what needs to be de-implemented, improved, or invested in. These aren’t just technical tools. They are the foundations that allow value-based healthcare to go from policy to practice. The plan’s references to “pay-for-impact” pilots are promising for this, hinting at a future where funding may follow value in health outcomes through full cycles of care, not just volume and process. It is clear to me that these levers must be matched by investment in data infrastructure, workforce capability, and co-production with communities, especially those most often left behind.

I’m energised by what this plan could mean for the future of general practice. It feels like an invitation to think differently, to organise care around people and outcomes. But it also feels like the start of a longer journey, one where transformation won’t come solely from structural reform, but from embracing the discipline of value, centralising what matters to patients, making costs transparent, and accountability for the full cycle of care. For NHS leaders working across all levels, whether in commissioning, neighbourhood teams, or national policy, the practical application of value-based healthcare, as defined by Michael Porter, may now feel urgent and essential. The question is no longer ‘if’ but ‘how’. We need increased understanding of outcomes that matter to patients and embedding PROMs into practice. We need to link these outcomes to cost using tools like Time-Driven Activity-Based Costing (TDABC), so we can make informed decisions.

Let’s not miss this moment to deliver not just care but more value and equity.

References

1. Porter, M. E. (2010). What is value in health care? New England Journal of Medicine, 363(26), 2477–2481. https://doi.org/10.1056/NEJMp1011024
2. Kaplan, R. S., & Porter, M. E. (2011). How to solve the cost crisis in health care. Harvard Business Review, 89(9), 46–52.
3. NHS England. (2025). NHS 10-Year Plan: Reinventing the NHS for the Future. https://www.england.nhs.uk/long-read/nhs-long-term-plan/

Author

Dr. Lynda Odoh

Lynda is a GP registrar in Wigan, Greater Manchester with a keen interest in population health, health equity, primary care transformation, value-based healthcare, and digitally enabled care.  She holds a Master’s in Public Health (Distinction) from the University of Manchester, with a focus on Implementation Science. She was part of the 2025 cohort of the Harvard Business School’s Michael Porter’s Value-Based Healthcare Delivery Program.

Lynda is currently an NHS Core20PLUS5 Ambassador which is part of the National Healthcare Inequalities Improvement Programme. Her recent work includes developing a culturally responsive, web-based prediabetes support corner and action pack at her host GP surgery, as well as introducing health inequalities teaching into the ST3 curriculum of the Wigan VTS programme for 2024/25.

She also served on the Greater Manchester North West Leadership School Subcommittee (2024/25), where she contributed to organising webinars and the annual conference to support leadership development for doctors in training across the region.

She recently completed a Medical Leadership Certification from Edge Hill University and will be taking time out for the National Medical Director’s Clinical Fellowship Scheme in September 2025, hosted by NHS England and the Faculty of Medical Leadership and Management (FMLM). Following the fellowship, she will return to complete her final year of GP training.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none