The state of health care and adult social care in England 2025/26

Primary and community care has a key role in preventative health care, which includes lifestyle support and advice, immunisations, early detection of diseases through screening programmes and routine checks and reviews, and managing long-term conditions to prevent them from worsening.

Through this prevention role, primary and community care plays a vital role in 4 out of the 5 clinical areas highlighted in NHS England’s national approach to reducing health inequalities for adults, Core20PLUS5. One of these clinical areas is early cancer diagnosis, which is discussed in the Hospitals section of this report. The other 3 areas are:

• severe mental illness
• chronic obstructive pulmonary disease (COPD)
• hypertension.

The fifth clinical area, maternity, is also discussed in the Hospitals section of this report.

Core20PLUS5 for children and young people is explored in the section on ‘Primary and community care services for children and young people’ later in this report.

The Core20PLUS5 approach is being used to focus resources and activities to reduce inequalities in these priority clinical areas, as well as the population groups most affected by them and other health inequalities. We note that the new Quality strategy for NHS-funded care in England explicitly states that NHS organisations must continue to systematically implement the approach, focusing action where gaps in access to services, experience and outcomes from care are widest, including for disabled people and inclusion health groups.

As part of our commissioned research, the Nuffield Trust surveyed leaders of integrated care boards (ICBs) about their priorities for addressing health inequalities. From the 21 responses across 13 ICBs (of 36 ICBs nationally), 16 leaders answered the health inequalities section of the survey. Cardiovascular disease (including hypertension) was identified as a clear area of priority, with 15 of the 16 respondents indicating it as a high priority (and no respondents indicating that it was low priority). Severe mental illness was the next highest area of priority (with 6 respondents considering it a high priority and 9 as medium priority).

However, fewer respondents said their ICB was prioritising inequalities work for non-clinical population groups. This included work concentrating on differing geographical groups, such as urban or rural communities (with 6 considering this a low priority, 8 considering it a medium priority, and 2 considering it a high-priority area), and socially excluded groups, such as people experiencing homelessness (with 5 considering this a low priority, 7 considering it a medium priority, and 2 considering this a high-priority area).

To help to identify priority populations, several interviewees in the Nuffield research referenced the use of local population data or population health management tools to help them build local needs profiles. Others cited the work they had undertaken with directors of public health at borough or neighbourhood level to assess opportunities to maximise the impact and co-design local health equity strategies that set out community priorities.However, respondents also described difficulties identifying baselines and challenges in measuring improvement. This was affected by recent re-organisations, mergers and boundary changes of ICB areas. Interviewees emphasised difficulties in understanding the impact of different interventions on local health inequalities without a robust evidence base that would give directors confidence in the work they are doing.

Severe mental illness

NHS England’s Core20PLUS5 approach to reducing health inequalities for adults includes severe mental illness as 1 of its 5 clinical areas of focus. The 10 Year Health Plan for England also announced plans for a dedicated Modern Service Framework for severe mental illness as a national mechanism for improving outcomes associated with these conditions and across priority groups.

Severe mental illness refers to mental illnesses, such as schizophrenia and bipolar disorder, that are often so debilitating that people’s ability to engage in everyday activities is severely impaired. Many people with a severe mental illness also have one or more chronic physical health condition at the same time as their mental illness.

For adults living with a severe mental illness, the risk of dying prematurely is almost 5 times that of those who do not have a severe mental illness, and premature deaths of people living with severe mental illness are increasing. This is a health inequality and this disparity in health outcomes is largely due to preventable physical illnesses, with high smoking rates making the largest contribution to the life expectancy gap.

The 6 elements of the ‘core’ annual severe mental illness physical health check are:

• alcohol consumption status
• blood glucose test
• blood pressure
• body mass index
• cholesterol test
• smoking status.

A range of health professionals can deliver the severe mental illness annual physical health checks and support for follow-up interventions. Roles include GPs, nurses, pharmacists, occupational therapists, healthcare assistants, health coaches, and voluntary, community and social enterprise (VCSE) staff.

After a large increase in the rate of people with a severe mental illness receiving all 6 health checks between 2019/20 and 2023/24, in 2025/26 the rate stood at 65%. This is a small decrease of 1.3 percentage points since 2024/25, after a change in the way the data was submitted.

When looking at health checks at ICB level there is huge variation – only 53% of people on a severe mental illness register had a full health check in the lowest performing ICB area compared with 81% in the highest. There are no discernible links to the top and bottom performing ICBs in terms of geography or level of deprivation.

Chronic obstructive pulmonary disease (COPD)

COPD is the umbrella term for serious lung conditions that include chronic bronchitis and emphysema. Smoking is the biggest preventable risk factor.

Early diagnosis and effective ongoing management of chronic obstructive pulmonary disease in a primary care setting allows people to start treatments to manage symptoms and improve their quality of life, as well as keeping people healthier for longer and reducing emergency admissions to hospital.

Nationally, 77% of patients with COPD (including people with personalised care adjustments) had a review in the 12 months preceding March 2026.

Regionally, this varied between 74% and 81%, with only slightly higher variation at ICB area level, ranging from 71% to 85%.

Hypertension (high blood pressure)

Uncontrolled hypertension, or high blood pressure, increases the risk of heart attacks, stroke, and heart failure, as well as a number of other diseases related to cardiovascular health. Following a diagnosis of hypertension, regular monitoring and reducing blood pressure to specific treatment thresholds is recommended to reduce these risks.

Hypertension prevalence has been increasing nationally, with 15% of patients on a GP patient list in 2024/25 recorded as having established hypertension. Data from CVDPREVENT shows that in 2024/25, 70% of people on the hypertension register had their blood pressure managed to NICE-recommended treatment thresholds, with a 9 percentage point difference between the highest and lowest performing ICB areas.

We see variation between different groups of people on whether hypertension is treated to the appropriate threshold, with the largest gap seen between younger and older adults. While younger adults are far less likely to have hypertension than older adults, only half (51%) of people aged 18-39 on the hypertension register were treated to the appropriate threshold in 2024/25, compared with more than 4 out of 5 (82%) people aged 80 and over.

We also see variation by ethnicity, with White or Asian people being more likely to have their hypertension treated to the appropriate threshold (both 71%) than people with Mixed or Black ethnicity (both 63%).

Smoking, prevention and health inequalities

Moving from sickness to prevention is 1 of the 3 core strategic shifts of the 10 Year Health Plan for England, published in July 2025. This includes the ambition to create a smoke-free generation through “bringing smoking prevalence to essentially zero during the expected lifetime of a child born today”. Achieving this will not only improve the health and wellbeing of individual people and their families, but it also has the potential to dramatically reduce health inequalities.

Neighbourhood health approaches, including integrated neighbourhood teams, are an important tool for achieving a smoke-free country by bringing easily accessible health services and advice direct to the communities who are most in need.

Through our work with the Nuffield Trust, we heard how one London borough used a neighbourhood health approach to improve child respiratory health in areas facing multiple deprivation. Using local health data, the pilot found that children living in the most deprived postcodes were more likely to live with a smoker, and young children from ethnic minority groups had disproportionately higher percentages of undiagnosed asthma.

As part of the pilot, family link workers joined a multidisciplinary team at a newly established community respiratory clinic. They also carried out home visits to support families to identify and reduce household pollution risks, including from tobacco smoke, and advised parents where they could find smoking cessation services where appropriate. Parents said they felt listened to and valued the time given by the workers.

Annual health checks for people with a learning disability

In our State of Care report last year, we discussed the barriers and inequalities faced by autistic people and people with a learning disability when accessing and using GP services. This year’s GP Patient Survey shows that they continue to have less positive experiences than others, with only 67% of autistic people and 70% of people with a learning disability reporting a good overall experience of their GP practice compared with 77% across all respondents.

People aged 14 and over who are recorded on their GP’s learning disability register should be offered an annual health check to help in preventing and treating new and unmet health conditions. We highlighted how, as at March 2024, there were around 1.3 million people with a learning disability in England, yet only around a quarter were recorded on their GP’s learning disability register.

Encouragingly, the number of people aged 14 and over on the learning disability register has been increasing – up 4.1% between March 2024 and March 2026, from 328,995 to 342,580 people. In March 2026, around 80% of people aged 14 and over on the learning disability register had received a health check in the previous 12 months (273,430 people with completed checks compared with 342,580 people on the register).

However, these figures vary by ICB area. The highest proportion of health checks carried out was 86% compared with the lowest at 70%. From a regional perspective, as at March 2026, London had the highest percentage of health checks at 84% and the South West had the lowest proportion at 76%.