The NHS 10 Year Plan promises easier access.
More care closer to home.
More self-referral.
More digital access.
More prevention.
More control for patients.
That sounds like a public-service improvement. In some cases, it may be one. If someone can self-refer to podiatry, MSK, audiology or talking therapies without first fighting for a GP appointment, that can save time, reduce pressure and get people to the right service sooner.
But easier access to a form is not the same as access to treatment.
The form can be easier to find while the clinician is still hard to reach.
That is the story.
What the plan says
The NHS 10 Year Plan is built around three shifts:
Hospital to community.
Analogue to digital.
Sickness to prevention.
Those are the official words.
The plan says the NHS App will become a main route into the NHS. Through the My Specialist tool, patients will be able to self-refer to specialist care where clinically appropriate. From the outset, the plan names mental health talking therapies, musculoskeletal services, podiatry and audiology.
That is not a small detail.
It means AHP-heavy services are being pulled into the new NHS access model.
Podiatry is not at the edge of the plan.
It is one of the named examples.
The good version
The good version is simple.
A person with a foot problem should not always need a GP appointment first.
A person with back pain should not always need to pass through a GP bottleneck before MSK support.
A person who needs hearing support should not have to waste weeks in the wrong queue.
A person seeking talking therapy should not be blocked by unnecessary referral steps.
Self-referral can be better than gatekeeping.
Digital access can be better than telephone queues.
Triage can be better than drift.
Good digital systems can spot risk, sort urgency, free clinical time and make the route clearer.
That is the promise.
The bad version
The bad version is also simple.
The NHS creates an easier online route, but the service still has too little capacity.
The patient fills in the form.
The form asks questions.
The system sorts risk.
The referral is accepted, delayed, redirected or refused.
The patient gets advice.
The patient is told to self-manage.
The patient is told they do not meet the criteria.
The patient is told to come back if it gets worse.
The patient has technically accessed the system.
But they have not received care.
That is digital access without practical access.
The dentistry warning
This is where dentistry matters.
NHS dentistry has not disappeared. It still carries the NHS name. It still has rules, treatment bands, charges, guidance and contracts.
But millions of people cannot get care when they need it. When they can, the offer is often delayed, limited and shaped around what is clinically necessary. More choice, more speed and some preferred options sit on the private side.
That is the warning model.
A service can remain public in law while becoming two-tier in real life.
The 10 Year Plan does not say podiatry, MSK, audiology or rehabilitation will become dentistry.
That would be too blunt.
The more precise point is this:
The same policy tools are visible.
Prevention.
Self-referral.
Digital access.
Community care.
Higher-value use of clinicians.
Targeting.
Productivity.
Value for money.
None of these ideas are automatically bad.
But under financial pressure, they can narrow the practical offer.
Dentistry shows how that can look once the public promise and the real access route separate.
Podiatry is the useful test case
Podiatry is a good test of the whole model.
It is preventative.
It is community-based.
It can keep people walking.
It can reduce falls.
It can support people with diabetes, vascular disease, wounds and long-term conditions.
It can prevent infection, ulceration, hospital admission and amputation.
It is exactly the kind of service a prevention-first NHS should value.
But that is also why the risk matters.
If podiatry becomes easier to self-refer into, but the service does not have enough staff, clinic time, treatment capacity, home-visit capacity and specialist pathways, the result may not be broader care.
It may be stricter sorting.
Who gets in.
Who waits.
Who is redirected.
Who gets advice.
Who is told this is not NHS care.
Who is considered serious enough.
Who must get worse first.
Community services are already under pressure
The hospital-to-community shift depends on community services being able to carry more work.
That is the weak point.
Nuffield Trust analysis found that the community services waiting list in England was almost 1.2 million in July 2025. Adult services accounted for around 870,000 people and children and young people’s services for 326,000.
For adults, 44% of people on the community waiting list were waiting for MSK services. Another 13% were waiting for podiatry.
For children and young people, community paediatrics, speech and language therapy, physiotherapy, audiology and occupational therapy all carried major waiting-list pressure.
This matters because the 10 Year Plan asks the community sector to become the future first line of care.
But a service cannot become the first line of care if it is already overloaded.
The new sorting system
Digital triage sounds technical.
In plain language, it means the system sorts people before they reach a full appointment.
That can be useful.
A person with an infected diabetic foot wound should not sit in the same queue as someone seeking routine nail care.
A person with severe pain, spreading redness, ulceration, suspected vascular compromise or sudden loss of mobility needs a fast route.
Good triage can save limbs and lives.
But triage also controls access.
It decides what counts.
It decides what waits.
It decides what is redirected.
It decides what is self-care.
It decides what the NHS will treat.
That is why digital triage has to be judged by what happens after it sorts people.
If it sorts people into timely care, it is access.
If it sorts people into delay, it is rationing with a cleaner interface.
The Band 5, 6 and 7 pressure
This also changes the workforce story.
Band 5 podiatrists may become part of a supported pipeline into a more digital, prevention-focused service.
That is the good version.
But the bad version is Band 5 clinicians being pulled too quickly into complex screening, risk sorting and high-pressure caseloads because the service is short.
Band 6 podiatrists are likely to become the pressure point.
They are senior enough to carry autonomous high-risk work, wound care, diabetes-related foot protection, MSK triage, nail surgery development, home visits, care-home work and supervision. But they may not be senior enough to control service thresholds, staffing or policy.
Band 7 podiatrists are likely to become the control layer.
They may lead pathways, supervise junior staff, hold complex caseloads, manage governance, audit outcomes and help redesign services around digital triage and neighbourhood care.
That can be clinical leadership.
Or it can become managing a rationed service with better dashboards.
The future of podiatry is not disappearance.
It is compression.
More importance.
More risk.
More sorting.
More proof of value.
More responsibility for deciding who gets care.
The language hides the narrowing
The public language is soft.
Digital access.
Neighbourhood care.
Self-referral.
Prevention.
Choice.
Productivity.
Patient empowerment.
Those phrases are not false.
But they do not answer the practical question:
What happens after the patient submits the request?
An online route can be open and still lead to a waiting list.
A form can be clear and still end in rejection.
A service can be visible and still unavailable.
A patient can be empowered to request care and still not receive it.
That is the hidden change.
The treatment-removal mechanism
The plan also contains a harder financial direction.
It says the NHS will use a value-based approach and that NICE will have new powers to withdraw treatments that are no longer cost-effective, so funding can move to more effective care.
That may be clinically sensible in some cases.
No public service should spend forever on low-value care when better care is available.
But the phrase “no longer cost-effective” matters.
It tells us the NHS future will not only be about more access.
It will also be about removal, sequencing, substitution and proof of value.
This is not just a clinical plan.
It is a sorting plan.
The TWIS point
The story is not that digital access is bad.
The story is that digital access can make rationing look like modernisation.
The old barrier was obvious:
You could not get through.
The new barrier may be cleaner:
You completed the form.
You were assessed.
You were triaged.
You were advised.
You were redirected.
You were told you did not meet the threshold.
The system worked.
The care did not arrive.
That is why this belongs in the same series as dentistry and mental health.
Dentistry shows the public-name, private-necessity model.
Mental health shows the public-distress, private-burden model.
Digital triage shows the next access model:
The request is digital.
The treatment may still be rationed.
The question underneath
The question is not whether the NHS App should exist.
It should.
The question is not whether self-referral can help.
It can.
The real question is:
Will digital access lead to treatment, or will it mainly organise the queue?
Until that is answered, the public should be careful with the word access.
Access to a form is not access to care.
Access to triage is not access to treatment.
Access to advice is not access to a clinician.
The form gets easier to find.
The question is whether care becomes easier to get.