This month’s developments across the NHS feel strangely familiar: major reports, stark findings, bold commitments — and the lingering question of whether anything will genuinely change. For those of us who have spent years in NHS management and primary care, the Covid Inquiry’s Section 5 findings read less like revelations and more like a formal acknowledgement of what the service has been saying for years.

Covid Inquiry Section 5: A Mirror Held Up to the NHS

The Inquiry’s latest report turns directly to healthcare delivery, workforce resilience and system leadership. It is sobering, but not surprising.

A Workforce Already at Breaking Point

Section 5 confirms what many clinicians and managers lived day‑to‑day: unsafe staffing levels, fragile surge capacity, inconsistent PPE access, and burnout “without modern precedent.” BME staff faced disproportionate risk, yet protections were inconsistent. (Source: UK Covid‑19 Inquiry, Module 5 Report (2024).

None of this is new — but it is now formally recorded. The question is whether it will be acted upon.

Primary Care: Essential, Yet Overlooked

General practice once again appears as the service that absorbed enormous pressure while being left out of national decision‑making. The Inquiry highlights delayed PPE and testing, unclear remote‑triage guidance, fragmented communication, and inconsistent support for shielding patients. (Source: UK Covid‑19 Inquiry, Module 5 Findings on Primary Care.)

Primary care delivered vaccines, urgent overflow, and continuity for vulnerable patients — yet its voice was marginal. Will this finally change?

Digital Acceleration Without Digital Assurance

The Inquiry acknowledges the rapid digital shift, but warns of unassessed risks, widening inequalities, and AI tools deployed without clear governance. (Source: UK Covid‑19 Inquiry, Digital and Technology Evidence Review.)

This aligns with current indemnity guidance: AI can support, but liability always sits with the clinician or practice. (Sources: MDDUS, MPS and MDU AI Indemnity Statements (2024–26).

Digital transformation is here to stay — but safety governance must catch up.

A Call for Long‑Term Reform

The Inquiry’s message is blunt: the NHS cannot rely on goodwill, heroism, or crisis improvisation. It needs sustained capital investment, stable workforce planning, modernised digital governance, and clearer national leadership. (Source: UK Covid‑19 Inquiry, Section 5 Recommendations.)

Primary care stands to benefit from the new capital programme — 800 surgery upgrades completed and £200m more allocated for expansions. (Source: DHSC Primary Care Estates Investment Update (2026).

List Cleansing: A Quiet Crisis for Practices

While national headlines focus on capital plans and workforce deals, list cleansing has quietly become one of the most destabilising issues for practices. Sudden drops in patient registrations — often without warning — are leading to significant reductions in income and operational confusion.

Practices report patients being removed despite recent attendance, discrepancies between local and national records, and unexpected deductions from monthly statements. (Source: NHSE Primary Care Bulletin & PCSE Operational Notices (2026).

The financial impact is immediate: reduced GMS/PMS baselines, lower ARRS allocations, and cuts to IIF and QOF payments.

For practices already stretched by inflation, staffing costs and rising demand, this instability is more than frustrating — it is damaging.

The Emerging Themes

• Lack of transparency: cleansing activity is happening without clear communication or criteria. (Source: LMC Reports and ICS Feedback (2026).
• Misalignment with access expectations: Practices are being asked to improve access and expand digital telephony — while their income is quietly reduced. (Source: NHSE Modern General Practice Access Guidance (2026).
• Financial instability: Deductions are often reversed only after lengthy time consuming, challenge processes.
• Inconsistent national approach: ICS responses vary widely. What is missing is a clear national policy that protects practices from inaccurate removals.

List cleansing is not new — but the scale and speed of recent activity raise a deeper question: how can general practice deliver stability and transformation when its financial foundations are being eroded without warning?

Digital Transformation & AI: Promise and Pressure

AI‑supported tools are now entering everyday practice workflows — summarising, coding suggestions, triage support, routing, analytics, and real‑time information retrieval. (Source: NHSE Digital Primary Care Update (2026).

They offer genuine potential to reduce administrative burden and improve safety. But indemnity organisations are united: AI can assist, but it cannot carry liability. Human review is mandatory. AI must never be the sole triage route. (Sources: MDDUS, MPS, MDU AI Guidance.

Governance is essential — safety leads, DPIAs, DCB0129/0160 cases, audits, and override protocols.

The technology is moving quickly. The governance is catching up slowly. The risk sits with practices.

General Practice Access Recovery

NHSE’s updated Modern General Practice Access model brings new digital telephony reporting requirements, mandatory monthly access data submissions, and additional funding for cloud‑based telephony upgrades. (Source: NHSE Access Recovery Guidance (2026).

Pharmacy First continues to expand, easing some GP workload but increasing pressure on community pharmacy staffing. (Source: DHSC Pharmacy First Expansion Briefing (2026).

Whether this shift will genuinely rebalance demand remains to be seen.

Junior Doctors’ Settlement — A Short Reflection

After 16 rounds of industrial action, junior doctors have accepted a multiyear pay and reform package. The deal includes a backdated uplift, a further 6% + £1,000 this year, and a pay trajectory delivering a 35.2% increase by 2027, alongside commitments on training reform and rota standardisation. (Sources: DHSC Pay Deal Announcement (2024), BMA Junior Doctors Committee Summary (2024).

It is not full pay restoration — but it is a significant shift in tone and approach. Whether it marks the beginning of a more stable workforce relationship is a question only time will answer.

Final Thoughts

This month’s developments — the Covid Inquiry findings, list cleansing instability, accelerating digital transformation and the junior doctors’ settlement — all point to a moment of potential reset.

But potential is different from action.

The NHS has no shortage of reports, recommendations, and commitments. What it needs now is follow‑through: workforce stability, premises investment, financial protection and safe digital adoption working together, not in isolation.

The Inquiry has told us what went wrong. The question is whether we will finally act on it.

Any opinions stated here are those of the author and not of FPM or any affiliated company.