Context:
In a system under immense strain, the case for rethinking how care is delivered — and funded — is no longer optional. In a powerful session at the NeoNavitas Sub-National Access Conference, Mani, Chief Transformation Officer at a large GP federation, challenged the audience to confront the deep inefficiencies and cultural inertia within healthcare delivery and commissioning. His message was direct: if we don’t change how we design care and funding around patients, the NHS cannot continue to function effectively.

1. Long Waiting Lists Are a Symptom of Systemic Failure

Across the UK, thousands of patients remain stuck on long NHS waiting lists. For Mani, this is not simply about hospital backlogs — it’s a signal that the system is still structured around vertical silos rather than integrated, end-to-end care pathways. Far too often, pathway specifications are either outdated or missing altogether, with local systems defaulting to “how it’s always been done.”

“We found entire services without any formal specification — just years of doing things the same way.”

Pharma can play a key role in helping NHS partners pause, assess, and redesign, rather than layering new solutions on top of broken processes.

2. Unlocking the Power of Primary Care

More than 90% of patient interactions occur in primary care, yet most system investment still flows into acute settings. Mani outlined a compelling model where enhanced primary care services, supported by rapid diagnostics and specialist input, are used to manage conditions early — keeping patients out of hospital.

In some of his federation’s redesigned pathways (e.g. dermatology, respiratory, diabetes), 95% of patients are managed in primary care, reducing unnecessary referrals and pressure on the acute sector.

This model relies on:

• Early access to diagnostics

• Rapid input from specialists

• Local, flexible decision-making

Pharma companies that tailor their offerings to support earlier, community-based intervention can create significant system value — but only if their approach reflects this new care architecture.

3. Horizontal Integration Beats Vertical Optimisation

Much of the system still works in isolation. Funding is fragmented, and providers focus on optimising their part of the pathway, rather than the whole. Mani made a compelling case for flipping this approach — focusing instead on horizontal pathway design that cuts across traditional organisational boundaries.

“Toyota created a horizontal team across General Motors to optimise flow — that’s what the NHS needs.”

ICBs, commissioners and providers need to work together — across general practice, social care, community services and hospitals — to redesign care around patient journeys, not institutional boundaries.

4. Follow the Flow of Funding

Pathway transformation cannot succeed unless funding mechanisms are aligned. Current financial flows often create the wrong incentives: hospital activity is rewarded, variation is unchecked, and many services are paid on outdated block or activity-based contracts.

“If we haven’t mapped the pathway, we can’t map the funding. And if we don’t fix the funding, we’ll keep wasting money we don’t have.”

The shift of specialised commissioning responsibilities from NHS England to ICBs presents an opportunity to start with the right principles — aligning funding to outcomes, not activity.

5. Industry Implications

Mani called on pharmaceutical companies to think bigger. Beyond selling products or solutions, he encouraged industry to become disruptive collaborators — organisations that challenge the status quo, support genuine service redesign, and contribute meaningfully to sustainable healthcare.

This means:

• Working with systems to co-develop new pathways, not just introduce new medicines

• Understanding local structures and funding flows before proposing solutions

• Embedding value propositions within real service pressures — capacity, inequality, variation, cost

• Supporting ICBs and PCNs to adopt new models with aligned funding and measurable outcomes

Conclusion: A Call for Transformative Partnership

Pathway redesign is no longer a theoretical exercise — it’s an operational necessity. For pharmaceutical companies, the opportunity is significant: by helping systems design smarter, earlier, and more joined-up care, they can demonstrate real-world value beyond the pill.

But that requires more than a good product. It demands local insight, flexible engagement models, and a commitment to shared success.

At NeoNavitas, we work alongside NHS systems and pharma partners to bridge this gap — helping industry play a meaningful role in reshaping how care is delivered and funded.

If you want to understand how your offering can enable better pathways and smarter funding flows, we’d welcome a conversation.