For years, community services have been positioned as the solution to many of the NHS’s most persistent challenges. Shifting care closer to home promised to reduce pressure on hospitals, improve patient experience, and support prevention rather than crisis response. 

That strategic intent remains sound. What is increasingly in doubt is whether the system has created the capacity required to deliver it. 

The December NHS England Board papers contain a clear warning: demand for community services is now exceeding available capacity, and access pressures that once characterised acute care are beginning to emerge elsewhere. Unless this is addressed deliberately, the NHS risks recreating its access crisis, this time outside hospital walls. 

 

Pressure does not disappear — it moves

The logic of shifting care into the community is compelling. Earlier intervention, reduced admissions, and faster discharge all depend on strong community provision. Over the past decade, policy has consistently reinforced this direction of travel. 

What the data and operational reality now show, however, is that pressure has not been removed from the system. It has been displaced. 

As acute services struggle with flow and capacity, demand increasingly lands in community pathways: rehabilitation, diagnostics, community nursing, mental health, and long-term condition management. In many areas, this demand has grown faster than workforce supply, estate availability, or funding growth. 

The result is a familiar pattern emerging in a new setting: longer waits, constrained access, and growing variation between systems. 

 

The early signals are already visible 

The NHS has been here before. Access crises rarely announce themselves suddenly. They build gradually, through rising backlogs, extended waits, and normalisation of delay. 

The Board’s Operational Risk Register explicitly recognises the risk that demand for community services now exceeds capacity. The forthcoming introduction of an 18-week access standard for community services further reinforces that this is no longer a peripheral concern. Standards are introduced when pressure becomes visible, not before. 

In practice, many community services are already experiencing: 

• extended waiting times for assessment and treatment, 

• increased acuity among patients who wait longer, 

• and rising pressure on a workforce that is already stretched. 

These are not theoretical risks. They are the early indicators of an access problem taking shape. 

 

Why community pressure feels different — but isn’t

Community services differ from acute care in important ways. Care is often less episodic, pathways are longer, and outcomes are harder to measure. Demand is more diffuse, and capacity is less visible. 

These differences can mask pressure for longer. Waiting lists grow quietly. Patients cope, adjust, or deteriorate out of sight. The absence of a four-hour clock or emergency threshold can give a false sense of control. 

But the underlying dynamics are the same. When demand persistently exceeds capacity, access deteriorates. When access deteriorates, risk accumulates. And when risk accumulates unnoticed, the eventual correction is more disruptive. 

The danger is not that community services face pressure, they always have. It is that the system underestimates how quickly pressure can become crisis when visibility is low and thresholds are poorly defined. 

 

Workforce constraints are the limiting factor

As with much of the NHS, the most significant constraint on community capacity is workforce. 

Recruitment challenges, vacancy rates, and retention pressures are particularly acute in community roles. Unlike acute settings, community services often lack the scale or flexibility to absorb sustained demand growth. Sickness absence or turnover has an immediate impact on access. 

At the same time, the complexity of community caseloads is increasing. Patients discharged earlier from hospital arrive with higher acuity and greater support needs. This raises the intensity of work without necessarily increasing headcount. 

The risk is clear: a strategy that relies on community services to absorb pressure without materially strengthening their workforce is not sustainable. 

 

Variation is already emerging

As with elective and urgent care, community access is beginning to diverge between systems. 

Some areas have invested early in multidisciplinary teams, integrated pathways, and flexible capacity. Others struggle to maintain core services. The result is growing variation in waiting times, service availability, and patient experience. 

This matters not just for equity, but for system stability. Where community capacity is weak, discharge slows, hospital flow deteriorates, and emergency pressure increases. Where it is strong, the system has a chance to rebalance. 

Community access, therefore, is no longer a secondary concern. It is a critical determinant of whole-system performance. 

 

The risk of repeating old mistakes

The NHS’s experience with elective backlogs offers a cautionary lesson. 

For years, rising waits were tolerated as an unfortunate but manageable consequence of demand growth. By the time the scale of the problem was fully recognised, recovery required extraordinary intervention and sustained effort. 

Community services now sit at a similar inflection point. Pressure is visible, but not yet politically or operationally dominant. There is still time to act deliberately, but that window will not remain open indefinitely. 

Introducing access standards without matching capacity risks formalising failure rather than preventing it. 

 

A different kind of response is needed

Avoiding a community access crisis will require more than incremental adjustment. 

It means: 

• being honest about what community services are being asked to absorb, 

• aligning workforce, funding, and estate decisions with policy ambition, 

• and treating community capacity as foundational, not supplementary. 

Most importantly, it requires recognising that shifting care left does not reduce demand, it changes where and how it must be met. 

Without this realism, pressure will continue to migrate until it finds the next weakest point. 

 

A warning, not a prediction

The emergence of access pressure in community services is not inevitable. It is a warning. 

The NHS still has an opportunity to learn from its experience elsewhere in the system and intervene earlier. Doing so will require visibility, honesty, and investment, not after crisis has taken hold, but before. 

Community services were meant to relieve pressure, not inherit it. 

Whether they become the NHS’s next access crisis depends on the choices made now. 

 

References

1. NHS England – Integrated Performance Report, December 2025 
2. NHS England – Operational Risk Register (Q3) 
3. NHS England – Medium Term Planning Framework 
4. The King’s Fund – Community services and system capacity 
5. Nuffield Trust – Access, workforce and demand in community care