Primary Care in Medway: Demand, Access and the Local Market

Medway's primary care market sits at the intersection of rising health need, marked inequalities and a national shift toward more care being delivered outside hospital.

The opportunity is not simply that GP practices are busy.

Primary care in Medway already includes general practice, community pharmacy, dentistry, social prescribing, community health, mental-health pathways and a growing neighbourhood model intended to organise services around local populations rather than around individual institutions.

NHS Kent and Medway's current strategy is moving in the same direction. It wants stronger access to primary care, more multidisciplinary working, greater use of community pharmacy, better digital access and more care delivered through neighbourhood teams.

At the same time, Medway has health needs that are not evenly distributed.

Local public-health data shows poorer life expectancy than the England average, a roughly ten-year gap in life expectancy between the most and least deprived parts of Medway, high levels of overweight and obesity, substantial anxiety and a significant burden from cancer, cardiovascular and respiratory disease.

For a prospective healthcare provider, this creates genuine need.

But need is not the same as an accessible market.

A viable service still needs a clear patient pathway, a funding route, the right regulatory scope, a workforce and a reason for the wider health system to use it.

The stronger question is therefore not:

Does Medway need more healthcare?

It does.

The stronger question is:

Which pressure can a new service relieve, for which patients, through which pathway, and who will pay for it?

For adult social care and neighbourhood independence, see the companion Medway market reports.

Medway primary care at a glance

~293k

Estimated population, JSNA 2024

10 years

Life expectancy gap between most and least deprived areas

51

Community pharmacies, 2025 PNA

89.8%

Residents within a 20-minute walk of a pharmacy

43.4%

Peninsula residents within a 20-minute walk

2 in 3

Adults overweight or obese, 2024/25

Medway's health need is substantial and uneven

Medway's more recent JSNA material places its population at around 293,000 people.

The population is growing and ageing, but the most important primary-care signal is not population size alone.

It is the combination of long-term conditions, deprivation, preventable illness and unequal outcomes.

Medway's public-health summary reports that:

2 in 3

Adults overweight or obese, 2024/25

23.6%

Residents aged 16 and over reporting high anxiety, 2022/23

11%

Adults who smoked, 2024

2,677

Premature deaths, 2023 to 2025

Around 10 years

Life expectancy gap between the most and least deprived parts, for both men and women

Life expectancy in Medway was worse than the England average in 2022 to 2024.

Circulatory disease, cancer and respiratory disease are important contributors to that inequality.

These patterns matter commercially and clinically.

They increase demand for:

• prevention
• chronic-disease management
• medication support
• diagnostics
• mental-health support
• weight management
• cardiovascular risk reduction
• respiratory care
• smoking cessation
• community-based monitoring

But they also create a warning.

A service designed around Medway-wide averages can miss the fact that health need, access barriers and ability to pay vary significantly between communities.

Primary care is much wider than GP appointments

Primary care is often discussed as if it means general practice alone.

That is increasingly inaccurate.

A Medway resident's route through primary care can involve:

• a GP practice
• a nurse or advanced practitioner
• a clinical pharmacist
• a physiotherapist
• a social-prescribing link worker
• a community pharmacy
• NHS 111
• an urgent treatment service
• a dental service
• community health
• mental-health support
• voluntary-sector provision

NHS policy is deliberately trying to route people to the most appropriate professional rather than defaulting every need to a GP appointment.

For a new provider, that changes the market question.

The opportunity may be to add another service.

It may also be to take activity out of an overloaded part of the system and deliver it safely somewhere else.

General practice is under pressure for several reasons, not only GP numbers

NHS Kent and Medway commissioned an independent review of general practice and published the findings alongside a 24-month improvement plan.

The review concluded that pressure is not simply the result of GP shortages.

It reflects a combination of:

• increasing patient need
• growing clinical complexity
• workforce pressures
• rising demand
• problems elsewhere in the health and care system

The ICB also found that the pressure is not distributed evenly.

Some communities and practices face greater challenges than others.

The response includes stronger support for practices under pressure, better digital and telephone systems, workforce development, recruitment and retention, neighbourhood health and improved coordination between different parts of the NHS.

That is important for anyone assessing the local market.

A business proposition based simply on "GPs are busy" is too weak.

A stronger proposition identifies a particular pressure and demonstrates how the service reduces it.

Medway already operates through Primary Care Networks

Medway's general practices are organised through Primary Care Networks as part of the wider Kent and Medway system.

Local profiles include networks such as:

• Gillingham South
• Medway Central
• Medway Peninsula
• Medway Practice Alliance
• Medway Rainham
• Medway South
• Medway Valley
• Strood

The exact membership and structure can change, so a provider should verify the current configuration before approaching practices.

The important point is that many services are increasingly organised above the level of a single surgery.

A provider seeking referrals, partnership or NHS-funded activity may therefore need to understand:

• the relevant PCN
• the local neighbourhood
• existing enhanced services
• community providers
• current commissioning priorities

Approaching individual practices without understanding the wider pathway can result in a proposition that does not fit how local primary care is now being organised.

Neighbourhood health is becoming the operating model

One of the most important developments in 2026 is the move toward neighbourhood health.

NHS Kent and Medway says neighbourhood services will be planned around populations of roughly 30,000 to 50,000 people.

30,000

Roughly the smaller end

to

50,000

Roughly the larger end

The intention is to join up:

• general practice
• community nursing
• mental health
• social care
• voluntary and community support
• other local services.

In July 2026, NHS Kent and Medway announced that every GP practice across Kent and Medway had signed up to its Single Neighbourhood Health offer.

That commitment covers more than 170 practices across the whole ICB area and is backed by nearly £10 million of new annual investment.

170+

GP practices signed up across the ICB

Nearly £10m

New annual investment

Kent-and-Medway-wide, not Medway-only.

Those figures are Kent-and-Medway-wide, not Medway-only, but the direction applies locally.

Medway's Health and Wellbeing Board was also developing a local Neighbourhood Health Plan during 2026, with partners describing a shift away from an acute-hospital model toward more primary and community care.

For a provider, this is a material structural change.

The strongest future proposition may not be a stand-alone service asking practices to send it referrals.

It may be a service that can demonstrate how it fits a neighbourhood pathway.

The commercial question is increasingly pathway fit

A new primary-care or community-health provider should be able to explain:

• where the patient comes from
• why the existing pathway is insufficient
• what the provider does differently
• how information flows back to the wider system
• what happens if the patient deteriorates
• where the patient goes next
• how outcomes are measured
• who funds the activity.

This matters because the NHS is trying to reduce fragmentation.

A service that creates another disconnected endpoint can add complexity even when it provides good clinical care.

A service that removes a bottleneck, manages a defined cohort and connects cleanly into the local pathway can be more valuable.

Prevention is one of the clearest long-term demand areas

Medway's health profile creates a strong prevention case.

High levels of excess weight, smoking, cardiovascular risk and premature mortality point toward substantial preventable disease burden.

The new Kent and Medway five-year strategy is also explicitly shifting emphasis from reacting to illness toward preventing it.

For prospective providers, relevant models could include:

• cardiovascular risk detection
• hypertension management
• diabetes prevention and support
• weight-management services
• respiratory monitoring
• smoking cessation
• targeted screening
• medication optimisation.

But prevention needs a route to patients.

A service may be clinically sensible and still fail commercially if there is no commissioner, referral pathway or private-pay audience.

The provider needs to identify whether the model is:

• NHS commissioned
• subcontracted
• employer funded
• privately funded
• grant supported
• integrated into an existing pathway.

Population need alone does not answer that question.

Long-term conditions create recurring rather than one-off demand

Primary care demand is increasingly driven by people living with more than one long-term condition.

An ageing population strengthens that trend, but deprivation and lifestyle risk can bring complex illness earlier in life as well.

That creates opportunities for models based on continuity rather than episodic appointments.

Potential service areas include:

• structured long-term-condition reviews
• remote monitoring
• medicines optimisation
• rehabilitation
• frailty management
• proactive case finding
• multidisciplinary care planning.

The local neighbourhood model makes this particularly relevant.

If the health system is trying to identify higher-risk patients earlier and coordinate their care, providers able to work with data, clinical teams and clear escalation pathways may have a stronger proposition than services based only on one-off consultations.

Mental health is part of the primary-care pressure

Medway's health-and-wellbeing data shows significant anxiety.

Mental-health demand also interacts with physical health, employment, housing, substance use, long-term conditions and social isolation.

Primary care often becomes the first place where those pressures surface.

This does not automatically mean there is a straightforward private market for another counselling or diagnostic service.

A provider needs to understand:

• what is already available
• NHS referral criteria
• waiting-list pressures
• the role of community mental-health services
• Right to Choose pathways where relevant
• local voluntary-sector provision
• how risk is managed.

The wider market trend is toward more mental-health support being connected to community and neighbourhood services rather than operating in isolation.

Social prescribing shows how non-medical support is already embedded

Most GP practices in Medway have access to an adult social-prescribing link worker.

Local PCNs work with services including voluntary and community organisations, carers' support and wider wellbeing provision.

This is important because a proportion of demand reaching general practice is not primarily medical.

People may need support with:

• loneliness
• housing
• debt
• employment
• caring responsibilities
• community connection
• lifestyle change.

A new provider should therefore avoid assuming that every unmet need requires another clinical appointment.

Sometimes the stronger solution is navigation or integration with existing community resources.

For commercial providers, this can also clarify where the opportunity is not.

If a need is already effectively managed through funded social-prescribing infrastructure, a duplicate private offer may have a weak market case.

Community pharmacy is an important part of Medway's capacity

Medway's 2025 Pharmaceutical Needs Assessment recorded 51 community pharmacies, including one distance-selling pharmacy.

That equated to 17.9 pharmacies per 100,000 population, slightly below the England figure of 18.1 cited in the assessment.

1. Medway17.9
2. England18.1

1719

Medway Pharmaceutical Needs Assessment 2025.

The number had fallen from 53 at the previous assessment.

1. Previous assessment53
2. 2025 PNA51

5055

The PNA formally concluded that there was no current gap in pharmaceutical services.

That headline needs interpretation.

The Health and Wellbeing Board and scrutiny discussions also highlighted fragility in the market, inconsistent access and concern around pharmacy viability.

The Board was told in 2025 that 47% of pharmacies were not profitable.

• 47%Pharmacies described as not profitable

That does not mean 47% were about to close.

It does show why nominal provision and sustainable provision are not identical.

Pharmacy access varies significantly by locality and time

The PNA found that community pharmacies are concentrated more heavily in areas of greater population density.

Walking access was particularly uneven.

Across Medway overall, approximately 89.8% of the population could access a community pharmacy within a 20-minute walk and 94.1% within 30 minutes.

But the Peninsula was markedly less well served on that measure.

Only 43.4% of the Peninsula population was estimated to be within a 20-minute walk and 56.7% within 30 minutes.

1. Medway, 20 minutes

   89.8%

2. Peninsula, 20 minutes

   43.4%

3. Medway, 30 minutes

   94.1%

4. Peninsula, 30 minutes

   56.7%

Medway Pharmaceutical Needs Assessment 2025.

Opening hours also matter.

The PNA recorded:

• 37%Open beyond 6pm on weekdays
• 80%Open on Saturdays
• 20%Open on Sundays

There were six pharmacies operating 72 hours or more each week, with none in Chatham or the Peninsula.

These are useful examples of why "there is a pharmacy" and "people can conveniently access pharmacy care" are not always the same statement.

Pharmacy First changes the role of pharmacy in primary care

Community pharmacy is increasingly a clinical service rather than only a dispensing network.

Pharmacy First allows pharmacists to assess and treat a defined group of common conditions without the patient first needing a GP appointment.

Medway's 2025 PNA found strong sign-up to Pharmacy First in a number of localities.

This matters strategically.

When more low-acuity clinical activity moves into pharmacy, GP capacity can be protected for patients who need broader assessment or ongoing management.

For a healthcare business, the implication is that some traditional "minor illness" demand may increasingly be absorbed by community pharmacy.

At the same time, pharmacy-led models can become part of the opportunity where the business is appropriately commissioned and clinically governed.

A new pharmacy is not automatically justified by the headline demand

The PNA's formal conclusion was that Medway did not have a current overall gap in necessary pharmaceutical provision.

That makes a simplistic "population growth means another pharmacy" case weak.

The more nuanced picture concerns:

• locality
• opening hours
• service mix
• financial sustainability
• population growth
• access for people without cars
• clinical-service provision.

The Peninsula illustrates this tension particularly well.

Residents and councillors have raised concerns about provision, while the formal assessment still concluded that the population-level test for a current gap had not been met.

A pharmacy proposal therefore needs to be grounded in the regulatory and commissioning framework for pharmaceutical services rather than in general primary-care demand alone.

Dentistry remains a separate access market

Dental care is part of primary care but behaves differently from general practice.

Medway maintains an oral-health strategy focused on reducing inequalities, particularly for young children and vulnerable adults.

Local services include emergency provision through DentaLine, while Medway also promotes targeted support for groups such as people experiencing homelessness and people with SEND.

For a prospective dental provider, the market question needs to distinguish:

• unmet oral-health need
• NHS-funded dental demand
• private-pay demand
• urgent access
• specialist need.

Those are not interchangeable.

A population can have substantial unmet oral-health need without a new provider automatically being able to obtain an NHS contract.

The private dental market, meanwhile, depends on affordability, competition and willingness to pay.

Digital access is becoming standard, but exclusion still matters

NHS Kent and Medway's primary-care strategy treats digital access as a fundamental part of modern general practice.

Online consultation, the NHS App, remote communication and improved telephone systems are intended to make access more flexible and help practices manage demand.

That creates opportunities for:

• remote triage
• digital monitoring
• online consultation
• asynchronous review
• digitally supported prevention.

But the ICB is also explicit that digital exclusion must not become a barrier.

This is particularly important in a place with significant health inequality.

A provider that moves activity online can improve convenience for some patients while making access harder for others.

A credible model should therefore consider:

• digital literacy
• language
• disability
• device access
• data access
• age
• alternative face-to-face routes.

Digital-first should not mean digital-only.

Primary-care estates are being planned around neighbourhood need

NHS Kent and Medway's current estates approach also affects market entry.

The ICB says proposals for GP buildings are considered in the context of wider neighbourhood health rather than as stand-alone practice projects.

Investment decisions consider population need, deprivation, growth, existing buildings, value for money and deliverability.

New GP-only buildings will not automatically be supported where existing estate can be improved or where a neighbourhood-health solution is more appropriate.

For a new provider, property should therefore follow the pathway.

A business should not assume that securing clinical premises creates a commissioning case.

Workforce is a system-wide constraint

The ICB's general-practice strategy explicitly identifies workforce sustainability as a priority.

The challenge is wider than GP recruitment.

Modern primary care depends on:

• GPs
• nurses
• pharmacists
• paramedics
• physiotherapists
• mental-health practitioners
• healthcare assistants
• care coordinators
• social-prescribing staff
• administrative and digital support.

A new provider competes for many of the same people.

That can become a major constraint on expansion.

A credible workforce model should consider:

• local recruitment supply
• salary expectations
• supervision
• professional registration
• clinical governance
• training
• retention
• sickness and leave
• use of locums or agency staff.

A service that addresses patient demand by worsening an existing workforce shortage somewhere else in the system may not be sustainable.

Private providers need to distinguish NHS opportunity from private demand

Medway's health needs do not automatically create a private-pay market.

This is particularly important for primary care.

Some services can attract private customers because people value speed, convenience or services not readily accessible through the NHS.

Others depend almost entirely on NHS commissioning.

A business case should identify whether revenue is expected from:

• an NHS contract
• subcontracting
• PCN or neighbourhood arrangements
• employer-funded care
• insurance
• direct private payment
• mixed funding.

The acquisition route changes with the payer.

A provider selling privately needs a customer-acquisition model.

A provider seeking NHS work needs a commissioning and pathway strategy.

They are different businesses even when the clinical service appears similar.

CQC registration depends on the actual healthcare activity

Healthcare providers should not assume that registering a company or opening a clinic is equivalent to becoming CQC regulated.

Registration depends on which regulated activities are carried on.

Depending on the service, relevant activities can include:

• Treatment of disease, disorder or injury
• Diagnostic and screening procedures
• Surgical procedures
• Transport services, triage and medical advice provided remotely
• other regulated activities.

CQC updated its provider-registration guidance during 2026 and expects applicants to be ready to provide the service when they apply.

The correct scope should therefore be established from the clinical model, not from the business name.

Online primary care now carries additional registration evidence

CQC changed its supporting-document requirements in June 2026 for online primary-care services.

That matters because digital healthcare can appear operationally simpler than premises-based care.

Regulatory expectations still apply.

A provider may need to demonstrate:

• clinical governance
• safeguarding
• medicines management
• consent
• recruitment
• quality assurance
• appropriate additional evidence for the service type.

A digital front end does not reduce the need for a robust clinical operating model.

What does the Medway evidence suggest?

Medway has substantial underlying primary-care demand.

But the best opportunities are unlikely to come from simply adding another undifferentiated front door.

The stronger market signals concern services that improve how patients move through the system.

1. 01

   Prevention and long-term-condition management

   Medway's health inequalities and burden of preventable disease create a strong clinical case. The funding and referral route still needs to be identified.

2. 02

   Neighbourhood and multidisciplinary services

   This is one of the clearest strategic directions in 2026. Providers that fit into GP-led neighbourhood working may be better aligned with the future system than stand-alone services.

3. 03

   Community pharmacy

   Pharmacy is being used to absorb more clinical activity, but Medway's formal PNA does not identify a general shortage of pharmacy provision. Locality, service mix and sustainability matter more than the headline count.

4. 04

   Mental health

   There is clear need, but providers need to understand existing NHS, community and Right to Choose pathways rather than assuming waiting lists automatically create an accessible market.

5. 05

   Dentistry

   Oral-health inequalities and urgent need are relevant, but NHS contract access and private-pay demand need to be assessed separately.

6. 06

   Digital primary care

   Digital access is strategically important, but models need to account for clinical integration, regulation and digital exclusion.

7. 07

   Specialist community healthcare

   Services that keep people out of hospital, manage complex long-term conditions or provide diagnostics and treatment closer to home are aligned with the wider neighbourhood direction, provided they integrate safely into the pathway.

Questions to answer before starting a primary-care service in Medway

A prospective provider should be able to answer:

Those questions should be answered before significant investment is committed.