X-NHS: Days of Future Plans
Professor X has a vision. Magneto wants control. Wolverine is exhausted. And the NHS is about to face another battle for its future.
By Dr Gandalf | eGPlearning
If you’ve ever watched the X-Men films or read the comics, you’ll know that the biggest threat to mutantkind isn’t always the giant robots trying to destroy them.
Sometimes it’s the disagreement between those who are supposed to be protecting them.
Professor Charles Xavier believes in a world where mutants can thrive, work together and use their extraordinary abilities for the greater good.
Magneto also wants mutants to survive. But his philosophy is somewhat different. He believes survival requires power, control and occasionally rearranging the entire world to suit his vision.
Both believe they’re protecting their people.
They just disagree rather spectacularly about how to do it.
Welcome to the NHS.
Because if we were casting the NHS as the X-Men, I think Professor Xavier would be the British Medical Association (BMA), Magneto would be NHS England, and the remaining mutants would be the hundreds of thousands of healthcare professionals trying to keep the system functioning.
And yes, that would make general practice Wolverine.
I’ll explain why.
Professor X: The BMA and the dream of a better future
The BMA represents doctors and medical students. It negotiates, campaigns, challenges policy decisions and advocates for the profession.
Much like Professor Xavier, its central argument is that extraordinary individuals should be allowed to use their abilities in an environment where they are supported, protected and valued.
In the NHS, this means adequate staffing, safe working conditions, fair contracts, professional autonomy and enough time to deliver appropriate patient care.
The BMA doesn’t always get everything right. Nor does it represent every professional working in the NHS.
But its argument around general practice is increasingly difficult to ignore.
How can you ask GPs to see more patients, manage increasing complexity, supervise additional staff, absorb work from hospitals, implement new contracts and maintain continuity when the underlying capacity is already insufficient?
Professor X might call this protecting mutantkind.
The BMA calls it protecting the profession and, ultimately, the patients who rely on it.
Magneto: NHS England and the power of central control
Now enter Magneto.
NHS England oversees much of the machinery responsible for planning, directing and monitoring NHS performance in England, working with local commissioners and providers.
It isn’t simply an organisation that tells everyone what to do. It has to manage competing demands, finite funding, national priorities and expectations from government.
But from the frontline, it can sometimes feel like Magneto manipulating the entire landscape from a distance.
Need to improve access? Introduce new requirements.
Need to reduce hospital admissions? Develop new service models.
Need to shift care into the community? Create new neighbourhood arrangements.
Need to improve accountability? Introduce new reporting frameworks.
The objectives are often reasonable. The problem is what happens when the people responsible for delivering them already have their hands full.
And now the storyline gets particularly interesting.
NHS England itself is scheduled to be abolished, with its functions transferred into the Department of Health and Social Care, subject to legislation, around March 2027.
That’s right.
Even Magneto is facing a restructuring.
Although, as anyone who understands NHS reorganisations will appreciate, removing an organisation doesn’t necessarily remove its responsibilities, instructions or reporting requirements.
Sometimes you simply get a different helmet.
Cyclops: GP partners and the burden of leadership
Cyclops is one of the most underrated X-Men.
He’s rarely the most popular. His powers aren’t the flashiest. But he’s often the person responsible for getting everyone organised, managing the team’s competing personalities and deciding how they survive the next encounter.
Which sounds remarkably like being a GP partner.
GP partners aren’t just clinicians.
They’re employers, business owners, financial managers, supervisors, educators, operational leaders and the people who ultimately carry responsibility for keeping their practices functioning.
They’re managing a team that may include GPs, nurses, pharmacists, physician associates, healthcare assistants, administrative staff and additional multidisciplinary roles.
They’re also trying to balance clinical safety, access, continuity and a practice budget that rarely feels as ambitious as the national policy announcements.
Cyclops can fire incredibly powerful optic blasts.
Unfortunately, that doesn’t help when the payroll needs signing, the duty GP is off sick and somebody has just announced a new contractual requirement.
And the number of people willing to take on this role is falling.
According to the BMA’s September 2026 analysis, England lost 336 full-time-equivalent GP partners between August 2025 and August 2026.
That’s not just a workforce problem.
It’s a leadership succession problem.
Who leads the next generation of X-Men when fewer people want to become Cyclops?
Wolverine: General practice and the myth of infinite resilience
Wolverine is famous for three things.
His adamantium claws.
His questionable bedside manner.
And his remarkable ability to recover from almost anything.
Sound familiar?
General practice has been demonstrating its own healing factor for years.
COVID? Adapt.
Increasing demand? Adapt.
Growing complexity? Adapt.
More hospital work transferred into primary care? Adapt.
New access requirements, digital systems, population health management and multiple forms of contractual change?
Adapt.
Every time general practice appears close to breaking point, it somehow gets up again.
But this resilience has become part of the problem.
Because policymakers can start treating recovery as proof that there was spare capacity all along.
There wasn’t.
The BMA’s 2026 workforce analysis highlights an uncomfortable contradiction: patients struggle to obtain appointments while qualified GPs struggle to find suitable employment.
A 2025 BMA survey found that 56% of responding GPs wanted more NHS working hours, while 15% couldn’t find suitable GP work at all.
We have patients who need doctors.
We have doctors who want to work.
And practices that cannot always afford to employ them.
Even Magneto would struggle to make those opposing forces fit together – even when Magneto tried to rip out the adamantium from Wolverine.
Wolverine might be able to regenerate after taking a beating – even continuing after having his adamantium ripped from him.
But general practice doesn’t have an infinite healing factor.
And we need to stop planning the future of the NHS as though it does.
Rogue: The NHS’s greatest work-transfer machine
Of all the X-Men, Rogue might be the most accurate representation of modern general practice.
Her ability is to absorb the powers of others.
Unfortunately, absorbing those powers comes with consequences.
Consider the everyday experience of a GP practice.
A patient is discharged from hospital with a request for the GP to arrange follow-up blood tests.
A specialist inappropriately recommends that the GP initiates or monitors medication outside an agreed shared-care arrangement.
A referral is rejected with advice to undertake further investigations…again.
A hospital appointment is delayed, so the patient returns to their GP for symptom management, reassurance and another attempt to navigate the system, sometimes being told to specify their symptoms are urgent as then they can be pushed forward.
Individual requests may be entirely reasonable.
Collectively, they represent an enormous amount of activity.
And if everything is pushed forward as urgent, then nothing is urgent.
And too often, the work transfer comes without the corresponding funding, staffing or agreement about responsibility.
Rogue can absorb someone else’s powers.
But absorbing powers doesn’t automatically mean having the capacity to use them safely.
This is where the BMA’s longstanding concerns about unfunded workload transfer become particularly relevant.
It isn’t about refusing to help patients.
It’s about recognising that work doesn’t disappear when it moves between organisations.
It simply lands somewhere else.
And increasingly, that somewhere is general practice.
Cerebro: The promise of NHS technology
Professor Xavier uses Cerebro to identify and locate mutants across the world.
Imagine what something similar could achieve in healthcare.
We already have enormous volumes of clinical information, patient records, population health data and increasingly sophisticated digital tools.
Used appropriately, these could help identify patients at risk, improve preventative care, reduce unnecessary administration and support better co-ordination between organisations.
This is one of the most exciting parts of the NHS’s future.
And it aligns with the government’s Ten Year Health Plan, which followed Lord Darzi’s 2024 investigation and was published in July 2025.
The plan proposes three major shifts:
- Hospital to community.
- Analogue to digital.
- Sickness to prevention.
All sensible ambitions.
The Medium Term Planning Framework for 2026/27 to 2028/29 then attempts to turn those ambitions into delivery priorities.
But Cerebro doesn’t work particularly well if everybody’s information sits in a different system, data quality is poor, interoperability is limited, and the people expected to act on the information don’t have time.
Technology can help us understand the problem.
It doesn’t automatically provide the workforce to solve it.
AI might identify 500 patients who need intervention.
Who is going to review them?
Who contacts them?
Who provides the appointments?
And whose clinical responsibility is it when an algorithm gets something wrong?
Who is the face and the voice the patient interacts with when they feel the weight of their health concerns?
Cerebro is an extraordinary tool.
But Professor Xavier still needs the X-Men to act on what it finds.
The new X-teams: PCNs, SNPs and MNPs
In the X-Men universe, there isn’t just one team.
There are the original X-Men, X-Force, New Mutants and various other groups created to address different threats and challenges.
The NHS is increasingly adopting a similar approach.
We already have GP practices working together in Primary Care Networks (PCNs), generally covering populations of 30,000–50,000 people.
These arrangements have helped practices collaborate and employ additional professionals, although experiences vary considerably.
Now the NHS wants to develop neighbourhood health services further.
The proposals include Single Neighbourhood Providers (SNPs), bringing services together around a defined local population, and Multi-Neighbourhood Providers (MNPs), supporting co-ordination and consistent delivery across multiple neighbourhoods.
The ambition is attractive.
Imagine community nurses, GPs, pharmacists, mental health professionals, hospital specialists and social care teams working together around patients rather than organisational boundaries.
Fewer duplicated assessments.
Better co-ordination.
Earlier interventions.
Improved continuity for vulnerable patients.
That’s an X-team worth assembling.
But here’s the catch.
In September 2026, the government confirmed that the proposed SNP and MNP arrangements were not based on a requirement for new national funding. The intention is to use existing resources more effectively.
Now, I’m supportive of better integration.
I’ve worked in PCN leadership. I’ve seen the benefits of professionals collaborating and the frustrations created by organisational boundaries.
But collaboration takes time.
It needs management, estates, digital infrastructure, clinical leadership and capacity.
Simply placing several overstretched teams under a new organisational banner doesn’t create extra appointments or additional workforce.
You cannot assemble the X-Men, give them a new team name, and assume they’re ready to save the world without providing the necessary resources.
Especially when half the team is already fighting elsewhere.
And when additional neighbourhood activity is funded by diverting resources rather than increasing overall capacity, we need to be clear about what stops, what changes and who becomes responsible.
Otherwise neighbourhood reform risks becoming another method of transferring activity into primary care under a more appealing name, and without the resources to keep the patients safe.
Mystique: The NHS structure that keeps changing shape
Mystique can transform herself into almost anyone.
A useful ability when trying to understand NHS structures.
Over recent decades, we’ve had Primary Care Trusts, Clinical Commissioning Groups, Integrated Care Boards and multiple accompanying reforms.
Now NHS England is approaching its planned abolition, neighbourhood contracts are being developed, and there is a change in political leadership.
Wes Streeting’s reform agenda has been inherited by Prime Minister Andy Burnham and Health Secretary Yvette Cooper.
With Burnham emphasising devolution, it will be interesting to see how much genuine decision-making freedom reaches local health systems rather than simply moving responsibilities between national bodies.
For clinicians, the problem isn’t necessarily the existence of reform.
Sometimes structures genuinely need to change.
It’s the uncertainty.
Should a practice invest in a particular delivery model?
Will PCNs continue in their current form?
Who will hold an SNP or MNP contract?
What happens to existing funding, staff and governance arrangements?
How much authority will ICBs actually retain?
And will the new structure solve problems for patients or simply introduce another layer of administration?
Mystique can change her appearance in seconds.
Unfortunately, NHS organisations tend to take considerably longer, often requiring consultation documents, governance meetings and numerous PowerPoint presentations.
Meanwhile, the patients are still waiting.
The Sentinels: Winter is coming
In X-Men lore, the Sentinels are enormous machines that keep pursuing mutants, adapting to their abilities and becoming increasingly difficult to defeat.
The NHS has its own recurring threats.
Winter pressures.
Rising demand.
Staff sickness.
Delayed discharges.
Hospital crowding.
A burnt-out workforce with pay erosion and poor morale.
Supply shortages.
Insufficient community capacity.
And the relentless accumulation of administrative work.
Unlike the movies, we know they’re coming.
Every single year.
And every single year, we appear surprised.
The biggest irony is that just as the NHS begins preparing for another winter, it is also being asked to deliver substantial organisational reform.
New plans, contracts, teams, reporting systems and expectations.
Some of that reform might genuinely reduce future demand.
But delivering change itself requires capacity.
If Wolverine, Cyclops, Rogue and Storm are already fighting the Sentinels, who has time to attend another neighbourhood transformation workshop?
Apocalypse: The ultimate threat to the NHS
And then there is Apocalypse.
An ancient mutant who looks at the existing world, decides it is beyond repair and believes the only solution is to tear it down and rebuild it.
Sound familiar?
The NHS has experienced successive waves of structural reform, each promising to deliver the transformation that previous arrangements apparently could not.
But the real Apocalypse isn’t a politician, an NHS executive or even another reorganisation.
It’s the growing gap between what the NHS is expected to deliver and the resources available to deliver it.
The Four Horsemen are already gathering: financial pressure, growing patient demand, workforce instability and ever-increasing central requirements.
And unlike the films, there is no single heroic battle that makes these problems disappear.
We can redesign organisations, create neighbourhood contracts and announce new plans. Some of those changes may genuinely help.
But unless we address the underlying pressures, Apocalypse doesn’t need to defeat the X-Men.
He simply needs to let them exhaust themselves.
Days of Future Plans: What happens next?
In X-Men: Days of Future Past, the characters try to change events before the future becomes catastrophic.
The NHS is attempting something similar.
Darzi identified the scale of the challenge.
The Ten Year Health Plan proposed a new direction.
The Medium Term Planning Framework laid out the next phase.
And neighbourhood reforms are intended to bring services closer to patients.
There is a plausible, potentially positive future here.
One where general practice is properly supported, community care has the resources to deliver, hospitals and primary care share responsibility appropriately, and technology reduces work instead of generating more of it.
But that future depends on recognising the difference between reforming a structure and increasing its ability to deliver.
The BMA and NHS England haven’t always agreed on how best to achieve change.
Nor should we expect them to.
Professional representation and system leadership have different responsibilities.
But both ultimately operate within a health service that exists to support patients.
And patients don’t particularly care whether the team helping them is called a PCN, an SNP, an MNP or the X-Men.
They want to get the care they need, from the right professional, at the right time.
They want continuity.
They want confidence that somebody is taking responsibility.
And they don’t want to be bounced between teams because the organisational boundaries are more important than their needs.
Professor X has a vision.
Magneto has a plan.
Cyclops has a practice to run.
Rogue has absorbed another four responsibilities.
Cerebro has identified another 500 patients who need intervention.
The Sentinels are approaching for winter.
And Wolverine?
He’s been on duty all morning, hasn’t had lunch, has 42 blood results to review, six discharge letters, three safeguarding tasks and two additional meetings about neighbourhood transformation.
His next patient is already waiting.
And perhaps that is part of the lesson here: sometimes a team can make sensible decisions, work hard, and still find itself overwhelmed by the scale of the challenge.
“It is possible to commit no mistakes and still lose”
The NHS doesn’t need another superhero.
It needs to stop assuming the ones it already has are indestructible.
Dr Gandalf | eGPlearning
Helping primary care understand the policies, technology and changes shaping general practice.
“I’m looking for hope.”
— Professor Charles Xavier, X-Men (2000)
In memory of Sir Patrick Stewart (1940–2026).
I grew up watching him as Captain Jean-Luc Picard and matured watching him as Professor Charles Xavier.
Two iconic characters.
Two very different universes.
Yet both shared something that feels increasingly rare today: leadership built on wisdom, compassion, integrity and the belief that understanding is more powerful than conflict.
As Picard, he taught us that leadership isn’t simply about authority, but about doing what is right, even when it’s difficult.
As Professor X, he showed us a leader who believed in dialogue rather than destruction, understanding rather than division, and hope even when the odds seemed impossible.
His passing makes publishing this X-Men-inspired reflection on the NHS feel particularly poignant.
Because right now, the NHS could do with a little more Professor X. And perhaps a few fewer battles between people who ultimately want the same thing.
Thank you, Sir Patrick. For the stories, the inspiration and the reminder that even in the darkest times, hope is worth fighting for.
Engage.
References
- Department of Health and Social Care. 10 Year Health Plan for England: fit for the future. GOV.UK. Published 3 July 2025.
https://www.gov.uk/government/publications/10-year-health-plan-for-england-fit-for-the-future - NHS England. Medium Term Planning Framework: delivering change together, 2026/27 to 2028/29.
https://www.england.nhs.uk/long-read/medium-term-planning-framework-delivering-change-together-2026-27-to-2028-29/ - NHS England. A consultation on proposed MNP and SNP contracting models: high-level summary.
https://www.england.nhs.uk/long-read/a-consultation-on-proposed-mnp-and-snp-contracting-models-high-level-summary/ - UK Parliament. Written Question HL2265: Single Neighbourhood Provider and Multi-Neighbourhood Provider contracts. Answered 4 September 2026.
https://questions-statements.parliament.uk/written-questions/detail/2026-07-17/HL2265 - BMA. Pressures in general practice.
https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice - Captain Jean-Luc Picard, Star Trek: The Next Generation, Season 2, Episode 21, “Peak Performance” (1989). Portrayed by Sir Patrick Stewart.