Bringing more healthcare closer to home through GP surgeries will be an essential element in protecting the NHS for the long-term. It will improve care for patients and should deliver value for money to tax payers.

In the eyes of the coalition government, community-based services tick a number of boxes. They match up with ‘big society’ principles like localisation and personal responsibility, and sit neatly with GP commissioning.

There is also the chance to step back from what was perceived as Labour's nanny state by using local care to encourage a shift in attitude towards self-management. This contrasts with an automatic reliance on hospital consultation and hospital treatments. Patients would inevitably want this change because of the increased choice and easier access to services. For hospital-phobes it could also mean they never have to go into a hospital again.

The main benefit however will be to address threats from the long-term illness time bomb. NHS figures claim that by 2050 the number of over 65s with two or more long term conditions will have risen by 252 per cent – making the current approach to treatment basically unsustainable. Half of people aged over 60 and one in three of the rest of the population have at least one of the typical long-term conditions like asthma, heart and lung disease.

A number of closer-to-home schemes have run or are still running. As part of its ‘Better healthcare closer to home’ scheme, Sutton council has enabled GPs to catch problems early by installing equipment in patients' homes to monitor blood pressure and other indicators. The reduction in hospital admissions from a six month pilot saved around £322,000. Community matrons are used in Swindon to help patients with long term conditions, giving advice and support on self-monitoring of blood pressure, weight and pulse, and to know when symptoms are a minor problem or something more serious.

But are these kinds of extended or additional services unaffordable in the current spending climate? The simple answer is no. But to be successful providing more care in local communities through GP surgeries cannot simply be about extra services and costs. Instead we need to see a much broader cultural and logistical shift to improve care and save cost by cutting out unnecessary steps in the pathway.

Independent providers have an important role to play. Infrastructure and investment can be used as a bridge to make closer to home services work in practice and not just as pilots, but as part of a major cost-saving, culture-changing transformation.

InHealth's diagnostics service in London provides an example. It gives GPs direct access to MRI scans, ultrasound and echocardiograms from over 70 sites, ranging from GP surgeries and health centres to supermarket car parks. Given the reduction in the number of hospital consultations needed, if this model was replicated across England just for MRI and ultrasound scans, the NHS could save an estimated £1bn each year.

In a further example, NHS Southampton City identified that patients were having regular appointments in acute settings for minor treatments such as ear dewaxing. Now ear, nose and throat and audiology services are being provided from three local health centres, including a one stop shop approach where the same appointment can be used for both routine diagnostics and treatment. Having the fresh eyes of an independent partner and a collaborative approach to pathway redesign has led to further cost-savings by changing unnecessary three-monthly check-ups, for treatments like dewaxing, to six-monthly.

Rather than being a luxury, localised services can be a stronger foundation for the future of the NHS. But creative thinking and new partnerships will be needed to make it possible.