The government's goal of moving care out of hospitals and into community health centers is under threat as community services are under too much pressure, the health and care regulator says.
In its annual report, the Care Quality Commission said waiting times were too long and staff in areas such as mental health, GP and social care were too overstretched.
The regulator said there was a real risk that patients would suffer as these services were unable to cope with the additional demands.
But the government said the investment was made to solve the problem.
The NHS 10-year plan, published in July, sets out a vision for a district health service by creating clinics that combine different elements of GP care and hospital services with wider community support.
Such a system is seen as a crucial way to cope with an aging population and the rise in chronic diseases such as heart disease, diabetes and dementia.
The CQC used its own inspection reports and published data to compile its annual analysis.
It raised a number of concerns about the current state of public services, including:
- Long waits for mental health: A third of adult patients report a delay of three months or more between first assessment and treatment, plus signs that waits are even worse in children.
- Persistent problems accessing GP services: only half of patients can be easily reached by telephone.
- There has been a sharp reduction in the number of community nurses – 50% fewer per person over 65 than 14 years ago.
- Struggling to receive government-funded social care: The proportion of older people receiving help from councils has fallen to 3.6%, from more than 8% 20 years ago.
CQC interim chief executive Dr Arun Chopra said: “The 10-year plan is a real chance to improve care by putting people's needs first. But for the plan to succeed, public health and care services need more support.”
“Without this, there is a risk that fewer people will be able to access good health care, with vulnerable groups hit hardest.”
He said those most at risk were older people, people with dementia, learning difficulties and complex mental health needs, as he called for more investment in services outside hospital.
The report also includes patient stories. In one, Arjun outlined his experience of trying to get support for depression and anxiety.
He was reluctant to take medication and it took him six months to convince his doctor to refer him to talk therapy. He then had to wait another nine months for treatment.
His mental health deteriorated and he began to have suicidal thoughts.
There were also warnings about inpatient care, with the CQC saying there were ongoing concerns about staffing levels, particularly in maternity hospitals.
But it says there are also excellent examples of good practice and innovation.
He described a scheme in Haringey, north London, where GPs, community services, hospital staff and social workers came together to identify and support local people with complex conditions.
By providing additional one-on-one support, the number of emergency room visits and hospital admissions in this group was reduced by 30%.
A Department of Health and Social Care spokeswoman said: “This report exposes the scale of the problem we inherited after years of neglect and underfunding.”
But she said the government was getting the NHS “back on its feet again”, starting with additional investment to help recruit more staff in key areas such as GP services and mental health.
“We know there is more to be done – we are working to fundamentally reform services as part of our 10-year plan to create a future-fit NHS,” she added.
But Dr Hugh Alderwick of the Health Foundation said the CQC was right to raise concerns.
“More than a year after the new Labor government came to power, health and care services continue to be under enormous pressure.”
He said the think tank's own analysis showed the government was still far from having a coherent policy program to deliver on its promises.
“A more specific plan is now needed, including to quickly test and evaluate innovations that could improve local services.”
