In 2010, the UK government launched the Demonstration Test Catchments (DTC) platform to evaluate the extent to which on-farm mitigation measures can cost-effectively reduce the impacts of agricultural water pollution on river ecology whilst maintaining food production capacity. In this paper, we compare the impacts on soil health of two types of conservation tillage (direct drill and shallow non-inversion) against conventional mouldboard ploughing after five years (2013–2018) of adoption within the River Wensum DTC. Across the 143 ha conservation tillage trial area, temporal changes in the physical, chemical and biological condition of the soils were examined through the analysis of 324 soil samples, whilst the impacts on soil water chemistry were assessed through the analysis of 1176 samples of subsurface field drainage. Riverine water pollution was also explored through high-resolution (30 min) hydrochemistry measurements generated by an automated, in-situ bankside monitoring station located 650 m downstream of the trial area. Results revealed that conservation tillage did not significantly alter the soil physical, chemical or biological condition relative to conventional ploughing during the first five years. In addition, conservation tillage did not reduce nutrient leaching losses into field drainage and did not significantly impact upon river water quality, despite the trial area covering 20% of the catchment. Economically, however, conservation tillage yielded net profit margins 13% higher than conventional ploughing after five years of practice due to a combination of operational efficiency savings and improved yields. Overall, the results of this study demonstrate that conservation tillage alone is ineffective at improving the short-term environmental sustainability of farming practices in this lowland intensive arable setting and indicates that a broader, integrated approach to conservation agriculture is required incorporating aspects of cover cropping, crop rotations and precision farming techniques. The improvements in farm business performance do, however, demonstrate land managers can make important financial gains by converting to a conservation tillage system.