2025/26 NHS priorities and operational planning guidance: what you need to know

Overview: national priorities for 2025/26

18 headline targets

Planning assumptions and funding

Systems must develop plans that are affordable within the allocations set, exhausting all the opportunities to improve productivity. To do so, providers will need to reduce their cost base by at least 1 per cent and achieve 4 per cent overall improvement in productivity, before taking account of any new local pressures or dealing with non-recurrent savings from 2024/25.

NHS England has issued updated revenue allocations for 2024/25. Service Development Funding (SDF) is rolled into core allocations. The contract default between integrated care boards (ICBs) and providers for most planned elective care will continue to pay unit prices for activity delivered in line with funded levels.

The revenue finance and contracting guidance ties capital payments to compliance with financial plans.

• Systems requiring deficit revenue about their ‘fair share’ will have 15 per cent of the difference between their plan limit and fair share funding deduced from their core capital allocations.
• Systems requiring deficit revenue below their fair share limit will receive their core capital allocation with no changes.
• Systems breaking even will receive a capital bonus worth 30 per cent of their fair share support funding.

Alongside the planning guidance, NHS England is consulting on a one-year NHS Payment Scheme which maintains the existing approach of Aligned Payment and Incentives (API), block contracts for Low Value Activity, payment by activity for electives (although with capped ERF) and the option for locally agreed schemes. The Payment Scheme is updated to reflect elective priorities, including with a stronger focus on activity that directly ends a patient’s wait for their care. It also encourages systems to pilot new payment mechanisms to help deliver priorities.

Reduce the time people wait for elective care 

The planning guidance builds on the recent Elective Reform Plan, published 6 January 2025. Over 6 million people are currently on a waiting list, waiting for over 7.5 million episodes of care, although the NHS in England is delivering more elective care than ever before and two-year waits have been all but eradicated and 18-month waits have been reduced by 96 per cent.

Trusts will need to make a minimum five percentage improvement in waiting times by March 2026, with the overall aim that 65 per cent of patients will be waiting less than 18 weeks for elective treatment. This progress will work towards the 92 per cent target being met in 2029.

Systems are also expected to improve performance against the cancer 62-day and 28-day Faster Diagnosis Standard (FDS) to 75 per cent and 80 per cent respectively by March 2026, an increase of 5 per cent and 3 per cent respectively. The contract default between ICBs and providers for most planned elective care will continue to pay unit prices in line with funded levels.  Systems are required to:

• Optimise referral management, including through the use of high-quality specialist advice and guidance, triage, patient-initiated follow-up (PIFU) and straight-to-test pathway approaches.
• Maximise digital tools to validate patients on a RTT waiting list after 12 weeks and every subsequent 12 weeks in line with good practice.
• Minimise unwarranted diagnostic referrals. 
• Implement Getting it Right First Time’s Further Faster methodology to drive optimisation of outpatient clinical processes with the aim of reducing 52-week waits.
• Improve patient experience and reduce inequalities of care for patients receiving elective care. A new NHS Quality Strategy (development announced in December 2024) will specify how the NHS should work with patients, carers and communities to improve experience.  This will align closely with the ten-year health plan.
• Improve performance against the cancer waiting time standards by maximising care for low-risk patients in non-cancer settings and improving productivity in cancer pathways.

Improve A&E waiting times and ambulance response times

NHS England will work with systems to improve urgent and emergency care (UEC) performance, including by expanding neighbourhood health services. In 2025/2026 systems must apply learning from best performing systems in four key areas:

1.Reducing avoidable ambulance dispatches and conveyances and reducing handover delays by:

• working towards delivering hospital handovers within 15 minutes, with joint working arrangements that ensure no handover takes longer than 45 minutes
• improving access to urgent care services at home, or in the community through virtual ward or urgent community response (UCR) services
• improving ‘hear and treat’ rates, increasing the proportion of category 2 calls and ensuring all category 3 and 4 calls are clinically navigated, validated and triaged. 

2. Improving and standardising urgent care at the front door of hospital by:

• increasing the proportion of patients seen, treated and discharged in one day or less
• optimising the urgent care offer to meet the needs of local populations.

3. Reducing length of stay in hospital and ensuring that patients are cared for in the most appropriate setting by:

• increasing the percentage of patients discharged by or on day seven of their admission in line with hospital discharge and community support guidance
• working across NHS and local authority partners to reduce average length of discharge delay in line with the Better Care Fund policy framework.

4. Setting the foundations of the neighbourhood health model by embedding, standardising and scaling core components of existing practice.

New capital will be made available to increase the number of co-located urgent treatment centres (UTCs) in 2025/2026 (working towards having a co-located UTC with every type 1 ED) and support expansion of same-day emergency care capacity. Systems will need to set out their approach to improvement, where they think capacity is required and the first set of investments will start in 2025.

Improve patients’ access to general practice and improve access to urgent dental care

ICBs are expected to continue to provide support to general practice to enable patients to access timely appointments and to reduce unwarranted variation. ICBs are expected to:

• put in place action plans by June 2025 to improve contract oversight, commissioning and transformation for general practice

• target support to practices based on their ability to provide access and a good overall experience for patients

• improve access to dental care by commissioning additional appointments in line with the national commitment to provide 700,000 more.

In dentistry, NHS England will provide general practice teams and commissioners with national guidance and support tools to deliver long-term improvements in dental access. This will be supported by a consultation on reforms to the dental contract. 

NHS England will work with primary care to streamline the patient pathway and improve the interface between primary and secondary care, supported by recommendations from the ‘Red Tape Challenge’ (due to report in early 2025).

Improve patient flow through mental health crisis and acute pathways and access to CYP mental health services

To support national mental health objectives and meet the Mental Health Investment Standard (MHIS), ICBs and providers are expected to work together to: 

• Deliver the ten high-impact actions for mental health discharges.

• Reduce waits longer than 12 hours in A&E by maximising the use of crisis alternatives, including 111 mental health option, home treatment, implementation of the mental health OPEL framework and use of the mental health UEC action cards.  

• Improve productivity by reduced unwarranted variation in the numbers of CYP accessing services and the number of contacts per whole time equivalent hours worked.

• Reduce unwarranted variation in the CYP service access rate by improving productivity and increasing the number of direct and indirect contacts per whole time equivalent hours worked.

• Reduce local inequalities in access to CYP mental health services, between disadvantaged groups and the wider CYP population.

• Expand mental health support teams, achieving 100 per cent coverage by 2029/30.

• Submit, implement and report against a plan to improve productivity during 2025/26.

• Ensure high-quality and accessible infrastructure for people with a learning disability or autistic people, and only necessary admissions to inpatient settings.

Ring-fenced funding is available to support the delivery of NHS Talking Therapies and ill-health related inactivity. 

Address inequalities and shift towards prevention

The planning guidance emphasises the critical importance of locally agreed delivery plans for preventative services, such as screening and vaccination, to address the leading causes of morbidity. NHS England will continue to support preventative care through the GP contract, with an increased focus on the prevention of cardiovascular events. 

ICBs and trusts are expected to continue to work together to reduce inequalities through the Core20PLUS5 approach and to ensure all age groups have been considered in any plans (explicitly CYP).  

Make the shift from analogue to digital

Systems and providers are asked to work together to deliver the shift from analogue to digital by making full use of digital tools, to drive reform and ensure the NHS is fit for the future:

• Making at least 70 per cent of elective care appointments available to view and manage on the NHS App. All providers should proactively offer NHS App-first communications to patients (with due regard for digital inclusion) by default through the NHS Notify Service.
• All systems to adhere to the Federated Data Platform (FDP) by connecting their own digital and data infrastructure to the FDP. By March 2026, 85 per cent of all trusts to have adopted the FDP.
• All systems complete Electronic Patient Record procurement and implementation as soon as possible.
• All GP practices have core enabled NHS App capabilities, including health record access, online consultations and appointments, prescription management, online registration and patient messaging. 
• All providers deploy the Electronic Prescription Service. 
• All providers use NHS multi-factor authentication and strengthen their cybersecurity. 
• All systems implement the NHS digital inclusion framework to mitigate against digital inclusion
• All providers shift to the national collaboration service NHS.Net Connect where feasible.
• All providers integrate systems with the NHS e-Referral Service.

Live within our means, reducing waste and maximising productivity

Systems and providers must stay within planned allocations. To reduce unwarranted variation and to exhaust all realistic in-year productivity and efficiency opportunities, ICBs and providers must:

1.Reduce spend on temporary staffing and support functions by:

• achieving close to 100 per cent of planned core capacity before accessing premium capacity 
• reducing agency spending at a minimum of 30 per cent reduction on current spending (further reductions are expected over the parliament)
• reducing bank use, at a minimum 10 per cent reduction
• conduct a robust review of establishment growth and reduce spend on support functions to April 2022 levels.

2. Improve procurement, contract management and prescribing by:

• working to accept operating models and commercial standards, including making full use of the consolidated supplier frameworks agreed through NHS Supply Chain
• optimising medicines value and improving the adoption of and compliance with best value frameworks in medicines and procurement
• reducing unwarranted variation in prescribing through implementation of Low Value Prescribing Guidance and ensuring patients are prescribed the best value biological medicine where a biosimilar is available
• reducing unwarranted variation in all age continuing care spend
• optimising energy value and using green plans to achieve savings from sustainable energy funding; trusts should procure energy through the new national contract developed with Crown Commercial Services.

3. Drive improvements in operational and clinical productivity. Providers are expected to:

• develop plans that address activity per WTE gap against pre-COVID-19 levels
• avoid duplication and low value activity, including a focus on minimising inappropriate spend against evidence-based intervention procedures
• implement all levels of the People Promise to increase staff retention.

NHS IMPACT will develop leadership and organisational capacity, capability and infrastructure to create the conditions for improvement. 

Analysis: recovery or reform?

NHS leaders will welcome and embrace the ambitions of the planning guidance for 2024/25, the first planning guidance since the government was elected at the 2024 general election. System leaders share the ambition and determination to improve access to care and deliver more efficient services. 

They will approach these ambitions having made commendable progress over the last year: the elective waiting list fell from 7.61 million to 7.48 million between November 2023 and 2024, while the target for the Cancer Faster Diagnosis Standard was hit nine out of 11 months in 2024 compared to one out of 12 months in 2023.  

There are some real changes to welcome which deliver on things we have been calling for on NHS leaders’ behalf: 

• Focus:  Reducing the overall number of targets from 31 to 18 (compared to 133 back in 2022/23) and 19 pages (compared to 41 in 2022/23) gives clarity and focus. (Although several ‘requirements’ are not counted amongst the headline targets.) 
• Devolution:  A greater share of funding and decision-making is being delegated to systems, closer to their needs of their population, with further flexibility and earned autonomy for more mature systems. Less micromanagement will empower local leaders to lead improvement and reform. 
• Neighbourhood: Setting up infrastructure for neighbourhood health teams will lay the foundations for reform and delivering the three shifts. 
• Mental health: Among a smaller number of targets, improving care related to mental health, learning disability and autism feature prominently. Focus on the 1.5 million adults and children waiting for community mental health is welcome and reduce the number of people with learning disability and autistic people being admitted to hospital. There is further to go, but together with retention of MHIS (although not perfect), helps to make progress on parity of esteem and improved care.
• Dental contract:  NHS England has committed to consult on much needed reform of the dental contract, which will help recover NHS dentistry services. 
• Payment reform: Alongside the planning guidance, the proposed NHS Payment Scheme commits to pilots to test out new payment mechanisms to support NHS reform.
• Digital and data: In line with the plan for Reforming Elective Care for Patients, at least 70 per cent of elective care appointments will be available to view and manage on the NHS App.

NHS leaders will welcome these steps (although perhaps a greater focus on 12-hour A&E waits – where there is the greater risk of clinical harm – than four-hour A&E waits might have been preferable). However, these are relatively cost-free commitments for the centre to make.  

This will feel more like 2 per cent real-terms increase for system leaders

The enormous challenge lies in the money. Despite a 4 per cent uplift in the Department of Health and Social Care’s spending at the Budget – very generous compared to other departments and relative to the growth of the economy – this is an exceptionally difficult financial situation. 

Once increased spending on areas such as employers national insurance contributions, pensions, specialised high-cost drugs and other key cost pressures are accounted for, this will feel more like 2 per cent real-terms increase for system leaders. This is in the face of ever-rising demand for care. The efficiency factor in tariff prices looks set to jump to 2 per cent from 1.1 per cent in recent years. This will play through in trusts’ already strained finances. 

Providers are asked to make eye-watering 4 per cent efficiency savings,  before new local pressures are accounted for. This is almost double last year’s 2.2 per cent target and more than four times the NHSs’ historical rate of productivity growth at 0.9 per cent. The guidance notes that NHS productivity has increased at around twice the historical rate since 2021/22, but the ask is to double that again. Systems will approach that challenge after the busiest ever year  for A&E and ambulance services in England, with unprecedented levels of demand in December. At its peak, flu admittances were 3.5 times higher than the same point the year before. All the while, the pressure from the centre on systems to achieve financial balance is increasing. 

After making a bold political choice to increase taxes and NHS funding at the Budget, there is a risk that government and public expectations may still exceed what the NHS can realistically deliver. 

This is where the hard reality of the ‘reform or die’ message will kick in

Systems will still have to make tough and, at times, unpopular decisions over service provision, closing some relatively lower-value services to balance the books. This is where the hard reality of the ‘reform or die’ message from the Prime Minister will kick in. It is welcome that the planning guidance explicitly states that NHS England “will stand behind local leaders to make the best choices to meet the needs of their local populations, including where this means reducing or stopping lower-value activity.” 

However, what practical form that support will take is clearly crucial. Requirements for public engagement are set in law and the new ministerial powers to call-in service reconfigurations, which started last January, potentially open the door to more referrals and interventions (although the Department of Health and Social Care has signalled it will set a very high bar for these). 

The ten-year health plan will need to work out how to do recovery and reform at the same time; the stakes are high

Yet where is the government’s reform agenda in all this? Understandably, the planning guidance is focused on recovery and financial balance. Targets for reducing avoidable ambulance dispatches, length of stay, transform and improve primary care and maximising use of the NHS App for patient communications align with the transformation agenda. Developing neighbourhood teams is meant to lay the foundations of reform. 

But NHS leaders will know that, ultimately, putting the NHS on a long-term sustainable footing will require more radical reform to curb demand for downstream services, but is ultimately crucial. This will require delivery of the three shifts: from hospital to community, from illness to prevention and from analogue to digital. Focus on improving immediate access and cutting waiting times must not hinder efforts to shift resources from illness to prevent and hospital to community. The ten-year health plan will need to work out how to do recovery and reform at the same time. The stakes are high.

Next steps and plan submission

ICBs and their partners and trusts are asked to work with wider system partners to develop integrated system plans by the end of March 2025 to meet the national objectives set out in this guidance and the local priorities agreed by ICSs. Plans should be measured against the quality objectives of the planning guidance and triangulated across activity, workforce and finance. 

NHS England will separately set out guidelines and supporting materials for plan development, submission and review. Boards will have to confirm how these have been used to inform the development and assurance of plans.

ICBs and trusts are advised (but not required) to perform a limited refresh of existing plans – including Joint Forward Plans (JFPs) by the end of March 2025, given the publication of the ten-year health plan in the spring of 2025 and the Spending Review 2025. 

How we will be supporting members

We will continue to engage with NHS England on behalf of members to represent your views and the reality of delivering services in the current environment. We will also continue to support members with the implementation of guidance through our networks and forums, at every level across the system and our support offer for ICS leaders and improvement leads through the Learning and Improving Across Systems programme.