NHS England has published its 2025/26 priorities and operational planning guidance, with a focus on local prioritisation and planning, reducing wait times, improving access and patient flow, and more.
In a foreword by Amanda Pritchard, the chief executive highlighted improvements in services and productivity, but noted that in areas like elective care and mental health services, “despite record activity, continued high demand means improvements are not yet nearly enough to allow everyone to access services in a timely or convenient way”.
The chief executive goes on to promise “greater financial flexibility” for systems in managing their budgets, and increased local autonomy with support and intervention from NHSE “based on their specific needs and performance”. In return, Pritchard asks ICBs to “take a forensic look” at their workforce and spending, adding: “We anticipate that both ICBs and providers will need to review their spend on non-frontline staff again for 2025/26 to prioritise frontline care. NHS England will do the same and, in line with the NHS Operating Model, will again become a smaller organisation this year, further reducing our headcount and reprioritising spend to allocate more funding to systems.”
Introducing the objectives and priorities, NHSE encourages systems to “shift their focus” from inputs to outcomes for patients and local communities, and notes the need for “a relentless focus” on operational performance, productivity improvements, and reductions in variation, delays, and waste. “We and government will stand behind local leaders to make the best choices to meet the needs of their local populations,” the guidance states, “including where this means reducing or stopping lower-value activity.”
From 2025/26, the NHS will move to a “more devolved system”, according the guidance, whereby ICSs and trusts can earn greater flexibility and freedom, and patients have more choice and control. Recognising that leadership is key to making this transition successful, NHSE commits to supporting local systems to transform leadership and management over the next two years, including by co-producing a development programme for strategic commissioning with NHS leaders.
National priorities for 2025/26 as set out by NHSE include reducing waiting times for elective care, with an aim of increasing the percentage of patients waiting no longer than 18 weeks for elective treatment to 65 percent nationally by March of 2026, and with trusts expected to deliver “a minimum 5 percent point improvement”. Improving A&E waiting times and ambulance response times is also a priority, with a minimum of 28 percent of patients seen within 4 hours by March 2026, and category 2 ambulance response times averaging “no more than 30 minutes” across 2025/26. Improving access to general practice and urgent dental care, improving patient experience, improving patient flow in mental health and acute pathways, and improving access to children and young people’s mental health services, are also outlined as priorities.
Systems and providers are asked to focus on developing neighbourhood health service models to help reduce demand, “with an immediate focus on preventing long and costly admissions to hospital” and improving timely access to urgent and emergency care; and making “full use” of digital tools to support the shift from analogue to digital. The outline continues to note: addressing inequalities and shifting toward secondary prevention; “living within the budget allocated”, reducing waste and improving productivity; and maintaining a focus on service quality and safety, “paying particular attention to challenged and fragile services including maternity and neonatal services”, whilst continuing to address variation in access, experience and outcomes.
Outlining specific actions to be taken on reducing wait times for elective care, NHSE sets out expectations of ICSs including the optimisation of referral management through use of triage and PIFU; making at least 70 percent of elective appointments available for citizens to view and manage through the NHS app; and validating referral to treatment waiting lists every 12 weeks and maximising use of digital tools for patient contact and data quality. Actions continue to state: minimising “unwarranted diagnostic referrals” to reserve capacity for appointments and tests that “truly benefit patient outcomes”; implementing the “Further Faster” methodology to optimise outpatient clinic processes and clinic utilisation; and improving experience and equality for patients. Performance against cancer waiting time standards is also an important function, and the guidance sets out that systems should improve productivity in cancer pathways by introducing teledermatology.
On improving A&E wait times and ambulance response times, the guidance says the immediate task for 2025/26 is applying learning from the best performing systems in key areas: reducing “avoidable” dispatches and conveyances, and tackling handover delays by improving access to services at home or in the community like virtual wards. It highlights: improving and standardising urgent care by utilising urgent treatment centres; reducing length of stay by increasing the percentage of patients discharged on or before day 7 of their admission, and working in line with the Better Care Fund (BCF) policy framework; and setting the foundations for the neighbourhood health model “by continuing to embed, standardise and scale core components of existing practice”.
To improve access to general practice and urgent dental care, the guidance stipulates that ICBs should put action plans in place by June 2025 to “improve contract oversight, commissioning and transformation for general practice, and tackle unwarranted variation”; support the delivery of modern general practice; and commission additional urgent appointments to meet the government’s commitment to “an additional 700,000 appointments” for dental care.
For improving patient flow through mental health crisis and acute pathways, and access to children and young people’s mental health services, ICBs are asked to focus on delivering the 10 high impact actions for mental health discharges, maximise use of crisis alternatives such as the 111 mental health option, reduce unwarranted variation by improving productivity, and expand mental health support teams in line with the government’s aim of reaching 100 percent coverage by 2029/30.
And when it comes to making the shift from analogue to digital, the guidance requires providers to offer “NHS App-first communications to patients”; ensure all GP practices have enabled all core NHS app capabilities; adhere to the Federated Data Platform First policy; shift to the NHS.Net Connect “where feasible”; complete EPR procurements and upgrades “as quickly as is safely possible”; deploy the Electronic Prescription Service “wherever possible”; integrate systems with the NHS e-referral service; achieve and maintain compliance with the NHS Multi-Factor Authentication Policy and act to strengthen cyber security; and “mitigate against digital exclusion”.
ICBs are asked to work with trusts and “wider system partners” to develop plans by the end of March to meet these national objectives, with NHSE committing to setting out guidelines and supporting materials for plan development, as well as its submission and review. The guidance also states that NHSE expects ICBs to need to “perform a limited refresh” of existing plans in light of the upcoming publication of the 10 Year Health Plan in Spring 2025, adding: “We will work with systems to develop a shared set of expectations and timetable for a subsequent more extensive revision of JFPs aligned to wider reform of nationally co-ordinated NHS planning processes. This will include a shift from single to multi-year operational and financial planning.”
To read NHS England’s 2025/26 priorities and operational planning guidance in full, please click here.
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In the last couple of months, we’ve also been joined by expert panellists to discuss how general practice, PCNs, and ICBs can utilise data and leverage technology to support operational efficiencies and improvements across primary care; as well as to discuss the role of digital in supporting NHS reform – modernising services, shifting from hospital to community, and supporting the move from reactive to proactive care.
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