NHS Medium Term Planning Framework: Quick Overview

This Medium Term Planning Framework – which is said to be the first of many upcoming guidance documents to be released – now translates those strategic shifts into a reality, establishing concrete targets, financial frameworks, and implementation timelines for 2026/27 and 2028/29.

Following a £22 billion funding injection and Spending Review 2025 settlement delivering 3% real-terms revenue growth, the framework moves away from short-term annual cycles toward sustainable, locally-led transformation whilst delivering immediate performance improvements.

The framework introduces the biggest financial regime shake-up in a decade, dismantling block contracts and implementing new payment models including a revised urgent and emergency care payment structure with 20% variable payment from 2026/27. All ICBs and providers must deliver balanced positions without deficit support funding by 2028/29, alongside mandatory 2% annual productivity improvements. Trust-level productivity statistics will be published monthly, with new costing dashboards enabling granular financial scrutiny.

Accelerating neighbourhood health sits at the framework's core, establishing integrated neighbourhood teams focusing on high-priority cohorts including people with moderate to severe frailty, care home residents, housebound individuals, and those at end of life. ICBs must ensure 90% of clinically urgent primary care patients receive same-day appointments, supported by reduced unwarranted variation in GP access. The neighbourhood approach aims to significantly reduce avoidable non-elective admissions whilst improving patient experience through joined-up care across NHS, local authority, and voluntary sectors.

The framework mandates digital-by-default service delivery, with the NHS App becoming central to patient interaction. By 2028/29, providers must make 95% of appointments available via the NHS App following appropriate triage, achieve full NHS Federated Data Platform adoption, and migrate all patient communications to NHS Notify. Ambient voice technology deployment and digital therapeutics implementation will drive productivity improvements whilst freeing clinical capacity.

Ambitious three-year trajectories include achieving 92% 18-week referral to treatment standard by March 2029, 85% four-hour A&E performance, and 18-minute average Category 2 ambulance response times. Cancer standards require maintaining 80% 28-day Faster Diagnosis Standard performance whilst improving 31-day and 62-day standards to 96% and 85% respectively. Mental health commitments include 94% coverage of mental health support teams in schools by 2028/29, with 915,000 NHS Talking Therapies courses annually.

The King's Fund's Katie Purbrick-Thompson notes the challenge ahead: “Currently more patients join the waiting list each month than receive treatment – so this will be extremely tough to achieve,” whilst acknowledging that “politicians are trying to balance both what matters most to patients (whether they can get the care they need when they need it) and necessary longer term system transformation.”

The framework transforms quality approaches through modern service frameworks for cardiovascular disease, serious mental illness, and sepsis, supported by National Care Delivery Standards ensuring consistent seven-day care quality. Workforce reforms include implementing the resident doctors' 10 Point Plan, establishing a new College of Executive and Clinical Leadership, and reducing sickness absence rates from 5.1% to approximately 4.1%. Agency staffing must be eliminated by August 2029.

Addressing obesity becomes central, with 220,000 adults accessing NICE-approved weight loss treatments by June 2028 and 250,000 annual referrals to the NHS Digital Weight Management Programme by March 2029. The framework supports a 25% reduction in cardiovascular disease-related premature mortality over the decade through expanded NHS Health Check services and tobacco dependence opt-out models.

Organisations submit three-year numerical plans by December, with full five-year strategic plans due February, demonstrating triangulation across finance, workforce, activity, and quality whilst securing board assurance of deliverability.

Key deadlines for NHS organisations:

• December 2025: Submit three-year numerical plans (finance, workforce, performance)
• February 2026: Submit full five-year strategic plans with board assurance
• April 2026: Begin implementing digital mandates, neighbourhood health, and productivity targets

At least 20 additional guidance documents will follow, including the Model Neighbourhood Framework (November 2025), Foundation Trust Framework (November), and Modern Service Frameworks throughout 2026.

As the NHS Confederation notes, "with much information still to come in and so many pieces of further guidance promised, the framework only goes so far to inform planning." However, what has been released now gives the sector a sense of direction, which we hope will only become clearer as implementation detail continues to emerge throughout 2026.