The NHS Medium Term Planning Framework – Delivering Change Together (2026/27 to 2028/29) is promising to strip out layers of bureaucracy, remove complicated and unnecessary rules and free up local leaders to focus on delivering for patients.
The three-year roadmap signals an end to the ‘short-term thinking’ that is holding back frontline services and aims to break the cycle of ‘just about managing’. It will give the NHS the certainty and headroom it needs to fix the fundamental problems it faces today, and be truly ambitious for the future.
Sir Jim Mackey, CEO of NHS England says: “For too long the NHS has been stuck in a doom-loop of not being able to properly plan beyond each financial year and responding to overly-bureaucratic processes that have stifled local leadership and innovation.
“We have to get out of the trap of short-term thinking and break the cycle of ‘just about managing’.”
Three-year roadmap
The planning framework is the product of intensive work over the summer by the NHS leadership community and will reset how the NHS works, how it aligns incentives to delivering more care and create a clear route map for the NHS to meet its commitments on improving access to care and returning waiting times to where patients want and need them to be.
The roadmap sets out the NHS plan to get back to delivering against its constitutional standards on elective care, which will see 2.5 million fewer patients waiting more than 18 weeks for treatment by March 2029.
It will ensure 85% of people with a cancer diagnosis receive their first treatment within 2 months of a referral – up from 70% today. NHS analysis suggests just over 300,000 cancer patients will get their first treatment within 62 days of receiving a referral in 2028/29, up from 226,939 last year (2024/25). While 96% of patients will begin treatment within one more of a cancer diagnosis by 2028/29.
Shaking up services and incentives
Meeting these ambitious targets will be achieved by radically transforming how services are delivered – shifting more care out of hospital, freeing up capacity to drive down waiting times – and major improvements in health service productivity.
As part of the biggest shake up of the NHS financial regime in more than a decade, hospitals will be financially incentivised to ensure more patients are treated out of hospital, instead receiving the care they need from local neighbourhood teams and in community diagnostic centres.
This will start with immediate action to improve GP access and tackle unwarranted variation between practices – consulting on a new priority to deliver same day appointments, whether face to face, online or by phone, for all clinically urgent patients.
The Framework also sets an ambitious target for 80% of community health service activity within 18 weeks – tackling long waiting times for community services, which have seen a surge in the number of adults and children waiting for more than 2 years for care.
This will be supported by shifting more resources into community services for people with highest needs – such as frailer older people – reducing unnecessary hospital admissions and helping them manage their health at home.
In line with the ambitions of the 10 Year Plan, the framework sets targets to make sure 95% of appointments after triage are available via the App and ensure all providers are leveraging the full potential of the Federated Data Platform by the end of 2028/29.
Patients will no longer be asked to waste their time at follow-up appointments that aren’t necessary – freeing up clinicians to see the patients that need to see them most. Areas of the country that fail to progress on unnecessary follow ups will be performance managed.
More patients will get appropriate care as part of the ‘Advice and Guidance’ scheme which allows GPs to get specialist clinical advice from leading experts at the touch of a button – rather than sending the patient for a hospital appointment which sometimes isn’t needed.
Radiology departments will no longer scan people unnecessarily thanks to the rollout of i-Refer – an online software linked to real-time, up-to-date clinical guidance to ensure only those who need a scan are offered one.
Jim Mackey adds: “The NHS needs to win back the confidence of the patients and communities it serves – so starting from now, every provider across the NHS will be required to more carefully measure what patients are telling them about their experience of care and act swiftly to fix the things that matter to them.”
