NHS England has unveiled its 2025/26 priorities and operational planning guidance, emphasizing local prioritization, reducing waiting times, and improving access and patient flow. The document promises greater financial flexibility for systems managing their budgets, alongside increased local autonomy, with NHS England offering tailored support and intervention based on specific needs and performance.
A Renewed Focus on Localized Decision-Making
Amanda Pritchard, NHS England’s Chief Executive, acknowledges the strides made in service improvements and productivity. However, she highlights the persistent challenge in areas like elective care and mental health services, where demand continues to outstrip capacity. In her foreword, Pritchard calls on Integrated Care Boards (ICBs) to scrutinize their workforce and expenditure closely. She stresses the importance of prioritizing frontline care, adding that NHS England itself will undergo further headcount reductions to reallocate funding toward system-level initiatives.
The guidance urges healthcare systems to shift their focus from operational inputs to patient-centered outcomes, emphasizing efficiency, productivity, and reducing unnecessary variations in care. NHS England reassures local leaders that they will receive full governmental support in making the best decisions for their communities, including discontinuing low-value activities where necessary.
A More Devolved Healthcare System
From 2025/26, the NHS will transition to a more devolved system, granting Integrated Care Systems (ICSs) and trusts greater flexibility in their operations. Patients will also gain more choice and control over their healthcare. Recognizing leadership as a pivotal factor in this transition, NHS England commits to supporting local systems with leadership development and strategic commissioning programs over the next two years.
Key National Priorities for 2025/26
-
Reducing Waiting Times for Elective Care: NHS England aims to ensure that at least 65% of patients wait no longer than 18 weeks for elective treatment by March 2026. Trusts are expected to achieve a minimum five percentage-point improvement in their waiting times.
-
Improving A&E and Ambulance Response Times: The goal is for 28% of A&E patients to be seen within four hours by March 2026, while Category 2 ambulance response times should average no more than 30 minutes.
-
Enhancing General Practice and Urgent Dental Care Access: NHS England plans to commission an additional 700,000 urgent dental care appointments and improve general practice oversight.
-
Enhancing Mental Health Services: A focus on patient flow through mental health crisis and acute pathways, expansion of mental health support teams, and maximizing the use of crisis alternatives like the NHS 111 mental health option.
-
Shifting Towards Digital-First Communication: Providers are required to maximize the use of digital tools, including ensuring NHS App-first communications and integrating electronic referrals and prescriptions.
-
Addressing Health Inequalities and Secondary Prevention: Prioritizing high-need areas, reducing disparities in access and outcomes, and emphasizing preventive care.
Actions to Reduce Elective Care Wait Times
NHS England has outlined specific measures for ICSs to optimize referral management, including:
-
Utilizing triage systems and patient-initiated follow-up (PIFU).
-
Ensuring at least 70% of elective appointments are accessible through the NHS App.
-
Validating referral to treatment (RTT) waiting lists every 12 weeks.
-
Implementing “Further Faster” methodologies to streamline outpatient clinic processes.
-
Expanding the use of teledermatology to improve productivity in cancer pathways.
Enhancing Emergency and Urgent Care
To improve A&E efficiency and ambulance response times, the NHS will implement strategies from the highest-performing systems. Key initiatives include:
-
Reducing avoidable dispatches and conveyances.
-
Expanding access to virtual wards and community-based urgent care services.
-
Shortening hospital stays by increasing the percentage of patients discharged within seven days.
-
Standardizing the use of urgent treatment centers to alleviate A&E pressure.
Investing in Digital Transformation
The NHS aims to harness technology for better efficiency and patient experience by:
-
Encouraging NHS App-first communications.
-
Enabling all GP practices to adopt NHS App core functionalities.
-
Prioritizing compliance with NHS Multi-Factor Authentication policies.
-
Expanding the Electronic Prescription Service to reduce reliance on paper prescriptions.
-
Strengthening cybersecurity measures to protect patient data.
Looking Ahead: Long-Term NHS Reform
ICBs are required to submit strategic plans by March 2025 to meet these national objectives, with NHS England pledging to provide guidelines and supporting materials. Additionally, the NHS will conduct a limited refresh of existing plans following the release of the 10-Year Health Plan in Spring 2025, ultimately shifting towards a multi-year operational and financial planning model.
Final Thoughts
The 2025/26 NHS England operational guidance signals a significant shift towards localized decision-making and outcome-driven healthcare. By empowering local leaders with financial flexibility and digital transformation tools, the NHS aims to enhance patient access, reduce waiting times, and improve overall service efficiency. This new strategy places a strong emphasis on frontline care, ensuring that resources are optimized to deliver high-quality healthcare to all patients.