Policy briefing: NHS England Medium Term Planning Framework

What has been announced?

NHS England has published its Medium-Term Planning Framework, which sets out how it believes change will be delivered between 2026/27 and 2028/29. NHS England describes this as the “end of short termism”, with the aim to “close the gap” between the national centre of the NHS and service delivery at local level. NHS England states that the report has been co-produced with hundreds of leaders from primary care, acute, mental health, ambulance and community services. The Secretary of State for Health and Social Care, Wes Streeting, and the NHS Chief Executive, Sir James Mackey, write that the Planning Framework marks a return to “locally led ambition in the NHS”, and set out how empowering local leaders will drive change for patients and communities.

The Planning Framework describes a new operating model for a variety of areas of the NHS, including primary care, with broad aims about how quickly patients should be seen and how a transformed NHS will operate. The emphasis on collaboration with primary care is clear, as are the roles for each part of the system. In the transformed NHS, the central NHS sets national outcomes, regions are the leadership interface, Integrated Care Board (ICBs) become strategic commissioners, while providers – in this context we presume referring to NHS trusts and similar entities – are responsible for collaboration, productivity and quality. ICBs will be expected to develop five-year plans that will allow them to transform services.

While the Planning Framework sets out many areas of care, there is much detail that will need to be provided. A Model Neighbourhood Framework, a Strategic Commissioning Framework and a Foundation Trust Framework, as well as a System Archetypes Blueprint will all follow in the next month or so. Additionally, Integrated Health Organisations (IHOs) are in effect a new mechanism for contracting – not a new organisation as their name suggests – and will be described more fully by the system archetypes framework.

The drive towards ‘digital by default’ is a recurring theme in the Planning Framework, with a push to make greater use of advice and guidance, clinical triage and single points of access. The e-Referral Service (e-RS) features prominently as a requirement from July 2026.

The Planning Framework provides some detail around Modern Service Frameworks (MSFs), focusing on conditions where there is potential for rapid and significant improvements in both quality and productivity. The first three of these will be cardiovascular diseases (CVD), serious mental illness and sepsis. MSFs on dementia and frailty will follow. Good practice guides, such as those produced by the NHS E’s Getting It Right First Time (GIRFT) programme, are referenced as examples of how future practice will be defined. Alongside these guides, there will be a push towards ‘straight to test pathways’ and ‘one stop clinics’, which will be instigated for the 10 largest specialities by volume. It is expected that this will include ophthalmology as one of the busiest NHS sub specialities.

Finally, the planning timetable makes it clear much work has already been undertaken, but ICBs must now work quickly to further develop their five-year plans in time for the next financial year.

What do we say

After the publication of the 10-Year Health Plan earlier in the year, it is positive to see further detail about how the Government plans to transform the NHS. The aim to enable longer term contracting to deliver assurance for providers is welcome. We have highlighted that the short-term nature of contracts has prohibited innovation and investment, and a decision to address these issues is long overdue. It is also helpful to have greater clarity about how the Secretary of State envisages decision making within the NHS will work in the coming years.

Despite this clarity, there are still many unknowns as we await the additional frameworks which will shape the future of the NHS, and we have many questions and also some concerns.

Unfortunately, our view is that the Planning Framework has given ‘primary care’ a narrow definition – in other words, the planning guidance seems to mean primary medical care. Our GP colleagues are, of course, central to the NHS, but they are one important pillar within an ecosystem that also includes pharmacy, optometry, and dentistry.

Also of concern is the absence of any direct reference to optometry, opticians, or eye care and eye health in the Planning Framework. This is not the case for the other providers of primary care. It is fair to note that, despite the many pressures the optometry sector faces, the services provided by optometry to NHS E are successful: patients can access high quality, timely care across the whole country. Our view is that while this success is well-documented, there are areas in England where enhanced services are not commissioned, leading to inequalities in access for patients due to a postcode lottery of care. The core sight testing service is chronically underfunded, but continues to be an exemplar in how to innovate and ensure patient focussed care delivers nationally.

Our research and evidence shows that if all patients, no matter where they live in England, could access the full range of enhanced NHS eye care services that optical practices based in the community are able to offer, we could help our colleagues in GP practices and secondary care by freeing nearly 2 million appointments and saving the NHS tens of millions of pounds.

We continue to call on the Government to include optometry in the planning of these services. The Government has been clear in its stated aim to bring ‘the best to the rest’. By optimising optometry as part of the transformation of the NHS, we believe this reform will be possible, and ensure that every member of the public has access to eye care, closer to home, with better clinical outcomes, wherever they live in England.