• A ‘big conversation’ will be started on significant contractual changes for all NHS staff, to be held with the NHS, DHSC, trade unions, the SPF (Social Partnership Forum) and others
• A digital HR strategy will be implemented over the next 5 years, with the aim of enabling staff to access HR services more conveniently, including to book annual leave or to onboard to a new organisation digitally
• Virtual HR ‘assistants’ will be introduced to free up HR professionals’ time for more complex issues
• A new ‘state of the art’ NHS payroll system is planned
• New staff standards will be developed in collaboration with the SPF, to be implemented by April 2026, and are expected to cover: 

1. access to nutritious food and drink at work
2. reducing violence against staff
3. tackling racism and sexual harassment
4. standards of ‘healthy work’
5. occupational health support
6. support for flexible working.

• Staff Treatment Hubs will be rolled out, to provide occupational health services for all NHS staff, including for mental health issues, back conditions, and other conditions linked to long-term sickness absence.
• The new staff standards and the Staff Treatment Hubs
• The delivery of the Messenger Review of NHS Leadership will be accelerated, with new Management and Leadership Framework to be published in Autumn 2025 and a new independent College of Executive and Clinical Leadership to be established. 

• The plan rejects the 2023 Long Term Workforce Plan projections of NHS staffing numbers and states that staff numbers in 2035 will be lower than previously planned.
• 1,000 new speciality training posts will be created over the next 3 years, with a focus on specialities with the greatest need.
• International recruitment to the NHS will be reduced to under 10% by 2035.
• Local recruitment drives will be supported, with an emphasis on bringing unemployed or economically inactive people into the workforce as part of efforts to widen access to NHS roles.
• This includes widening access to the medical profession for people from underprivileged backgrounds, with the upcoming 10 Year Workforce Plan set to explore how the admissions processes for medical schools can support this.
• Overseas UK-registered professionals may be used to provide remote services for NHS patients - with further details to come in the 10-Year Workforce Plan.
• The use of agency staffing is expected to be ended in the NHS by the end of this parliament, with agency workers transferred to staff banks.

• UK Medical graduates, alongside doctors who have worked in the NHS for a significant period, will be prioritised for foundation training and speciality training.
• Based on the findings of the Leng Review, the introduction of new and expanded roles should ensure that public, patient, and professional confidence is maintained, including by providing clear detail on what tasks these roles will be delivering, what supervision they require, and how they fit into wider teams.
• All NHS staff will have personalised development plans and career coaching by 2035.
• Pending agreement from trade unions, NHS revalidation and appraisal systems will be asked to transition to a model based on continuous skill development and real-time feedback.
• DHSC will work to ensure a more streamlined path for experienced specialty doctors to develop and operate at the specialist level.
• DHSC will also work with the GMC to streamline pathways for experienced doctors to become consultants.
• DHSC will work with professional regulators and educational institutions to reform education and training curricula over the next 3 years, to include: 

1. comprehensive AI and digital tools
2. promote generalise skills required for Neighbourhood Health Service
3. focus on competencies and skills to deliver as soon as they are acquired rather than waiting until the end of formal training.

• A targeted expansion of clinical educator capacity is planned.
• Funding for under and postgraduate placements will be reformed to support focusing clinical placements in priority settings, i.e. in the community.
• Changes to clinical placements will also begin to incorporate simulated learning.
• Mandatory training for staff will be replaced by focused support on specific skills, with the aim of freeing up time for frontline staff.
• As part of an effort to ‘move beyond traditional professional boundaries’ DHSC will work with regulators to explore a ‘train to task’ model, where staff can carry out more tasks under supervision while in training.

• The plan reaffirms the stated commitments to bring back the family doctor and to end the ‘8am scramble’ for appointments.
• This includes a broad aim to train thousands more GPs and to shift the emphasis of overall NHS recruitment into primary care.
• The plan states that the traditional partnership model will be retained where it is working well - but also seeks to set alternative ‘neighbourhood health’ models (covered below), with the aim of delivering at-scale services over larger areas.
• The Carr-Hill formula is due to be reformed alongside wider shifts in funding, to help target resources at areas with disproportionate economic and health challenges.
• With the intent to free up GP capacity, the recommendations of the ‘Red Tape Challenge’ will be implemented, and technology like ambient ‘AI Scribe’ voice technology, digital telephony, and the Single Patient Record (SPR) will be deployed.
• Advice and guidance will be rolled out to additional specialties over the next 10 years – as a means of reducing referrals.
• GPs will be supported to carry out research via the NIHR (National Institute for Health and Care Research) School for Primary Care and Primary Care Commercial Research Delivery Centres opening in 2026.
• AI advice will also be added to the NHS App, to offer patients alternative options for support and help reduce demand for GP practices appointments.
• My NHS GP – an AI-enabled tool in NHS App – will be launched by 2028 to help patients to access appropriate care via a GP or pharmacist, particularly as an alternative to attending an A&E department.

• Two new contracts will be introduced from next year:

1. Single neighbourhood providers – covering a single ‘neighbourhood’ (around 50,000 people) to deliver enhanced services for groups with similar needs. Existing PCNs may be a foundation for these.
2. Multi-neighbourhood providers – covering multiple ‘neighbourhoods’ (more than 250,000 people) and delivering care across a wider area, these providers are expected to utilise greater at-scale working and take advantage of shared back-office functions, digital transformation, estates plans, and data analytics. They will also be expected support struggling practices, including by taking over their functions if needed. 

• The plan does not provide specifics on the exact eligibility for these two new contracts, but suggests they could be held by PCNs, GP Federations, or NHS trusts.
• The services will be delivered in NHCs (Neighbourhood Health Centres) – framed as ‘one stop shops’ based, open 6-days a week, at least 12-hours per day and staffed with multi-disciplinary teams, to be rolled-out nationally by 2030.
• NHCs will draw staff from primary, community and acute backgrounds, and involve social care professionals and voluntary organisations.
• The skills mix and staffing within these providers will be adjusted based on population insights, including the use of genomic insights to identify demand.
• The centres could offer services like day surgery, urgent treatment centres, pharmacy, physiotherapy, specialist clinics, outreach services, evening and weekend GP appointments, and consultant-led outpatient clinics. 

• All NHS Trusts are expected to be a Foundation Trust by 2035.
• High-performing Foundation Trusts will have the opportunity to become IHOs (Integrated Health Organisations) with responsibility for all services within a wider area – this is a new iteration of the previous ACO (Accountable Care Organisation) and Integrated Care Provider contract models attempted previously.
• To reduce demand in urgent and emergency care, more patients will be able to book urgent care appointments via 111 or the NHS App before attending and same-day emergency services and co-located urgent treatment centres will be expanded.
• 85 dedicated MHEDs (mental health emergency departments) will be established, either co-located with, or near to, existing type 1 A&E units.
• PIFU (patient-initiated follow up) will be made the standard approach for all clinically appropriate pathways by 2026 to reduce outpatient appointments.
• Patients choice of providers will be expanded, with more information available to them on journey times, waiting times, quality, patient outcomes and patient experience through the NHS App.

• Financial incentives and flexibility are intended to increase the use of existing estates and make it simpler for trusts to dispose of surplus land and reinvest that money.
• Government will consider the use of PPP (Public Private Partnership) to secure funding for capital projects in a limited set of circumstances and where they would represent value for money.
• The use of PPP has been ruled out for hospitals but could be used to support the roll out of neighbourhood health centres. 

• The NHS App is a central part of the plan, which aims to significantly expand its functionality to allow:

1. patients to view their data; book, move, cancel and hold appointments; communicate with their healthcare team; manage medications and vaccinations; and manage long term conditions and care via the app
2. direct messaging via the app to replace much of SMS and letter contact between NHS and patients
3. the ‘My NHS GP’ tool to provide AI-based advice for patients and signposting to services. 

• New technology is also intended to support clinicians in their working lives, including a single sign on for NHS software and the roll out of ambient voice (scribing) technology in 2026-27.
• The aim to deliver a SPR (single patient record) is restated, to be enabled by new legislation and reform of the legal framework for the use of health data. 
• The SPR will be accessible to clinicians across the healthcare system, but also for patients from 2028.
• A national, AI-led quality issue warning system will be established in Trusts to help highlight and address safety issues.  

• No new funding is announced in the plan beyond the spending plans announced in the comprehensive spending review.
• Over the course of the plan, funding is expected to gradually and proportionally move out of secondary care and into neighbourhood, community, and primary care – mirroring the intended shift in services.
• The NHS will be expected to deliver 2% year-on-year productivity gains for the next 3 years as part of an overarching aim for the NHS to deliver surplus budgets by 2029-30.
• Deficit support funding for trusts will also be phased out from the 2026-27 financial year.
• All NHS organisations will be expected to deliver operational plans that are fully compliant with the NHS planning guidance from 2026-27.
• Block contracts will be ended, with the intent of more explicitly basing tariffs and payments to providers on the level and quality of care provided.
• With a view to establishing longer-term planning, a 3-year revenue and a 4-year capital settlement will run from 2026-27.  
• From 2029-2030, 5-year rolling capital budgets will be introduced, to help with longer-term planning.
• NHS funding flows will be broadly shifted, to target resources at areas with the greatest health needs – with an emphasis on deprived and working class areas.
• NICE will be given new powers to withdraw treatments that are determined to no longer be cost effective.
• A pilot will be run in 2026-27 to test how patient voice could directly impact payments to providers, based on their experience of services – this has been modelled as a trial of Patient Power Payments.
• New Foundation Trusts will not receive capital allocations but will determine their own capital spending using funds generated through their operating activity.
• Funding for operational capital expenditure (e.g. routine maintenance and equipment replacement) will go to NHS providers determined by need.
• Capital allocations will be held regionally and allocated based on local population health needs, with NHS Regions, ICBs, and providers collaborating accordingly.
• Few capital budgets will be held nationally – with the notable exception of the New Hospital Programme budget which will remain with DHSC. 

• Dedicated mental health emergency departments will be established - with £120 million to be invested by 2030 to ensure there are 85 mental health emergency departments (see also A&E section above) across England.
• Increase the number of mental health support teams in schools and colleges, while also enhancing services for children and young people through the Young Futures Hub.
• Virtual therapists will be available 24/7 to assist patients with mild or moderate needs.
• For patients with more serious mental health issues, there will be remote monitoring which is intended to help with a pre-emptive response in emergencies.

• The plan – in line with already-announced plans on the structure of the NHS – sets out a new operating model based on a smaller ‘centre’ based in DHSC, with authority and finances increasingly devolved downwards to ICBs and providers.
• A system of ‘earned autonomy’ is intended to mean that providers are rewarded with greater freedoms for strong performance and that poor performance is subject to direct interventions via a ‘failure regime’.
• DHSC hopes that every NHS trust will become a Foundation Trust by 2035, with freedoms set to include determining their own board composition, retaining and reinvesting surpluses, and borrowing for their own capital investment.
• High-performing foundation trusts will have the opportunity to become IHOs (Integrated Health Organisations) with responsibility for all services within a wider area.
• Resources allocated to providers and commissioners will be tied to outcome-based targets (e.g. elective activity rates).
• League tables will be reinforced, with more information on provider and commissioner performance published and ranked publicly.
• These rankings will have an emphasis on patient experience, outcomes, and feedback – as part of a new ‘choice charter’ intended to empower patients.
• NHS leaders’ pay will be tied to performance metrics too.
• The plan sets out a desire for a ‘plurality of provision’ – with traditional boundaries blurred and, for example, GPs running hospitals, nurses leading neighbourhood providers or acute trusts running community services.
• Private providers will continue to be used – particularly to support improved access and to clear waiting lists – and the plan outlines potential efforts to expand private provision of NHS care in more deprived areas.
• The NHS will be expected to work more closely with local government, which will be supported by making ICB boundaries coterminous with local authorities where possible.
• ICPs (Integrated Care Partnerships) will also be abolished, with its previous focus on population health shifting into the remit of ICBs.

• The plan reiterates the government aims to create a smoke-free generation and significantly reduce smoking rates – including via its Tobacco and Vapes Bill
• New programmes such as Health Coach and AI tools will be rolled out with the aim help people quit smoking and make healthier choices, while hospitals will provide quit smoking support as part of routine care, especially before surgery to reduce health risks.
• With the goal of eliminating cervical cancer by 2040, more HPV vaccinations will be made available for young people who missed the vaccine at school.
• A new genomics population health service will be established by 2030, with universal newborn genomic testing and population based polygenic risk scoring, to target early detection and intervention for people who pose a higher risk of developing common diseases.
• The plan recommits to a number of previously announced policies or commitments targeted at children and young people’s health, including limiting junk food advertising aimed at children, banning the sale of high caffeine energy drinks to under 16s, extending the Soft Drink Industry Levy (the “sugar tax”) to milk-based products, restricting multi-buy promotions of unhealthy food and authorising councils to ban new fast-food outlets near schools.
• The plan also commits to extending free school meals to more children, revising the school food standards and restoring the value of the Healthy Start scheme from 2026 to 2027. Pregnant women and children aged one or older but under 4 will each receive £4.65 per week (up from £4.25). Children under one year old will receive £9.30 every week (up from £8.50).
• The plan includes new announcements aimed at tackling obesity including introducing new mandatory reporting and targets for sales of healthy food.
• The NHS Digital Weight Management Programme will be extended to 125,000 more people to support weight loss and the Government has committed to seeking further collaboration with medicine suppliers to widen access to weight loss medications, on a pay by impact basis, focusing not just on weight lost but on key outcomes such as fewer strokes, heart attacks and cancer diagnoses.
• Alcoholic drinks will be required to display consistent nutritional information and health warning messages.
• The plan reiterates wider Government commitments on air pollution, including decarbonising the transport system, rolling out clean technologies, and supporting active travel.

• The plan includes a broad range of policies – including reforms to how funding is distributed – that are intended to focus support on deprived and working-class communities.
• The shift to neighbourhood services is expected to enable holistic ongoing care, particularly for people living with disabilities and those with complex needs.
• The new operating model - with ICBs supported as strategic commissioners - should allow local use of budgets to match their population’s specific needs and to address local inequalities.
• An HIV action plan will be published later this year and will include actions to address inequalities in accessing HIV preventative measures and prophylaxis, particularly in Black African and Black Caribbean communities.
• Mental Health outreach care will be extended throughout England and will focus on narrowing mental health inequalities.
• DHSC will partner with charities to provide formal support for people after they receive a new diagnosis, to address inequalities in accessing empowering support for patients.
• The Government wants to more closely connect support from health, work, and skills services, and will test models in which NHS systems receive extra support and are held responsible for helping people stay in work.

The Health and Social Care Act 2012 Act created NHSE (originally called the NHS Commissioning Board), its regional structure and CCGs (Clinical Commissioning Groups). The Act was a top-down reorganisation of the healthcare service, leading to substantial change, diverting scarce funding away from patient care. 

Public health services also changed significantly as a result of the Act, with the establishment of Public Health England and granting the 152 upper tier local authorities in England responsibilities for the delivery of the majority of local public health services, moving these out of the NHS. This increased fragmentation, not least because CCGs and upper-tier local authorities were not coterminous. There were further disruptive changes to Public Health in England in 2020 which reduced the independence of Public Health with the UK Government's decision to abolish PHE mid-pandemic and move its functions to the newly created UKHSA and OHID (Office for Health Improvement and Disparities). UKHSA was established as an arm's length body (as PHE was), responsible for health protection, while OHID became responsible for health improvement and sat as a government unit within DHSC - less independent from the government than before.

10 years later, the Health and Care Act 2022 significantly altered the NHS again, undoing or amending many of the 2012 Act’s reforms. ICBs were formalised under statue replacing CCGs (Clinical Commissioning Groups) which were abolished, ICSs (Integrated Care Systems) were created, NHS England and NHS Improvement were formally merged (albeit had been working together as a single organisation since April 2019). NHS commissioners were no longer compelled to put services out to competitive tender, and the Secretary of State for Health had expanded powers, allowing them to create new NHS trusts, direct NHSE, and amend/abolish arms-length bodies (for example, Health Education England, NHSX and NHS Digital were formally merged with NHS England). Local Education Training Boards were abolished, with their powers transferred back to Health Education England (now NHSE). The Act imposed a duty on all NHS bodies to simultaneously pursue three aims: better care for all patients, better health and wellbeing for everyone, and sustainable use of NHS resources.

The BMA opposed the Health and Care Act and campaigned for it to be heavily amended, seeing it as failing to address the NHS’ challenges of poor resources, the state of social care, and health and care staffing. The BMA also had concerns that the Act could increase the level of private sector involvement in the NHS without adequate scrutiny. There was, and remains, concern over a lack of statutory ICB/ICS board-level positions reserved for clinical and public health leadership.

ICSs (Integrated Care Systems) were designed to deliver better, more integrated care for patients, by bringing together the NHS, local authorities and third sector bodies to take on the responsibility for the health and resources of a region (or ‘system’). These had effectively been operating for many years (under the label of STPs – Sustainability and Transformation Plans and then later Partnerships) but were formalised by the Health and Care Act 2022.

The 2022 Act dissolved CCGs (Clinical Commissioning Groups – formed by the Health and Social Care Act 2012) and transferred their powers, including power over NHS commissioning and spending at a local level, to ICBs (Integrated Care Boards) as one of two statutory bodies making up an ICS. 

The 2022 Act formalised 42 ICSs across England, working on three key levels: System, Place, and Neighbourhood.

1)    System – with two core statutory elements, where major decisions are taken, and overarching strategies agreed:

a)    ICB (Integrated Care Board) - focused on core NHS services, with responsibilities including NHS funding, commissioning, and workforce planning. 

b)    ICP (Integrated Care Partnership) – a wider group of organisations, typically led by local authorities, with a broader scope to examine and plan for the health and wellbeing of the local population. 

2)    Place (or Place-based Partnerships) - can vary significantly in their form and function, but are normally based around towns, cities, or major NHS trusts within a system. While they are not statutory bodies, ICBs have been expected to devolve some funding streams down to ‘places’ to allow them to plan localised services. 

3)    Neighbourhood – (or localities in some ICSs) based around populations of 30,000 to 50,000 people, designed to build upon Primary Care Networks where multi-disciplinary teams of NHS and local authority services work together.